Launch HN: Shimmer (YC S21) – ADHD coaching for adults
Getting diagnosed with ADHD as an adult is complicated—equally heartbreaking and liberating. You literally need to rewrite your whole life narrative in light of this new realization. The process currently is super confusing and expensive (medications, therapy, coaching, tools, apps, etc.) and I just wished someone would guide me through it. Someone to personalize things for me, ask me good questions, and encourage me when I was feeling down.
My experience was the basis for what Shimmer is today. We’re creating an ADHD coaching service that is actually affordable (5-10X cheaper than traditional ADHD coaching, in fact!), personalized to your life (because what works for me may not work for you), and focused on action instead of theory (because we’re not short of knowledge—we just aren’t doing it!).
Our service is fit for ADHD brains. We merge the best worlds of telehealth (e.g. therapy/coaching sessions) and asynchronous apps (e.g. Headspace, Noom) to create a solid combo of human accountability and app-based support. You get matched with an ADHD-specialized coach, meet weekly in focused video/audio sessions where you set weekly goals, and over time, bit-by-bit start building a new day-to-day that supports your goals: new routines, systems, and skills.
Our program is rooted in science-backed methodologies including Health & Wellness Coaching, Cognitive Behavioral Coaching (CBC/CBT), Acceptance Commitment Training (ACT), positive psychology, and solution-focused coaching. The way we deliver it, however, is less rigid and more experimental. In each 15-min session and in the asynchronous portions, you’ll draw on collective ADHD community knowledge to work with one thing a week in your life that you’d like to improve on. Your coach will support you via text access (in-app) and by seeing and reacting to your weekly “Actions”.
In terms of the app itself, there are 3 main components: (1) a daily/weekly simple check-list where you track your coaching tasks, checking them off (automatically pings your coach) and reflecting on your progress in-app, (2) a resource hub where you’ll find short, bite-sized content in service of your coaching journey, not standalone education to just “read up on”, and (3) your personalized chat with your coach where they’ll guide you through the journey—checking in on your completed/in-completed tasks, giving you feedback, and sending you resources.
On the back end, our coaches have web and mobile apps that are designed to save them time and cognitive effort, so that they can focus on coaching. Simple things like “scheduled sends” and a prioritized message list are included to help them manage a large case load with less effort.
It’s $99/mo. for 15-min weekly “bite-sized” sessions, or $349/mo. for 45-min “similar-to-traditional” coaching sessions. Traditional coaching can run $400-700+/mo. (up to the thousands depending on the coach). We also reserve a portion of our memberships for those with financial need, on a case by case basis.
If you have ADHD (or think you do), we’d love for you to check out our platform and give us critical feedback (or positive reinforcement!). It’s a super streamlined and ADHD-friendly signup process and in honor of our launch and celebration of October being ADHD Awareness Month, the first month is 40% off (offer until Nov 12).
I invite the greater Hacker News community to share any experiences you have with ADHD & navigating care, and am always open to scheduling a 1:1 call to learn more!
263 comments
[ 2.8 ms ] story [ 215 ms ] threadWill your company be accepting medical insurance? $350/mo (~$90/session) is roughly half of what billed-to-insurance therapy costs have looked like for me ($150-200 per weekly session), which could make this a competitive option for people who are uninsured. However, with insurance I've usually paid $25-40/session out of pocket.
Right now coaching is not covered under most insurance plans, unfortunately. Some members have been able to work with their employer benefits to get Shimmer covered but it's definitely a case by case basis right now. However, we try our best to work with our members (we have a needs-based financial aid package and have something in the works that's a bit bigger than this!) where we can!
Respectfully, in my experience therapy is very focused on outcomes and skills. (A very short list of examples: CBT's thought records, DBT's DEAR MAN, ACT's defusion.)
Is the distinction pedantic, or does it have more to do with the qualifications or certifications the provider holds?
As a coaching psychologist and a member of Shimmer team, I should firstly confirm that we work in close alliance with the other helping professions in the clinical and psychotherapeutic space and we understand each other’s limitations.
And while each of the helping professions pay attention to the outcomes and skills, ADHD coaching we do at Shimmer is characterised by the relentless focus on the future vision, goals and tactics to help the ADHD folk get there. Think regular coaching supercharged by the power of prospective psychology, coaching psychology, health psychology and neuro-developmental perspectives.
We all stand on the shoulders of helping professions’ giants, but our focal areas are different. And considering the time limits involved in helping, the focal areas do matter.
Our coaches fall in 1 of 2 categories: (1) Coaching or MH professional credentials (ICF, Therapists, Psychiatrists) or (2) Masters-level or equivalent of psychology- or ADHD- related field along with extensive hours of client-facing facilitation & coaching work.
100% of our coaches fall into 1 of the above 2 categories.
Looks like they accept people with coaching licenses (this often means less than 200 hours of training).
My understanding is that coaches are typically qualified to work with people who don't have acute mental health needs. For example a coach might help someone figure out how to eat healthier, but wouldn't be qualified to treat an eating disorder.
The reality is there are often co-occuring conditions in the mix here so we often either refer out or ensure our clients are also working with a therapist on other mental health challenges / issues like eating disorders, OCD, anxiety, and depression.
This is what insured people need to keep in mind.
Always look up the actual cost estimation through your insurer's website first. It's not uncommon for health insurance at tech companies to have therapy options that come out to $20-30/session. Worth checking first!
Also, note that the service offered here is explicitly "coaching" and not "therapy" as you'd receive from licensed therapists through your insurance.
I don't know anything about Shimmer, so I don't know how well they fit the mold, but as I understand ADHD Coaching: The general idea is that the coaches are there to supplement therapy and/or drugs with practical "in the weeds" advice. A Therapist would worry about making you feel better, and might point you in the direction of some resources to learn practical coping skills. A coach is one of the resources to help you learn practical skills.
My coach gave me strategies to fit my life. Usually in the form of me presenting a problem, and getting several tricks to try.
I don't think the meds or the coaching would help in isolation. I don't do the coaching now unless I come across a new problem. I have my book of trivks and triggers that remind me to reach for them.
When you say book of tricks and triggers, do you mean a physical book? Curious how other folks hold on to their learnings etc.!
Ok so in general I'd chalk this up to being disinterested, but I think this is relevant for a product meant for people with ADHD:
After a couple pages of choices, I was met with a screen with options A through K, and I instantly closed the tab. I didn't even read what it was asking. I realised that this may literally be ADHD like behaviour, so I opened it back up again, but it was still quite overwhelming and it took conscious effort to read through the form. I think this is just because I'm used to just entering my email and password, or using social logins, so filling the form seemed to be a substantial point of friction (even though I realise how it could be useful)
I'm unsure if I have ADHD, and it's never been a problem for me, but I sure do have a short attention span haha
I personally believe from a UX perspective when you can make things simpler for people with ADHD, you make it simpler for all! Basically the premise of docusign :)
Does the "or think you do" mean you perform diagnoses too?
What we mean by that is we coach people who don't necessarily have a diagnosis. We welcome anyone who wants to come and be coached on ADHD-related skills & goals. For example, if you want to work on your executive function but you don't have an ADHD diagnosis, you're completely welcome here!
This is also because certain cultures (or an array of different circumstances could put someone in this position) prevent folks from getting a timely diagnosis and/or they don't want to tell their parents, etc. But in this case they can still get coaching with less of the stigma. This is a broader challenge/problem in society though that we're barely scratching the surface on.
As a female, queer, BIPOC/AAPI person who grew up in a certain "bubble", I've definitely faced head on how hard it can be to take the first step to diagnosis.
In terms of pricing, we offer financial aid to those who are in need as well. Hopefully we'll help bridge this gap and are actively working with a few non-profits to help sponsor these costs too!
Personally I would argue from working with some kids who have adhd in the past that more gamification and reasons to use their phone will exacerbate some of the worst symptoms of their adhd.
I don’t see the niche this fills. In any case, good luck.
We're definitely aligned / agree that it's really hard to get affordable care. Unfortunately, we've found that our members have tried (but haven't succeeded) in finding a good therapist who is ADHD-informed and can do the specific things they are looking for in regards to coaching. Additionally, we definitely acknowledge that we provide a completely different service than psychologists / psychiatrists, and we work hand in hand with them post diagnosis. We do not offer diagnostics or pharmaceuticals and rely on other medical professionals externally to do so.
Also agree on not using gamification to worsen symptoms. That's something we consider very deeply with our clinical team to ensure we don't exacerbate our relationships to our phone. I'm personally a client on our platform and have that in mind constantly!
Thank you so much for the good luck!
These ADHD coaching services come up a lot, and this is the general advice I give out:
Always start with your insurance options first. Many people are surprised to learn that they can get therapy (for ADHD or otherwise) for as little as $10-20 per session through their normal health insurance. Telehealth has been normalized, too, so it's likely you can do it from home.
Always check insurance first to evaluate costs. Consider how deductibles play out through the course of the year, too. This coaching service is a lot to pay out of pocket relative to what many people in tech would expect to pay with insurance involved.
I just realized part of it is not knowing how to vet them, part is figuring out how to find availability for a psych, and then part is me not wanting to call in to set up my initial appointment.
As a coaching psychologist and senior member of Shimmer team, I concur with the prevalent view that the way to improve the quality of life of someone with ADHD is through integrative approach comprising each of the helping strands: the clinical, psychotherapy and coaching.
In this “holy trinity”, the niche filled by coaching reflects on the state of affairs which demonstrate that while humans are fairly capable of navigating their past experiences and manage the “present immediate”, we are not so successful at thinking about, and getting the best out of the future. This gave rise to the areas of psychological sciences which are focused on goal setting, planning, self-motivating and developing through the entire life-course. These pretty much inform our trademark Shimmer approach to coaching psychology and what happens during the coaching sessions, therefore.
Thank you so much for the good luck wishes. These are especially valuable since our aspiration is to evolve efficacy and the evidence-base of ADHD coaching, and to help ADHD folk have an active role in moving towards a better quality of life.
Person with severe adhd and disposable income here: Nope. This is too much. Especially if you're not offering psychiatric services (e.g., no meds).
> in honor of our launch and celebration of October being ADHD Awareness Month, the first month is 40% off (offer until Nov 12).
I can appreciate celebrating october being adhd awareness month in november.
I also want to call out that there's no regulation around adhd coaching. More or less anyone can do it with out qualifications. You'll notice that there's no mention of insurance being accepted. I say this because it's a ripe area for taking advantage of people. In the absence of regulation, extra scrutiny is warranted.
The faq states:
> All of our Shimmer ADHD Coaches are licensed or certified mental health professionals or have extensive experience with ADHD & undergo our Shimmer Coach Training program developed alongside our clinical advisors Dr. Amin Azzam (MD, MA), Dr. Anil Chacko (PhD), and our Head ADHD Coaching Psychologist Xenia Angevin.
> All of our Shimmer ADHD Coaches are licensed or certified mental health professionals or have extensive experience with ADHD
That's a sneaky 'or' there -- What're the statistics around the coaches qualifications?
> have extensive experience with ADHD & undergo our Shimmer Coach Training program
So not mental health professionals
> our clinical advisors Dr. Amin Azzam (MD, MA), Dr. Anil Chacko (PhD), and our Head ADHD Coaching Psychologist Xenia Angevin.
No linkage to their qualifications
Thanks for pointing this out, we know it's still not in reach for most people. We're trying our best to get it as low as possible and are working on alternate routes, especially for those with the financial need. Right now we have our financial aid application, and we're working on something a bit bigger that will disproportionately impact communities of need
> I can appreciate celebrating october being adhd awareness month in november.
Haha, yes, we're a few days late. The month we're observing is Oct12-Nov12
> I also want to call out that there's no regulation around adhd coaching. More or less anyone can do it with out qualifications. You'll notice that there's no mention of insurance being accepted. I say this because it's a ripe area for taking advantage of people. In the absence of regulation, extra scrutiny is warranted.
Agree on extra scrutiny. The area of ADHD coaching has been unregulated and quality is definitely variable (really great coaches costing $2,000+/mo. and other new coaches marketing their services without much training etc). I have a separate comment down / up there somewhere on insurance. We're standing on the shoulder of giants by putting together psychoeducation that is science-backed and pooling resources & knowledge to help guide with what has worked for ADHD brains. We're working towards some loftier goals right now as well including an Academy-like offering...
> That's a sneaky 'or' there -- What're the statistics around the coaches qualifications?
Our coaches fall in 1 of 2 categories: (1) Coaching or MH professional credentials (ICF, Therapists, Psychiatrists) or (2) Masters-level or equivalent of psychology- or ADHD- related field along with extensive hours of client-facing facilitation & coaching work. 100% of our coaches fall into 1 of the above 2 categories.
> No linkage to their qualifications
Dr. Anil Chacko: https://steinhardt.nyu.edu/people/anil-chacko
Xenia Angevin: https://www.linkedin.com/in/xenia-angevin/ Dr. Amin Azzam: https://meded.ucsf.edu/people/amin-azzam
Even for people with disposable income, a rate like this should trigger some cursory research on your insurance provider's website. Common tech company insurance plans might very likely come out much cheaper than this when multiple sessions are considered across a year and deductibles are taken into account.
And you get to choose your provider and know their qualifications as a mental health professional. Telehealth is commonly available, too.
Don't let the high price of any of these cash-only services discourage anyone from seeking therapy. If you have insurance, always check that first and do the math.
My ADHD has cost me a lot more than money, but what specifically, or HOW specifically is your therapy different than the therapists I have already spent $$$$ on?
For me the symptoms are loosing around a few ten to hunderd of thousands of dollars a year (maybe even millions) in my work/career. How can my lifestyle changes manage that?
No attack, really really curious.
I'll start with (1), at work:
At work I struggle with time management, prioritization, getting stuck in "waiting mode", not being able to finish any detailed task (very important for legal etc), and getting easily distracted from any task at hand
Concretely, with my coach we started with helping me envision what would be different in my life if I fixed a certain number of the above. She explained this hope and motivation created would help me draw from an internal source of motivation since for a long time I theoretically wanted to change certain things and knew the path but couldn't actually bring myself to do it. I'd say this helped mildly, but I did feel a lot more hopeful and supported.
For me the most impactful change was having my coach guide me through the process of experimenting with different daily schedules that incorporated deep work blocks (she helped me set up triggers, rewards, plans for distractions, etc), certain auditory alarms throughout the day, and very specific systems that helped me get these small "detailed" items changed. I'm simplifying this a lot and I'm happy to go into detail more if anyone wants.
(2), at home:
I struggle with impulsivity, especially when I'm super stressed at work and not getting enough sleep. We addressed this a few ways, including some psychoeducation around nutrition and sleep, setting up some decent systems there (but it definitely didn't get me the whole way).
What was most helpful was to do a journaling exercise my coach led my through where I identified things I said that I regretted (this was a tough exercise for me to do, to have it written out), and rewrote these situations after the fact. Then when I had a long enough list, we looked for themes around triggers/situations and then rewrote the book for what would happen in those situations. We went through a light "practicing" exercise and eventually I had those on sticky notes in front of me until they got etched in my brain.
Overall, both (1) and (2) I'm still not great at, and we try to view everything as an ongoing journey of management, rather than "curing" ADHD, which won't happen. The biggest impact for me (and many of our members) has been having someone guide me through the steps and ask me questions and kind of just support me when I'm really hard on myself.
I know I could be working on things that generate a lot of money but I am just constantly distracted by HN, Games, YT etc.
So happy if you would go into detail about "set up triggers, rewards, plans for distractions, etc), certain auditory alarms throughout the day, and very specific systems that helped me get these small "detailed" items changed".
Not convinced that there is anything that I would not just ignore after a day or two but extremely happy to be proven wrong. I tried a lot of things, all failed after a very short time
But back to the topic...
> Setting up triggers, plans for distractions, rewards:
1. Triggers: I get a glass of this special coffee (smart energy coffee, a brazillian brand that just came to US actually) every time I enter a 3 hour deep work block. It signifies the ritual has started, essentially
2. Plans for distractions: We tried a lot of things here, some worked and some don't (it's important you test and experiment to find what works for you). For me, I pre-came up with what sort of situations would take me out of flow easiest and planned around it. It was cumbersome but helped. E.g. for me it was "if a member emails I feel inclined to respond right away to help them", my solution was to give that 3 hour "shift" to my co-founder and trust that he's got it. Another one that worked was having a distraction log stickynote. If something happened that wasn't on my deep work agenda, no MATTER how important it was, I wrote it down on the sticky note and moved forward. This was really hard in practice but now I have it a lot better down
3. Rewards: This we also tested a lot and tbh I don't have anything perfect here yet but after each deep work session I allow myself to bask in the sun on my balcony and now I find myself nearing the end of the block and feeling the sun already as a physical response (I'm very sensory)
> Auditory alarms: I used to have terrible alarms that induced anxiety, fear, and surprise. My coach had me change it to things that are pleasant (oddly I never thought alarms should be pleasant lol). Now I have certain ones that signify the start and end of sessions, my work day, etc. They're just on auto-pilot and they help me build an awareness of time. Once again, like the other stuff, daunting to set up but once it's set up and you find your flow, it runs itself.
> Detailed items: THIS ONE is definitely still a challenge for me BIG TIME. I now have a specific part of my to-do list that is for items like this and I've experimented with different times in the day I do it, how I do it, in what chunks, etc. And we landed on me setting aside 1 time a week for "these tasks" that are kind of gross and I do it with wine (I know... not great) and with my partner, and with a pomodoro clock and we race each other to finish our annoying tasks.
Stepping back and looking at the big picture, there will always be an effect on my life from having ADHD, but I do have influence. Focusing on the things you can control is important.
I do both, does not change my ADHD at all (it has other benefits surely)
Telling me to stop coming to HN is like telling a drug addict to just not take drugs.
Even if I block HN, I will just be distracted by something else.
I ride my bike LITERALLY 1,000 miles a month. ADHD is not mitigated by this - only my focus on depression is... and still... that doesnt relieve it.
I think this is uncalled for, especially when in your very next sentence you clarify that you’re speaking about your own experience. Everyone’s can be different.
All of these things help with my ADHD and I'm much more affected by symptoms when my body is not in shape. Not sure why that other commenter insists on being so offended.
Here are two basic things that worked for me and I recommend to everyone.
1. A pill organiser. Medication helps a little, but not a lot for me, however if I don't take it I know I'm increasing my risks of having a bad day somehow. So I know I need to regularly take my pills. Problem was, I kept forgetting if I'd had a morning dose, or a lunch dose, or maybe if forgotten to fill my prescription on the weekend and ran out midweek, or forgot to pack my pill bottle. On Saturday mornings I fill a weekly pill organiser (7 removable plastic box things with 4 sections). This way I know if I need to top up at the pharmacy ahead of the work week. I also visually see if I've taken a particular dose. It's also more compact and easy to carry than bottles and blisters.
Sure it's not perfect. Last saturday night I filled it up then went to bed forgetting to take the actual dose for that night. I missed my antidepressants and the repercussions from withdrawal can last a couple of days. However, this was a much more common occurrence before I started doing this.
So that's a big change for managing my symptoms right there. Sure it might not be relevant for your situation but it's an example of a system/habit that helps manage symptoms
2. A translucent plastic water bottle with a built in straw. I'd hate to think what my kidneys look like. I've never been good at staying hydrated because (as I now know) my nervous system isn't very good at telling me about those sorts of things until it's dire. I'd easily go a whole work day without any fluids and not notice. I'd try jugs of water on my desk, or setting alarms. All to distracting. I'm also clumsy (dyspraxia como) so would end up spilling stuff everywhere, or dropping glasses.
Then someone suggested a water bottle with a straw. I was sceptical but it has changed my life and I know how stupid it sounds but I can't stress enough how much of positive impact it has had on my health and well-being.
I (and others) theorise that it's much easier to drink while still maintaining visual attention on what your doing. You don't need too engage as much hand eye coordination etc.
So there's another change.
I don't want to sound like some corny psa, but having simple systems to help support me in properly taking my medication and staying hydrated means I can take on the world freeze frame. cut to titles
But seriously. These have by no means "cured" me. But they really help. A lot.
Another one that worked well for me is putting laundry baskets in each corner of my living space and swapping out my closed clothing drawers with open hanging shelves (from Ikea, <$20) and small open boxes (<$5) on the ground for underwear, socks, etc.
It's experimenting with these small things to put on autopilot that have helped me a lot too!
I've seriously considered installing some kind of soundproofed/vibration-isolated cupboard inside my walk in wardrobe to just keep everything in the same place, but my wife is less than keen. A laundry chute, however, surprisingly, still on the cards.
For example, something super small but I've been working with my coach to set my room up so that it's harder for it to get and stay messy. I've - put up these cute hooks all over my room to put up hats and clothes so they don't get thrown on the floor - put a laundry basket in each of my closet, bathroom, and bedroom - switched my closed wardrobe to an open-concept hanging closet (which was so much cheaper too!) so I can see all my clothes in one place which is less overwhelming and messy, since I'm not pulling all my clothes out each time - switched my waterbottle to a straw-system so I actually get my 2 bottles a day
... the list goes on, the more I can settle and make "auto-pilot", my life gets a bit easier to manage
> what specifically, or HOW specifically is your therapy different than the therapists I have already spent $$$$ on?
First I want to re-clarify that we are not providing therapy. We providing coaching services for ADHD-related symptoms and skills (like executive function). However, coaching (along with therapy) definitely does not cure ADHD, as ADHD is a lifelong neurodevelopmental condition.
Answering your question directly, our approach is rooted in Health & Wellness coaching, and incorporates large amounts of positive psychology and behavioral change science. The way Shimmer works is that you pair up with an ADHD coach and each week you declare 1 focus area (2 or 3 if you're feeling ambitious) that you're going to work on. It could be implementing a habit or system, or practicing a skill. Throughout the week, your coach helps you fight fires if something comes up.
Specifically re: Therapy, it's different in that it's focused on the daily actions and routines/habits you will try out and implement. It will require significant effort or at least commitment on the member's part as well, as our coaches cannot make the changes for them.
Really appreciate your question, and thank you for your patience as we work through these comments.
I developed ADHD as a symptom of being in IT/OPs/Devops/Director of IT my entire career, which when managing a large team and an enourmous mount of servers/data -- and designing a lot of things... I was mentally task switching CONSTANTLY
So my mind is always all over the place because I can think of several subjects simultaneously in great detail.... (but Can't everyone?)
People with "ADHD" are already covered by the Big Five Personality Traits https://en.wikipedia.org/wiki/Big_Five_personality_traits like every other person is.
Apologize if the "heartbreaking" and "liberating" language felt a bit dramatic (I am a bit dramatic...), but it really did feel that way for me after living my whole life feeling like I was constantly doing everything wrong.
Ever since slowly going deeper and deeper into the ADHD community, the positive spark of the community is undeniably special and since reframing a lot of my views on ADHD & myself, I've been able to lean more heavily on some of my "superpowers" as well.
We actually love the Big 5 personality traits out of all those similar quizzes, backed by good science and I think it's actually the fan fave of our Head ADHD Coaching Psychologist, Xenia!
There's an organization understood.org that is starting/forwarding the movement (neurodiversity as a whole, not just ADHD) exactly as you say! We're excited about some upcoming partnerships with them :)
It is a disorder which has a material impact on a person's ability to live in our society. In more severe cases, the afflicted benefit greatly from medication. No amount of rebranding or projection will change this.
However, the Big Five model only talks about the most notable personality traits in statistical terms, whereas the lived experience of a person with ADHD is illuminated by the richness, variety and the amplitude of the rest of the personality traits which may be less statistically profound but critically important to a particular person and the way in which they relate to their ADHD.
While I can’t talk about the ADHD coaching overall, the “Shimmer model” is acutely attuned to the lived experience and phenomenology of each member we work with. And we always welcome critical and well-informed enquiries about what informs our approach. Thank you!
[1] https://www.additudemag.com/attention-deficit-disorder-vast/
This is totally a problem with the manufactured society we have created as humans. I'm absolutely certain that when we lived off this earth more naturally, the traits that have become disadvantages were originally communal strengths. My personal hypothesis is that ADHD is a series of traits that evolved to make wonderful hunters. The ability for the slightest noise/motion to grab our attention, the hyperfocus on things that do grab our attention, the ability to make connections extremely fast in a fractal manner, all of these traits would be a huge advantage when hunting prey to feed your social group or to protect your group from predators.
I’m on an iPhone SE 3rd Gen running iOS 16.1.
(Meta-comment questions aside, congrats on the launch!)
Unfortunately, yes. There are many businesses that take advantage of not only people with ADHD but people in other vulnerable communities (e.g. other neurological conditions and mental illnesses). I've been in this space for a long time since I started with my Eating Disorder amongst other things in my teenage years.
Of course, as most of you have seen, there's a lot of splash currently in the news especially in the ADHD space so I completely understand the skepticism.
Quite honestly it's not easy for me to have my story out vulnerably in the open and linked to our business but for me it's worth it! So I really appreciate your positive feedback, it goes a long way!
I can imagine that starting a mental health business that hits close to home can feel more vulnerable than starting a business is already, so kudos.
I hope that is helpful.
For now... this is a good self test from WHO: https://www.shimmer.care/adhdtest
I'm also glad you felt reassured!
Yes. Well, not really snake-oil, but this spaces is definitely associated with low-effort pill mills and broken marketing promises.
Therapy is hard. Doing it at scale is nearly impossible. Doing it at scale at a price point consumers expect is literally impossible. As a result, you end up with a bunch of "mental health" "tech" companies that are making big promises, but essentially just putting their patients through checkboxes.
In my case the issue is that despite having a growth mindset for learning pretty much anything, in the case of ADHD stuff I've been trying for so long to fix myself that it feels like I'll never be able to. And that trying out this service and making efforts would be more draining than living with the symptoms is.
I realise that's not true so I could force myself to do it, it's just what I feel.
Going to go talk with an ADHD specialized psychologist this month and will see if a service like this can be extra help perhaps.
Oh man this hits too close
We're trying to make it less effort and easier, but at the end of the day we know sustained behavioral change will take effort. Along that vein, it also may not always be the best time, and may not be best fit for everyone. We totally acknowledge that and hope to just be one piece of the greater ADHD-care pie!
Good luck with your ADHD specialized psychologist!!
The ROI of this could be tremendous for someone in tech. If this helps you get your shit together enough to be promoted a cycle early, for example, or find a new job, it could be a bargain.
Sure, but if someone in tech is seeking help it's better to start with ADHD therapy (not "coaching") from licensed medical professionals, utilizing their insurance to offset the costs.
The issue a lot of us are trying to raise in this thread is that the program seems designed to take advantage of the lack of understanding about therapy versus coaching and cash-only versus insured programs. They make it easy to pay and get connected with someone, but if you're looking for true therapy (not "coaching") then you want to go through traditional channels. It will likely be cheaper with most tech insurance plans anyway.
I definitely agree ADHD therapy can be hugely beneficial but most of our members have cited it as next to impossible to find a therapist (within their insurance / state / etc) who is even ADHD-informed, let alone practices ADHD-specialized therapy. Unfortunately, I've also gone through this process and found the same.
We in no way aim to replace therapy or put ourselves against therapy. Many of our members are also in therapy (for OCD, anxiety, depression, other things) and we are more than supportive of that. For many of them, their therapists are the ones who recommended them to coaching, and how they found us.
And lastly, yes. If you're looking for therapy, we're definitely not the place to go. We try to make that super clear on our website and in all of our communications (we have many drip campaigns, campaigns, Instagram posts, etc. trying to help raise awareness and shed light on the differences between therapy and coaching for ADHD). Additionally, anyone who comes through our flow (get an email) are given the option to speak with me directly before joining and I can answer any question they have / help them even if the answer is not Shimmer.
Thank you for your point. Actually one of our members was recently working on a career change and their coach helped them get a job relatively quickly. Of course, the success is the members' and not the coach's! But the member cited it as a massive help :)
The issue is that this is likely more expensive for someone with health insurance than it would be to go out and engage with a guaranteed licensed medical professional for ADHD therapy.
They use some vague language on the website (look carefully for the "or" in the qualifications listing) to obscure that fact that you might be working with a "coach" instead of a licensed therapist. They also use some moderately misleading language to avoid saying they offer therapy for ADHD, instead offering things like life skills.
Basically, anyone looking at this should first go to their insurance company's website and check the price of true ADHD therapy from a guaranteed licensed medical professional that you can choose yourself. Over the course of several sessions, the cost of doing this through insurance could be much lower and you're arguably likely to get better treatment (coaches cannot provide therapy by law, so they're kind of coaching around it instead).
We will definitely look into our language on our website to make sure we're not obscuring anything. We definitely do NOT offer therapy, and you ARE working with an ADHD Coach rather than a licensed therapist. In fact, even if the coach you're working with has a therapist/counselor credential, on our platform that is not the service they are providing.
I'd love to get a better sense of what language you feel is misleading, and we'll work hard to change that to reflect the reality of what we're offering!
But I can see your point. If I had been looking at this as more of a medical condition that insurance would cover for me, this wouldn’t be my go-to substitute. I also see what you mean about the wording. I gave them the benefit of the doubt since they are trying to convey meaningful authority based on science without trying to claim to be your therapist…they are in an in-between space. But I admit there is likely a way to describe such a positioning without such likelihood of being perceived as being misleading.
I imagine for the younger folks on HN, we grew up with what seemed like >50% of people claiming to have ADHD, OCD, Tourettes - or some other TikTok-fad "cool" disorder - which obviously not that many people actually have these problems.
At least not too long ago when I was young enough to be in that crowd - ADHD was the king of "cool" disorders. Everyone wanted to have ADHD. If you were "normal" - that was "uncool". It was like - what's wrong with you? Why don't you have some debilitating problem like everyone else?
So like claimed gluten intolerance in the adult population - I think there could be some skepticism to the occurrence and severity of some of these disorders - and to anyone making products for such groups to be a snake-oil salesman trying to capitalize.
But, who cares? Is anyone getting hurt? Let people do what makes them happy.
Speaking as someone who definitely, definitely has rather severe hyperactive type ADHD complete with anxiety comorbidity and tactile defensiveness that presents sufficiently severely to look like mild ARFID and was diagnosed over a decade ago in early adulthood:
How, just -how-, could anyone want this disorder? It's miserable, it's embarrassing to constantly blurt things out and to immediately regret it and yet not be able to change the behavior, it fucked up my educational experience (I wasn't diagnosed until AFTER that happened), every day is a struggle with it, and because of the stigma it has, I can't even communicate to people effectively what it means that I have it!
So who cares? I care! It hurts ME when people self diagnose or claim to have my disorder when they don't. It's a struggle every. Single. Day. And thanks to people apparently deciding it's cool to pretend to have, a lot of people don't even believe my disorder exists
Endlessly frustrating.
Because they don't understand just how debilitating it is and how much trauma it causes a person. It's absolutely shit, especially for those of us who find out later in our lives like both of us apparently. Aside from the normal issues that go with it, now I'm also plagued by the thought of how things could have gone had literally anyone picked up on it when I was a kid.
I don't think it's about being cool, at least not completely, I legitimately think some folks want at least some struggle in their lives. Something to fight against, something to give them...purpose? I'm honestly not sure, but I know if they did have it they'd do everything they could to get rid of it.
First time in my life I was able to work on something boring where it didn’t feel physically painful to be doing it. Sadly I don’t tolerate the medication well. (Pain) so I do without it.
Alternatives are always very attractive.
I’ve often thought it would be awesome if I could just pay someone minimum wage to sit behind me and tap on my shoulder every time I got off task.
But when you said boring tasks are painful, and wanting someone to tap you on the shoulder when you get off task, I was nodding along vigorously. My best solution to this (so far) is to ensure my way of contributing meaningfully to things doesn’t require rote, boring work. :) I’ve considered setting up a camera over my shoulder just to give myself the feeling of being observed…
Thank you for sharing your story. I'm sorry about the pain re: Medication :(
Body doubling seems to be a common technique. I've often considered if some form of self surveillance (webcam, heart rate, computer usage metrics) combined with ML could observe and "nudge" you along.
For (intrusive) thoughts sometimes I'd rather not fight it because I'll randomly suddenly remember something that I couldn't recall over an hour ago, or be reminded, or see a vague connection to another topic that could be useful to investigate later.
Maybe it's not so much being reminded to stay on task but make it as frictionless as possible to capture something and put it away safely so before you get completely derailed...
As for attention "drift" when you're forcing yourself to work on something that really saps your energy so your subconscious is trying to protect you by pulling you away? The only thing I've found to help is to organise my life so that the conditions that cause that to occur have less of a chance of happening (getting enough sleep, eating protein, taking medication at consistent time with food, meditating, listening to my body and taking regular breaks to prevent crossing the overwhelm threshold, do enough housework on routine so there's no reasonable excuse to do a load of laundry) which I guess is what a lot of coaching will try and help you do, setting up practical systems to remove triggers and optimise the ideal conditions (my speculation).
I can't remember why I started writing this reply or if I'm even anywhere close to it being on topic now, but rather than delete it, I'm just going to leave it here.
With ADHD? Not really, but compared to other disabled people those with ADHD tend to be extremely pro mainstream medicine because they have basically the most effective pharmacological treatments of ANY mental disorder. Stimulants are several times more effective than treatments like SSRIs. So there is a strong bias towards conservatism because well why rock the boat when you have extremely effective treatment options?
Other disabled people tend to have a much more ambivalent or sceptical view of mainstream medicine since trying to treat most mental disorders is akin to trying to stop smoking. It does happen and it's more likely to happen the more times you try, but it's a plodding frustrating business that makes you desire something better. So they're more keen on more, lets call them "speculative" approaches to health.
For me with this specific case, it's them talking up the "science-based" (lol) nature of their program and them directly marketing it to people not diagnosed with ADHD but who suspect they have it. Show me the science showing this is an effective treatment for people who THINK they have ADHD. Thus essentially encouraging people to defer a diagnosis which results in insanely effective treatments to try a program that is experimental at best and is based off methodologies which are far less successful than pharmacological interventions. It smacks of exploitation. I'm not inherently opposed to the fundamental idea they're presenting, I simply don't trust these people AT ALL and think they're dangerous.
I feel you
However... we definitely try to be more than that! Here are some of the #1 benefits our members have cited: - Someone who understands - A safe space to talk about ADHD stuff - Guidance - Discovery of new tools & systems and someone to think of them for/with me - Accountability to do the things I said I'd do - A way to verbalize what I intend to do so they can better get done
I'll try and describe one briefly: I use a free app called Virtual Motivaider[1] to make my phone vibrate every 2 to 6 minutes. I'll print a sheet[2] that has a table with two columns. Every row is the same: the first column has the text "Am I on Task?" and the second column has two check boxes, "[ ] Yes [ ] No". When I start a task that I typically struggle to hold my attention to, I start the app, and when I feel the vibration, I check off if I was on task or not. I picked the 2 to 6 minutes interval arbitrarily; there could be many other intervals that work just as well. There's also probably other apps out there that just vibrate at a user-set interval.
This has worked extremely well for me. It seems that just recording a behavior can increase it or decrease it in the direction that you want.
I learned about this from a textbook called "Applied Behavior Analysis" by Cooper et al, in a chapter titled "Self-Management". If my technique (technically known as "self-monitoring of attention" or "self-monitoring of on task behavior") sounds interesting, I would recommend finding a pdf of that book and reading that chapter. It has some vocabulary that's defined earlier in the book, so you can just look them up in the index or glossary as you read. The book and the field it hails from can be annoyingly dogmatic, though.
I'll stop talking about it for now, but I do like to share this whenever adult ADHD comes up because its helped me dramatically, and much more so than any professionally-run special education program I was in or popular psychology book about habits or getting things done. OP, I haven't looked at your app or page too deeply so maybe you're already doing something like this or other behavioral techniques, but if you're not, it might be worth checking out.
[1] The company that made Virtual Motivaider also sells (well, they stopped producing them because of COVID difficulties, but they're currently trying to get them back) a physical product called Motivaider. It looks like a digital kitchen timer but it just does the same thing as the app. I bought one after using the app for some time, and while the app worked very well, the physical product has some nice benefits, like a very distinct and quiet vibration, and a lot less friction to start a new session.
[2] Printing out new sheets for each task, or printing out a lot and then having to get one for each task, turned out to be pretty inconvenient, so I've since compressed the table into a 2 row by 15 column one, where in the first column the first row has a "Y" and the second one has an "N". The rest of the columns are for putting an x in the Y or N row. I fit 6 of these in a 6 x 9 inch document, made a pdf of 100 of these pages, then used a print on demand service to print a spiral bound book of it, which I carry with me between work and home. This has eliminated a ton of friction and I've ended up using this technique much more often.
There is such a gap of "people who have ADHD sharing the things that actually worked for them." One of the best strategies for me "task bracelets" I didn't get from my therapist but a random TikTok.
I don't really know if this service is the one to pull it off but I want something like it to exist.
Those 2 items above are what our coaches try to help with.
With 1., just picking up and trying something someone else is using can get exhausting. Our coaches help you dissect what the problem is, what sort of systems work well for you (in the past), what don't, and why, and then help you pick from a narrowed list to choose. For example, accountability works really well for me (body doubling) but another one of our members hates it because they are introverted and easily distracted by movements of others.
With 2., sometimes we pick up the right tool/tip but we don't implement it properly. We try it hastily for one day and then give up. Our coaches use behavioral change psychology to break down the steps, implement it into your life in the way that sticks, then keep you accountable to actually giving it your best shot.
I'm excited that you have found your exact mix, and our mission is exactly to help other folks just like us found their unique mix of tools & systems that work for their life. With their commitment to experimenting, the abundance of resources like the ones you've shared, and our coaches' guidance, we hope to get our members to their version of where you're at! Ideally with free stuff too!
The goal of coaching is most definitely not to be a crutch that you have to use forever. Ideally they can get to a point similar to yours with the aid of their coach! Oftentimes, the sifting through info, experimenting, and staying motivated part is the hard part (that we hope to be able to help with!)
Well, sure, it's not like I own them!
I guess the first line of my post came off a bit jaded. After having people paid to deal with my ADHD not come up with anything truly effective in my whole education since high school, it was both relieving and disappointing to end up figuring out something myself. If your app helps people figure out what works for them, then best of luck to you.
We'll be updating the flow today.
It seems like a small price to pay if it works! My therapist (Cognitive Behavioral Therapy/CBT) and Internal Family Systems (IFS)) always says that the key to ADD/ADHD is to have structure, and this looks like shimmer could fit that prescription!
Chris, I am in your knowledge learning section of the app and your videos are not able to be played on Android because they are stuttering. I think maybe your server is getting hit too hard? I finally got through the welcome video in the app but it did stutter a bit.
We'll definitely investigate on our backend and see if we can reproduce the stuttering on our Android test devices as well. You can always email support@shimmer.care or message the Shimmer admin account directly within the app and we'll make sure to log your bug and prioritize it with the team after investigating!
The description of your app sounds almost like a one to one copy.
EDIT: I checked the Inflow offering and even the pricing is similar to yours.
2nd EDIT: Also, the 'coaching, but not therapy' thing is similar.
Our service (Shimmer) is focused on the coaching relationship itself. So you get matched with a 1:1 coach and meet every week over video/audio to develop that relationship and work on specific focuses. We do have a smaller element of education in it but it's only deployed in the context of your coaching journey (e.g. your coach may send you a resource related to the task you're working on for the week).
For each person, something different will resonate. For some people, multiple things will resonate! We have members who use or have used Inflow as well.
Thinking of giving it a shot. I'm curious though, how long does it take to start seeing results from the coaching? I suspect that it'll take some time for your coach to get familiar with you and recommend strategies that actually work.
Also curious about what retention looks like. I tend to try a bunch of different methodologies to manage my ADHD but have trouble sticking to them -- I've tried so many productivity tools lol. What's going to get me to stay?
TIL this is a thing.
I have the same. Body doubling is the single most effective strategy I use whenever I can. I'm extremely accountability (or maybe... validation?) driven.
a therapist is going up help talk you through this but the point is you have ADHD so it's no system is going to stick, so what you need to do is reframe it so that it's not that you tried a system and it failed, but to look at the 3 days/weeks/months and celebrate the time that you had with it, and to see that as positive. from there, launch into being able to pick up systems, new or different, doesn't matter, and use them to improve your life within your means. with practice it gets easier and easier and suddenly things aren't in shambles anymore.
I know this isn't the answer you're looking for, but it's definitely an "it depends". Statistically, 83% of our members say by 2 months they're seeing improvement in reaching their goals but I must admit for now it's quite a high level metric with a lot to unpack. It'll depend on a few factors including how specific your goals are, how much time/effort you're willing to put into it, your attitude/mindset coming in, the coach/client rapport, to name a few things. For example, you could come in with 1 laser focused goal and achieve in a few weeks, or you could come in with the want to unpack your goals and find a new career trajectory etc., and that would take quite longer.
Most of our members work in 3-month goals. Some of our members are on their 2nd set of 3-month goals. However, of course there are some that found that they couldn't fit coaching into their life in the way they want and didn't continue after the initial 4 weeks. We do ask that all folks commit to trying for 4 weeks and giving it their best shot since as you mentioned, it's important to develop the coach-member relationship, set proper goals, and start to create some action plans!
For each person it'll be different. But in short, these are the stories you tell yourself, about yourself.
For example: when I was a kid I was always put in this "special" desk that faced the back wall, or the other "special" desk that was pushed up against the blackboard next to the teacher. I was always "other"'d and kept away from others. I started growing this idea that I was just a "bad kid", that I needed to be removed or separated from others. That nobody wanted to hear what I had to say. That I was a "bad apple". This really demotivated to try at all in school, and the only place I felt confident was in Physical Education class where I was allowed to be loud and move around without being yelled at. Over time, as I learned about ADHD, I wasn't a bad kid... and that sports wasn't even really my thing (lol). With this new "fact", I was able to separate some of my behaviors and tendancies from me as a person.
That was just 1 little example. I have tons... but I hope that made a little bit of sense!
I understand your need to ensure your time is not wasted, but policies like this can wreak havoc on people struggling with executive dysfunction and that's your target audience. I don't know what the right solution is, but a company serving this market needs a more flexible policy for something like this.
Also last minute rescheduling means last minute scheduling for other people too. They may find that they just offer this to everyone and the costs balance out. It does seem like imposing too many scheduling constraints on a specifically ADHD audience could lead to a lot of friction!
However, after the first few weeks, we try our best to uphold the policy because the nature of our coaching service (and we want to keep the integrity) is that the member is best fit to meet their specific assigned coach to continue the relationship (trust, openness, safe space, etc.). In practice though, as long as our coaches have time, most of them will offer a rescheduling of some sort. We do want to set good examples and boundaries and have members practice this wherever possible, while of course being sensitive to ADHD accomodations.
cc: OP, iamdbtoo
Yes I know I can set up calendar alerts, but odds are I screwed that up somehow, and a call will get through.
Bonus points for telling me not to feel bad and stress too much if I'm late. If it's an hour appointment and I joined 30 minutes in, that should be okay. Yeah I've lost the unused time, but otherwise that would reduce my stress.
Also I'd rather have a change under 24 hours, be accommodated (if it's possible on your end )without an extra charge.
I can definitely see myself the day before "going wait can we move our 3:00 to 5:00 instead? And if that's not possible I may just want to keep 3:00, but if it works for everyone I'd rather have 5pm"
We definitely have a huge culture of kindness, understanding, and non-judgemental-ness if someone misses or is late to an appointment.
Thank you for your ideas!
I would include the accommodations in the policy, then. Right now, you have a strict policy with accommodations being hidden and handed out arbitrarily instead of making them default and transparent while the vast majority of your clients will require the accomodation.
I would also include the ability for the coach to notify the client they are currently missing the appointment. Time blindness is a very real thing and unless I stop everything I'm doing and stare at the Zoom screen there's a chance I will miss the appointment. I missed some doctor appointments this way, but if they had just texted or called me to break my hyperfocus, I would've hopped on the call right then.
Lastly, just seeing policies like this out in the wild would give me more confidence in the service you offer. Seeing the same policy that every other doctor has that ADHDers get "taxed" from all the time just makes me think you don't understand.
And yes, we currently have a notification & text from the coach 30 minutes before appointment, and coach messages once they're in the appointment!
We also have a culture of being non-judgemental if someone misses or is late to an appointment. This is something several clients have cited as something refreshing and nice about Shimmer.
Mmm, yes. Totally understand. I think there's a few points I've noted today to better have our language to reflect our actual policies! Thank you for this.
Thank you for your ideas!
Unfortunately for our specific service, where the focus is on the coaching relationship between the specific coach and member, doesn't make us best fit for a "drop in" session, at least for the core model. Creating and maintaining a trusting relationship with the coach is a multi-step (multi-week) process and for many members redeveloping this trust with a 2nd/3rd coach may be out of the question.
However, I could imagine this being kind of an add on to our normal sessions, and there could be times you could talk about something separate from your specific coaching journey with a coach that may or may not be yours.
You got my wheels turning.
We currently have 8h/day direct line access to your coach, but definitely see your use case for the 3am example. Kind of like a hot line with an ADHD expert on the other end for support.
The sad part is, it would be entirely possible for ADHD and other ASDs to be accomodated in daily society. But, people without those differences would abuse the absolute piss out of those accomodations. How do we prevent abuse without harming those who legitimately require such accomodations? There's a reason there is such a concept as "ADHD tax".
ADHD is caused by poor functioning of the connections between neurons in certain areas of the brain that are responsible for impulse control and attention. You can't fight this functional deficit with willpower or coaching alone. Decades of research shows that ADHD is highly treatable with medication and there is almost no evidence that therapy or coaching is effective.
All this being said, I think that people with ADHD develop patterns of behaviour to cope with ADHD symptoms. Once medication has restored proper functioning in your brain, I think coaching and therapy definitely play a role in helping you learn new patterns of behaviour that are more appropriate in the context of a properly functioning brain.
Shit at some aspects of life? All good. Good at some things? Great.
Not saying treatment is bad, just that being yourself, with all its costs and benefits, is a completely legitimate option.
Medicate always as a last resort
Shit at some aspects of life that are easily treatable? Treat them.
ADHD remains one of the most easily medically treatable diseases. Do not listen to people propagating the stigma that you should just accept a substandard life. For most people with ADHD, medical treatment works very well and massively improves quality of life. Medical treatment does not have to be a last resort.
This is a hereditary neurodevelopmental disorder, not just a feeling anyone can pick up tomorrow and be cured of again in a couple of weeks if they just put in the work and keep smiling.
Society is very clear that it is not okay with this. If I'm "just myself" then I wouldn't be able to hold down a job and survive.
> Medicate always as a last resort
We shouldn't be so hesitant to medicate. It can be extremely useful, especially in combination with other management techniques. This stigma against medication hurts people.
this is the thing i don’t get: for someone who’s by nature not accustomed to doing things in the prescribed way, how can they be expected to resolve that via the prescribed way?
i.e. i have to meddle through insurance, appointments, specialists that cost $$ for an assessment which _might_ lead to something useful or might just tell me things i’ve already learned via other means while waiting 2 months in line (actual ADHD specialists are in high demand) and then follow through with monthly checkups and such. if part of my issue is “i just can’t do things that way”, how can the expected solution require me to overcome that before getting treatment? it’s circular; it’s a contradiction.
> We shouldn't be so hesitant to medicate. It can be extremely useful, especially in combination with other management techniques. This stigma against medication hurts people.
i have a lot of friends for whom others would label non neurotypical. i’d never use that word myself, because i’m in such a bubble that i literally don’t know what the word is supposed to mean. but they point out my habits enough that it’s clear “you should see about a diagnosis”.
of course i haven’t, for reasons you can infer from the earlier paragraph. but these friends did turn me onto some QoL improvements like alarms, journaling systems, etc, and i also found that some meds help. it’s better, but now i’m stuck in a situation where i ration meds because the only way to get them through a system i understand involves paying 10x what i’d pay if i could jump through hoops for the professional medical system.
someday i’ll get around to actual diagnosis, but, well, i’m very good at finding excuses not to. it would be nice if i could be allowed to pursue these things in my own way instead of people using the law to block off as many alternatives as they can. allow me options, let the knowledge be easy to find, and sure promote awareness so that i can understand sooner that and how my mental experiences differ from what is normal or healthy. and then let me try these different options and figure out what works best for me. why can’t i have this?
Along that vein, there is a level of acceptance (at least for me) that I will always be different. The decision of what I want to change (just like any neurotypical person decides to embark on a 'personal growth' journey) is also each individuals to take. Of course, the flip side here is that the societal pressure etc., obviously makes it not that simple (holding down jobs, etc.).
Another distinction for those new to ADHD is that by definition, your life needs to be significantly impacted (at home, school/work, etc.) in multiple domains for a diagnosis.
In terms of medication, right now for ADHD it's the most scientifically proven way (70-80% of people with ADHD see benefits) to manage ADHD symptoms but can also have some side effects. Because of this and many other reasons, some folks prefer to engage in behavioral change solutions not necessarily to 'fix' themselves only, but potentially just to reach certain goals they have. This may be used together with medication/therapy or on its own.