Some Thoughts on ADHD

With so many people having ADHD these days, especially children, I decided to put together some resources on ADHD.

Getting Treatment

  • For Kids. ADHD isn’t that complicated. It’s often easiest to go to a pediatrician who can prescribe it vs. going to a psychiatrist. Kid psychiatrists can be very expensive. Get a diagnosis from an expert but see if your pediatrician can prescribe.
  • Adults with ADHD. Most people don’t understand adult ADHD as it’s often masked and presented as just “lazy.” Dr. Hallowell, the popularizer of ADHD has ADHD clinics in some large cities. They know how to treat ADHD in both kids and adults. You can find them at drhallowell.com. Note that just sending this information to a person with ADHD may not be effective because they will find a million reasons not to call.

Symptoms

  • As I understand it, ADHD in adults can present as a pathological deficit in executive function skills. I’ve heard these types of examples:
    • “I always feel guilty. I can never spend enough time with my family, getting my work done, or relaxing. I feel like I’m constantly playing catch-up.”
    • “I feel like I need an inordinate degree of self-care. It shouldn’t take 3 hours of meditation, exercise, and reading to feel good enough to do the dishes.”
    • “I procrastinate just to get closer to the end of the day, just sitting there and wasting time until it’s getting close to the end of the day and then I start doing work. Then I work well past quitting time because I need to get my stuff done.”
    • “I use time very poorly. If I have a 2-hour block of unscheduled time in the day, I’ll just waste it.”
    • “I can’t sit still to get my work done. Even when I’m doing exactly what I know I should be doing, I feel the need to get up and walk around. I feel compelled to think about and do other things!”
    • “Everyone always tells me, ‘You’re so smart. Why can’t you get these simple things done.’ Why can’t I just do simple adult things like pay the bills?”
    • “I feel like I’m constantly procrastinating, but not in the normal way. I’m afraid of being early to things because I’m not sure what I will do with that time. Also, I normally “enjoy” the rush of getting things done. Here’s a good example of ADHD procrastination.“
    • “When I’m on medication, my default setting is no longer, ‘That looks really hard’ but ‘Let’s get started on doing it.'”
    • “At work I feel like I’m only able to work about 1/2 of the time because I’m wasting the other 1/2 of the time. So I constantly feel like I have to overdeliver just to avoid falling behind.”
    • Without Concerta: My brain is composed of brigades of tiny soldiers. They are tired and muddy from their long march through the night. There are holes in their boots and they are hungry.
      With Concerta: Hup, two, three, four. The soldiers are back on their feet. They are off and running in formation.
    • “My biggest fear is, ‘What if I don’t have ADHD and I’m just lazy.”

Taylor Tomlinson on Mental Illness

I don’t think anybody should feel bad if they get diagnosed with a mental illness ’cause it’s just information about you that helps you know how to take better care of yourself. There’s nothing wrong with it. It’s like not knowing how to swim. It might be embarrassing to tell people and it might be hard to take you certain places.

But they have arm floaties. And if you just take your arm floaties, you can go wherever the hell you want. And… I know some of you are, like, “But Taylor, what if people judge me for taking arm floaties?” Well, those people don’t care if you live or die, so maybe who cares? Maybe fuck those people a little. I don’t know. That being said, you have to take your arm floaties because it’s not cool to know you can’t swim, go to the public pool anyway, and jump into the deep end, making it everyone else’s problem.

And you thrash around going, “I’m good!” They’re like, “You’re literally drowning.” And then someone nice and handsome jumps in to help you. And you’re, like, “See? I’m fine. I can totally swim.” And they’re, like, “No, you’re holding him underwater. You turned Kevin into an arm floaty and that’s not a fair relationship for Kevin.” Then someone floats by you on their back and you’re, like, “What was that?” And they’re, like, “Oh, that’s someone whose parents supported them in the pool…

— Taylor Tomlinson on her bipolar disorder in Look at You from Netflix.

Poems I Found on What ADHD Feels Like

Things I Have to Do

So many things to do
I can’t contain myself
I’m overwhelmed with ideas
So I overcommit
And fall flat on my face
Because I can’t do everything I want
Especially if my brain can’t figure out which of my super-wonderful fantastic, but-I-have-to-do-this-right now ideas to focus on
Sorry. Done Writing. Time to get up and stretch my legs. I’ll be back in a…

Time. (A Poem About ADHD Medication)

I never got along with my watch
I’d literally just freeze and wait for an hour to wash over me
Hoping the day would be done

But now I’m a mountain climber
Moving through my list, item by item
Finding the small-time cracks in the middle of the day

It’s amazing what you can do with one minute or two
Decisions that seemed like mountains now are just molehills—tiny little problems that only take a few minutes. And if they need more time. I’ll find it somewhere else.
Now I love “boring time.” That time when I move things around and make sure that I’m on top of things.
Because now time is my friend. Full of promise, opportunity, and adventure.

Videos

Books

  • ADHD 2.0 by Ned Hallowell. Hallowell is the largest selling author of ADHD books. This is good overview of adult and child ADHD. There’s an audiobook version which is helpful because many ADHD people have problems paying attention to books.
  • Cognitive-Behavioral Therapy for Adult ADHD: Targeting Executive Dysfunction by Mary Solanto is a guidebook of how to run an adult group for ADHD. It probably works best in a group setting but it has some really good tips and exercises on time management, organization, and emotional management.

Websites

Organizational Tools

Here are a couple of awesome organizational tools that work well for people with and without ADHD:

Interesting Quotes from Articles

From this online article:

  • “When a person with ADHD complains of severe anxiety, I recommend that the clinician not immediately accept the patient’s label for her emotional experience. A clinician should say, “Tell me more about your baseless, apprehensive fear,” which is the definition of anxiety. More times than not, a person with ADHD hyperarousal will give a quizzical look and respond, “I never said I was afraid.” If the patient can drop the label long enough to describe what the feeling is like, a clinician will likely hear, “I am always tense; I can’t relax enough to sit and watch a movie or TV program. I always feel like I have to go do something.” The patients are describing the inner experience of hyperactivity when it is not being expressed physically.”
  • “At the same time, people with ADHD also have fears that are based on real events in their lives. People with ADHD nervous systems are consistently inconsistent. The person is never sure that her abilities and intellect will show up when they are needed. Not being able to measure up at the job or at school, or in social circles is humiliating. It is understandable that people with ADHD live with persistent fear. These fears are real, so they do not indicate an anxiety disorder.” So what does this mean for me? I think it means that I’ve been seeking jobs where someone else takes on the Executive function skills. I feel like the jobs where I am most successful is where somebody else is handling the executive functions. And I can focus on being smart and giving advice and good stuff like that. So when I’m in an Executive job where I have to do lots of administrative things, I just feel like an imposter and don’t know what to do.

Some Things About Adult ADHD

  • No one seems it’s a thing. They think, if you’re good so far, why would you need something now?
  • Symptoms — like above, seem like they must be normal for everyone…
    • I finally sit down to do the 2 hours of work that I know I need to do — now I can’t do it. I immediately need to do something else. It’s not abut physically running around as much as it is just not being able to mentally sit in one space.
    • Trying to meditate and really hating it — like feeling so nauseous I might vomit because it was such a big transition from normal.
  • One of the craziest things is what happens when they take medicine and see the difference:
    • Before Medicine: Previous to the medicine, they always felt like they had to overperform. They new they were going to fail at something so they needed to really do much better at the things they were good at. It’s like a student that in order to maintain a B average, they new there would be some C’s and D’s. So they couldn’t just get A’s on the things they were good at. They needed to get A-Pluses and even get extra credit on those things to pull them up. They always felt like they were failing and not living up to their potential.
    • They Take Medicine: Initially, they don’t notice a change. And if there is a change they might attribute it to something else. They have this awful fear of, “What if I don’t have ADHD and I’m just lazy.” But gradually the medicine starts to kick in and they realize that they can actually accomplish what they want to accomplish. They can get a B average by doing well and focusing on the classes they don’t find interesting. Or at work by doing the monotonous reports they used to find very boring. They don’t need to stay up all night racked with anxiety about not accomplishing things and getting extra credit in their chosen fields. Weirdly, oddly, they have calmed down. As Eric says, “Now I have all this free time. I need to focus on getting hobbies.”
    • Readjusting to the New Normal: I talked to one of my friends about this. I said, “You seem so much more relaxed.” He said, “My wife thinks I’ve turned into a huge asshole.” This makes sense. Before, the person with ADHD couldn’t accomplish things. They knew they couldn’t accomplish things so they let lots of things just slide. Also, it meant that they didn’t hold other people to account because they knew they couldn’t deliver. Now, with the ADHD meds, they are able to accomplish things but…:
      • A lot of the previous behaviors are ingrained. It’s hard to forgive someone for years of inaction and incompetence at accomplishing tasks when things have just changed.
      • Now that they can accomplish things, their expectations are changed. So it’s “Now I’m ready. I’m always the last person ready, so why aren’t you ready!”
      • They need to change their mindset to “I can be ready early. People who are ready early can help other people.”
      • The argument between the couple changes — and it should change for the better. It’s no longer “I have to do everything. Why can’t you do anything.” It should be “Hey, we think differently. How can we work better together.”
      • What are some ways that spouses can learn more about ADHD?
        • Wife who talks about ADHD and cleaning the house…

ADHD Meds

  • Medication. I’m not a doctor by any means but we have spent a lot of time with medication with various different doctors. ADHD medicine is a bit of a scam. The medicine really works. Dr. Halliwell shows that it works amazingly (cite ADHD 2.0 notes). However it’s a controlled substance
    (WHY).
  • We got great advice from a psychologist about getting prescriptions for ADHD meds. He said there are two types of psychiatrists in New York City. The good ones are very expensive. The cheaper ones are not very good. You need a doctor to diagnose ADHD, it’s not a crazy process. Basically, it is diagnosed as a syndrome based on various different characteristics (list characteristics from DSM-5)
  • One of the best places I’ve found for ADHD help is The Hallowell Center. This is not surprising as Dr. Hallowell is one of the most famous people about ADHD. The cool thing is that they treat adults!

That Doesn’t Make Sense

One of the big problems with ADHD is the gap between “What should be happening” and “What’s actually happening.” Basically, it’s the difference between the potential of a person and the results. This is why you often hear, “He’s not living up to his potential,” or “Why can’t you just get this simple thing done?”

One way of looking at ADHD is a pathological deficiency in Executive Functions. If you look att Executive Functions as literally, “Getting things done that you want to get done,” you can see a diagnosis as “Why aren’t you living up to your potential?”

Here’s one story of a person who was diagnosed with ADHD later in life but some of the signs were there but ignored in their early life. They were in high school in the mid-90s and had a highly uneven high school transcript. They were really good in math and science, arguably the best in the school. They even overheard a chemistry teacher say, “I know I’m the Chemistry teacher but they are much better at Chemistry than me.” But in English and Social studies they struggled–but they still managed to pull through pretty well. They ended up attending an Ivy League school. The school published a list of anonymous GPAs and where kids went to school and man, this one was an outlier. There were fully 10-15 other students who should have gone to better schools than them.

In high school, the head of the science department talked to a small group of honors students and said, “I know that 2 of you are going to do very well on this test but I’m not sure about the third (our protagonist).” They got a 5 (A) on the exam. They convinced the head of the science department that the school should attend the county science bowl with the teacher acting as the advisor. They were very excited about signing up and the team was super smart and even made it to the county finals; however, they hadn’t prepared and didn’t even understand the rules particularly well. Other schools were frustrated and thought they were intentionally misunderstanding the rules to cheat.

But the biggest puzzle was in college. There were five levels of Physics in college, physics for poets, physics for biologists, physics for chemists, physics for physicists, and advanced physics for physicists. So they decided, “Well, I was so good in high school, I should obviously take the hardest physics. It seems like the most fun.” They did not do well in this class. The class was made up of the best physics students in the country. Many of them had talked more advanced physics classes in high school (who knew there were physics classes beyond AP Physics in high school) and all of them had better study skills. So they ended up near the bottom of the class.

That part of the story makes sense. If you take a class that’s too hard for you and you don’t study, that makes sense, but what doesn’t make sense is what happens next. The realized that this was the problem. They took at class that was too hard and they couldn’t study for it. But when asked, “Would you do it again, they invariably said ‘Yes.'” Why would they take a class knowing that they wouldn’t succeed? Because they knew that they had the potential to succeed, if they could just study enough. Only when they got an ADHD diagnosis did this make sense. They couldn’t miss the opportunity to take such an interesting class because of their impulse control. Also, because of their ADHD, they couldn’t put in the work that they needed to succeed, so they were destined to fail.

With undiagnosed ADHD the world is very binary. It’s like Yoda says, “Do or not do, there is no try.” So in their mind, it’s about “Do I take the class or do I not take the class.” In reality, there are a lot of other things going on. If they had been diagnosed with ADHD at this time they could have taken a more reasonable approach. They could have looked at this problem not as a binary problem of “Do I do this or not do this?” but of “If I do this I can’t do something else.” They would have realized that taking the class would have meant a lot more work. Or, they could have taken the class and done a ton of work. Either way, they would have needed to look at this as a trade-off in time and effort vs. the other things that they want to do. Being a college freshman has a lot of fun opportunities and things to try. They couldn’t conceive that having “unplanned” time could be a “good” thing. But having ADHD meant that they didn’t have the skills to make that trade-off.

As they got older, still before they were diagnosed, they started to learn about Executive Skills but not under those words. It was often called “Time Management.” Two of the great methods are Steven Covey’s Seven Habits of Highly Effective People and David Allen’s Getting Things Done. Oh my goodness, they thought! Everyone has the same problem that I do! So I can just follow these lessons and I’ll get better at this. They did, but still there was a big gap on execution and planning. They felt good doing the planning when they could get to it but there just wasn’t enough time. And as it became routine and boring they stopped doing it.

Jessica audiobook out..

On Weaponizing/Stigma ADHD

You’ve got to be careful about weaponizing ADHD treatment. Many adults don’t talk about ADHD because they think that others will think poorly of them. I know one 10-year-old who described this well. He was going to a regular camp that was very forward-thinking about neurodiversity. They even had a “calm room” which was an air-conditioned room that let the kids cool off. He said, “Make sure they don’t use the calm room as a punishment. I should get to decide to use the calm room. They shouldn’t put me there as a punishment or threaten to put me there if I’m acting out. They can punish me in other ways but the calm room should be a space that I own.”

There was the time when someone with ADHD started reading Seven Habits. They thought it was a good book and helpful and would help them with planning. Specifically, the Eisenhower matrix is a godsend for people with ADHD. His boss seemed to have similar problems, he was a super-smart guy who just couldn’t get things done. He was being thoughtful and gave a copy of the book to his boss as a gift. One of the boss’s colleagues scoffed, “I can’t believe you did that. Giving your boss a book about how to be effective at his job.”

Executive Functioning and ADHD

Other Things

  • r/ADHD has some very interesting stuff as well
    • Advice for getting out Mildew.
  • About Hallowell Center…
  • To Do — EFD and ADHD
  • Look at helpful tips from the Executive Function book and grab tips from there.