Getting ADHD Again

Now, hold on. I have always had ADHD (a look into my history shows that), and I always will have ADHD. (Even if they can ever restructure the brain, the neuronal-restructuring equivalent of anti-vaxxers will make sure it’s distrusted. I fear for treatments of Alzheimer’s that involve messing with the microglia. But I digress.) But an odd thing happened to me when I got a fatal brain tumor treated (successfully, or I wouldn’t be here typing this).

My ADHD got worse. At least, it got more noticeable.

Now, I don’t know if it’s measurably worse, or if the (small) side effects have made it difficult or impossible to continue the coping strategies that I had. For instance, I used to whistle a lot and the tiny bit of nerve damage I suffered means that I can’t whistle any more. Nine years on, I suspect that whistling was a kind of fidgeting for me…it kept part of me occupied so the rest of me could get on with life. So I’m not saying that, say, brain surgery worsens ADHD. (I looked; there’s nothing in the literature about that.)

I’ve had to learn new coping mechanisms, though. I suspect that my effectiveness dipped at work, partly because of the problem and partly because I didn’t recognize the problem. I am a much better worker now than I was eight or nine years ago. I have more tools in my toolkit to strategize and to achieve. Am I perfect? No, of course not. In some ways, I’m just not as good as I was before the acoustic neuroma. On the other hand, I’m a decade older; in some ways, I wouldn’t be as good even without the acoustic neuroma.

It’s rather like being diagnosed with a whole new problem.

You’re going to run into this, too. Maybe not as severely as I did, but if you have a chronic condition, the way you change as you age will change your ability to adapt.

So write something down in your planner. At regular intervals (maybe every six months, maybe every year), check to see if what you’re doing to help is really helping. And see if you can’t do something anymore that you can now see used to help. Because it sneaks up on you. “Oh, it doesn’t matter that I can’t whistle any more.”

It matters. Or rather, it might matter.

My mailing today from Additude magazine included this sentence: “ADHD never sleeps. It’s a 24-hour, 365-day reality.” Most chronic conditions are.

And sometimes, through no fault of your own, they find a new way to get in, or to express themselves.

So be careful out there.

Procrastination and ADHD

Are you one of those people for whom it could be said, “I’m procrastinating right now”?
I have that. And I recognize it from descriptions of ADHD. And recall that one of the ADHD doctors (Dr. Thomas Brown, perhaps? Not going to look it up, though) has pointed out that motivational tricks used for most people don’t work particularly well with ADHD people. Instead, he finds that they respond only to actual interest, novelty, or urgency. The promise of rewards (for example) does not work for them, possibly because time sense tends to be very skewed.

The question of procrastination came up on Quora recently, and Sara Wedeman wrote a rather extensive reply, some of which I’m excerpting here. (The question is “How do I get over my bad habit of procrastinating?”)

Of the seven predictors she identified in her doctoral thesis, I found these familiar:

  • Issues with Authority Figures (“I am the boss of me” syndrome)
  • Reality Interference (having too many things on one’s plate)
  • Issues re-Frustration Tolerance (easily frustrated and/or avoid the experience)
  • Unrealistic-to-completely-absurd planning skills

Reality Interference is a consequence of the others, but it’s likely to come up after the ADHD person is old enough (like, twenty). And lots of ADHD people also suffer from issues with authority figures. But lo and behold, frustration tolerance was the best single predictor.
And who has frustration intolerance? Yeah. People with ADHD. To quote:

There are nuances.
It’s not just a question of avoiding doing something that is frustrating, difficult, and anxiety provoking: the mere anticipation of frustration prevents the procrastinator from even starting.
People who procrastinate tend to avoid things they imagine to be frustrating – even if they turn out not to be so. Typically, they begin only when the consequences of notcompleting the task become, in their minds, more painful than the consequences of completing it.
Once that tipping point (pain of not doing exceeds pain of doing) is crossed, and they actually begin the task, they are often shocked to discover it was never that bad at all.
And, in fact, we see that often in advice on overcoming procrastination. “Get the first ten minutes in; you might discover that it’s not so bad. Not pleasant, but not so bad.”

Her suggestions for potential fixes?

  • Start with the low anxiety parts of the task first. That way, when the crisis hits, you’ll at least be better prepared.
  • Set exceptionally low goals. For instance, if you have a sink full of dirty dishes, set the goal of washing one fork. You’ll be surprised at how well this works. I mean it!
  • Set a timer, for a maximum of 20 minutes. Your goal is to do the task you’re avoiding for 20 minutes. After that, you must stop. It is a requirement.

Is it selfish of me?

That right now, I don’t care if my ADHD kid succeeds, I’d just like to get my head above water?

Just…so much of the self-help material that’s out there is about getting your kid to succeed. Well, I’d like to succeed. You know that desperation and exasperation that permeates suffers of ADHD in things like Gabor Mate’s Scattered Minds? I am not only there, I zoomed past it a couple of days ago. 

I hate vacations. I hate special occasions. I loathe Mother’s Day and birthdays and Christmas. Why? Because whatever I manage to do to keep myself from drowning just…goes out the window.

I’m probably better at handling them than I used to be (thanks to my wife) but I am so much more tired of it. Christmas and birthdays don’t feel like a celebration to me: they just feel like another chance to fail.

I feel like I already fail enough. Why am I setting myself up for this?

I can understand why sufferers of ADHD sometimes end up old and alone and friendless…because it seems like too damned much work trying to handle the special occasions.

Ah, well. This, too, shall pass.

Current strategy for Christmas and birthdays (and this is the first year I’ve tried it): I have a reminder in Evernote (but any calendar will do) for about a month before The Event that lists what I should be doing. I have smaller reminders on week-by-week basis.

So Christmas has a first one that outlines what needs to be done overall, and what needs to be done that week if I’m not going to end up spending a bazillion dollars.

Three weeks before the event is another that outlines what should happen that week, and so on, and so on.

This year was just as stressful as the others (or my tolerance is lower as I age), but it seemed to work correctly. Possibly a different topic…but I take no joy in that. I only feel as though I’ve escaped doom this time, and next time might be as bad.

(Perhaps it’s a hallmark of ADHD that we don’t seem to get the emotional benefits of mastery.)

Sorry, I was going to write about procrastination but I kept putting it off

I was reading a paper on procrastination, and I came across this sentence:

“A perfect storm of procrastination occurs when an unpleasant task meets a person who’s high in impulsivity and low in self-discipline. ”

Remind you of anyone? It reminds me of several someones.

That particular paragraph is quite rich because it goes on:

“Most delayers betray a tendency for self-defeat, but they can arrive at this point from either a negative state (fear of failure, for instance, or perfectionism) or a positive one (the joy of temptation). All told, these qualities have led researchers to call procrastination the “quintessential” breakdown of self-control.”

Oh, and: “The chronic procrastinator, the person who does this as a lifestyle, would rather have other people think that they lack effort than lacking ability,” says Ferrari.

Yup. That describes me. Somewhere along the way, I got the idea that not-trying was cooler than not being able to…or, more accurately, that failing was much more painful than not trying.

If I can go ahead and talk about ADHD for a moment… Maybe it’s partly because of the see-saw nature of ADHD, the lack of consistency. It felt like that the amount of effort I put into things had no bearing on their success. (It still sometimes feels like that.) And if you put effort into something, it is that much more heartbreaking when you fail. (It is the nature of life that sooner or later you will fail; it is the nature of ADHD that sooner you will fail.)

I see this in my son. He would rather not try…because then he still has the illusion that he could try and succeed; he just chooses not to try.

I wonder if the generally poor emotional regulation that seems to result from ADHD has something to do with it? After all, the article goes on to point out that mood and procrastination are linked, and contains this item:

“Emotional regulation, to me, is the real story around procrastination, because to the extent that I can deal with my emotions, I can stay on task,” says [psychologist Timothy] Pychyl.

I’m not in any way saying that the problem isn’t attention, but rather that in the rather complex dance of ADHD, emotional regulation might play a bigger part than we suspect at first.

Ah, medicine

So my son is on Vyvanse and Concerta. Has been for a while…months.

Yesterday, he pipes up that the Concerta has no effect.

Huh?

No, no effect. 

Now, from listening to numbers from Dr. Dodson, about the same percentage of people are affected by the stimulant class drugs (Vyvanse) and the methylphenidate drugs (Concerta), but not the same people. So if you add them together, some percentage in the 80s can be helped by medication but you do have to search.

We are going to try a higher dose of Concerta, in case that’s the issue, but he might be a stimulant-only kind of kid. (We know Strattera doesn’t work.)

Aside: New idea for parenting. We have this problem where I say, “Hey, do this chore,” and the kids don’t, and because I am also ADD-distractable, I don’t check, and the kids get off without doing the chore. So here’s what we’re going to try: When I give a chore like “clean up the kitchen” I’m going to take something essential from the thing the kids want to be doing, such as a bike helmet or a laptop computer. This serves two purposes: first, the kid can’t go off and do the preferred thing. Second, it’s a tangible reminder to me. When the kid is done, he or she comes to me for the object, I check the job, and if it’s good enough, they can continue. 

I foresee possible pitfalls here, but benefits, too.

Okay, not as dire as I feared

There is life after Fast Forward math. We met with the teacher and really, it comes down to the fact that last year brought him up to one year behind. That is, instead of doing 8th grade math in 8th grade, he was doing 7th grade math. To switch over, he essentially has to do the fast forward and then take 9th grade math….a bit more math than he’d like, but you can go from one stream to the other.

So this doesn’t necessarily close any doors for him.

Whew.

Deep breaths, remember

My very ADHD son started high school this year, and in our area that means he’s been in school since September 3: Sixteen days. Last year they made great strides and actually got him back into a mainstream classroom, though granted it was a year behind his social grade. (I don’t know what the real term is…nominal grade?) But still: given that he had lost essentially three years dealing with anxiety and other issues and that he has his own learning style, bringing him up to a point where he could be with the other students was huge. Huge.

And now, sixteen days after the start of the school year, thirteen school days after the start of the school year, I got a call from the teacher.

He doesn’t seem to be absorbing the math. He seems okay when you talk to him about the concepts, but it doesn’t show up on the tests. We’d like to move him from the Applied stream into the Fast Forward program.

Brief digression: In our school system, the Fast Forward program is essentially where they teach skills for living and abandon all other pretense. (There might be one lower, but at Fast Forward, we have left the normal school system entirely.) Once your child has gone into Fast Forward, I suspect they never get out: It is the bourne from which no traveller returns.

My heart sank. I have been listless, depressed, angry since they called. This is a decision more far-reaching than any other we have made because we cannot turn back if we say yes.

At least, I have that impression. I feel like this is the point where the school system gives up, where they stop trying anything like a normal education for my child, and they settle. “Oh, he can add. Good enough.”

Am I right? I don’t know.

Reasons why they might be right: He does have trouble learning things. He is anxious and that will hold him back. These people are professionals who work with kids all the time: they might be seeing signs that I’m ignoring. My son would rather be active doing things than studying, reading, doing schoolwork. He is, though I am sad to say it, a prime candidate for the kind of kid who drifts into a life of…not crime, but with no direction and bad behaviour that has never been thought about.

Reasons why they might be wrong: He is not stupid. This teacher is new for this kind of Special Ed work. I am not certain that he studied for this test–he was at the house of one of his classmates and I have no idea if actual studying happened. It has been thirteen school days: this first test should be a chance to be mistaken and then rectify it.

Heart-sick. That’s how I feel.

Even if we say, “No, you can’t put him in Fast Forward yet,” there is clearly work ahead of us, going through the math every night, and finding a way to make him successful.

Disorganization that looks like organization

As a person who has been plagued by organization problems all my life, I do have a couple of things to say about it, not in the useful sense of what to do, but one or two things in the possibly-useful sense of what to avoid.

(This is prompted by events at work, so you’ll forgive me if I don’t use details from there.)

My problem with organization has always been that (a) I can’t remember the system from last time and (b) most systems seem exactly as good as each other. So next time I start from first principles (sounds better than “from scratch”) and create a new system, putting stuff away in the new place while everything else is still in the old place for the old system. However, living like this has led to a couple of insights.

First, there are organizational systems that only look organized. They impose some kind of order, but they’re not useful. As a totally silly example, let’s suggest that I have in my garage a new organizational system based on mass. Heavy stuff in one place, light in another, eight or nine gradations in between. This is nonsensical (I think you’ll agree), but it looks good: all the heavy power tools are over here, together, along with the bar fridge and the bicycles; all the light stuff is here in bins: washers and nuts and caps for bicycle inner tubes and gloves and those really small screwdrivers I need once in a while. Over there are most of my wrenches and some screwdrivers, but the rest are over on this other spot with my hammers and the long screwdrivers and some sections of copper pipe I have for plumbing repairs. Over there is my propane torch for sweat-welding.

Looks good and has some kind of organizing principle, but the system doesn’t take into account what I use things for. I mean, wouldn’t you figure that maybe  I want to visit only one or two spots in the garage to gather what I need to fix the bicycle? Or to saw wood?

I could do it by purpose, except there are some common things that get used a lot (the screwdrivers and wrenches, for instance). If we were talking about separate rooms, I might actually buy two different sets (one for upstairs, one for downstairs) to avoid the travelling-and-distracted problem…but we’re talking about my garage. 

So: an organizational system that puts the bulk of the materials in one place is good…that place is the garage. But then you have to subdivide the garage, because there’s just too much stuff. 

Fortunately, stuff doesn’t have to be right the first time, but you have to do two things, both of which I suck at:

  • You have to evaluate whether the current system is working, and be willing to listen to other people if you are not the only one using the system.
  • You have to be willing to make the changes to try something new.

(Dis)Organization

Organization has long been a hassle for me. Almost every organizational scheme seems as good as any other, and when asked where I put something, I often have to figure out what I considered most important at the time in order to figure out what schema I made up…recreating it from scratch, as it were.

I’ve been reading a couple of books on organization and disorganization for the ADHD mind, and one of them had a couple of items that really struck home to me as being important (for me, anyway).

First, emphasize utility over beauty. Having the towels in the hall closet, the shampoo under the sink, and the shower in its own small room looks great–the towels and the shampoo are nicely hidden away–but sucks as an organizational strategy for me because I have to remember where the pieces are if I’m going to take a shower. Better to put the shampoo by the shower and some kind of towel rack in the same room as the shower.

Second, make things easier to put away than to take out. Think about it: when you need something, you have the impetus of that need to get it out; when you don’t need it any more, there is no impetus. So clever stacking arrangements, while they save space, are a pain to reassemble. If you have so much stuff that everything has to be arranged in the cupboard just so, you have too much stuff! Or the stuff is in the wrong cupboard.

Both of these come from Organizing Solutions for People with ADHD, by Susan C. Pinsky. I’m using the electronic edition, and it sometimes freezes up on my Kobo app on iPad, but is generally fixed when I go back in, so I don’t know whether the problem is with the book or the app.

The return of bad habits

It’s been a while since I posted…six months.

Ahem.

See, I haven’t made a habit of posting. And habits…are <em>tangentially</em> related to what I wanted to talk about. (I have Charles Duhigg’s <cite>The Power Of Habit</em> sitting here as an audiobook, waiting to be listened to, but I haven’t done that yet.)

You might have heard somewhere that it takes three weeks to establish a habit. I can tell you that it is not true for me. Six weeks might work, but there is still the chance that I will backslide.

If it’s a particularly unpleasant task, after years there is the chance I will backslide.

Now, the current speech I hear is that ADHD is related to problems or underdevelopment of the executive functions portion of the brain, such as inhibition. Those can grow or shrink or be otherwise modified through practice. (In fact, I suddenly suspect this is part of the practice of meditation: the need to exercise control over the self might lead to the encouragement of those functions, especially if they’re located in one or two section of the brain. I digress.) Habits increase the inhibition areas of your brain, at least in areas related to the habit. You inhibit behaviours X, Y, and Z until your habit is complete.

Except as I’ve always practiced it, creating habits doesn’t necessarily carry over to other areas.

I have also noticed that bad habits never go away: they’re always lurking there, waiting to re-establish themselves. I think this is probably something to be aware of: when everything is going well, you can’t abandon what has made your life go well. (Yes, there’s an edge condition where following the new behaviour is magical thinking; those are rare.)

So: in times of great stress, you might fall back into old habits. And, perhaps equally importantly, when everything is going well, you might also fall back into old habits.

I have Charles Duhrig’s Habit here on audiobook, so I’m going to give it a listen.