Sunday, February 28, 2010

Inspirational Quote for ADHD--Proverbs 14:23

Construction Workers on Building Site

I came across this scripture, Proverbs 14:23, when I was in high school, feeling horrible about my work ethic. Something about it made sense and clicked in my brain. It gave me comfort, and it gave me sound direction. I still view it as one of my life's mottoes. It's very simple:

In all labour there is profit: but the talk of the lips tendeth only to penury.

When I first encountered it, I was struggling. My dad and I had had a hard time--he sometimes found it difficult to be understanding of my situation, probably in part because--ironically--he experiences many of the same symptoms himself, and knew what hard work it was mitigate them and make something of oneself.

When I saw this, it hit a very real place for me. I wrote it down on a 3X5 card and taped to to my door so that I could see it every day. It gave me comfort and counsel all at once. On the one hand, it made me feel okay, because in ALL labor there is profit--so even when it is hard for me, and I struggle for hours and hours to eke something out of my brain, there is profit in that labor. It is still worth something.

On the other, it warns that the talk of the lips tendeth only to penury. This is something, because my intentions were always good, I had (and still have) a problem with at times. I talk a really good game when it comes to getting things done, yet when it comes down to it talking about it has taken the energy out of actually doing it-- a lot of times it's all talk.

Talk tendeth to penury--to the poor house--to making me amount to nothing financial. This makes so much sense to me! What good is it to say something will get accomplished? None whatsoever. It simply robs energy and make one feel accomplished when nothing has actually happened. So much better it is to take that energy and actually do that thing.

I still view this quote as a guiding principle in my life--it works for me and my ADHD-I. It helps me. I'm glad I found it.


Saturday, February 27, 2010

A Supportive Parent--how to support a child with ADHD

Close-up of a young woman teaching her daughter to color

Someone recently asked a question that has me thinking a lot.

Reader Marcia asked:

I guess my curiosity is about if you do find your child has some of these characteristics, whether or not there is proof that your child actually fits the profile of adhd Inattentive type... what is a good way to be supportive?

Marcia was referring to this post in which I brainstormed a list of questions that a parent might ask themselves as preparation to begin the process of diagnosis for their child. This is a really great question that gets to the heart of what might be helpful to a child who is struggling with the inattentive subtype of ADHD (or ADHD-H, or ADHD-C, for that matter). Here are some tips that I would say might be very helpful for those that fit the criteria. (I'll leave answering the broader question about being supportive to kids who have any of the characteristics for another day.)

1. Strongly avoid labels. This includes labels involving reference to ADHD.

The most damaging labels will come from outside the home, probably. Teachers are bound to refer to your child as "lazy" or "distracted" or "forgetful" or "absent-minded." Peers might call your child "stupid" or any number of other names. Take special care to not re-enforce these labels when the child is at home. Yes, your child will likely forget a lot of things, but calling him or her "absent-minded" or "forgetful" internalizes those events--makes the child percieve them as a part of who the child is, not a description of an event.

From a personal place, the brunt of my own self-loathing came from the label "lazy." I plan to talk more about this later, but this was a label that I heard so often that I literally thought I was about the laziest person in the world. This was not a hyperbolic exaggeration--I wouldn't say the words "I am the laziest person you will every meet" (which I said often) just for kicks and giggles. I seriously, fo realz, thought that in a room of 100 randomly selected people, I was always going to to be one of, if not the, laziest person in that room.

Obviously, that doesn't do much for a person's self-esteem.

Thankfully, I was self-confident enough not to let this inaccurate self-label do much damage to the totality of my person--but it certainly wreaked some havoc on my life. To a child whose self-concept, for whatever reason, might be more fragile, a label this pejorative and ingrained could do some serious, serious damage.

So, avoid labels. Don't call your child names. Describe behaviors, and even this, be careful with. Your child is your child. He or she is better than a label, and is so much more complex and nuanced and wonderful than a four or five-lettered word.

Also, talking about symptoms is helpful for a child. Explaining why those labels exist helps a child feel normal--they struggle with ADHD, just like a lot of other kids. But deciding to tell a child he or she "has ADHD" can be very, very tricky. For sure, use this diagnosis as a descriptor, not as a noun. A child never "is ADHD." A child might "have ADHD." I prefer to think that a child "faces" or "struggles with" or "combats ADHD." A lot of this is personal preference, I realize, but I like to keep the label as far away from the person's identity as possible.

2. Be understanding.

If your child has the inattentive subtype of ADHD (or any subtype) he or she will do a lot of really annoying things. For ADHD-I kids, this includes losing things over and over and over and over, lots of having to go back and pick up forgotten items that are necessary for school or home, gross disorganization, and difficulty in finishing tasks around the house in an adequate or timely fashion.

As a parent, these things aren't fun. They mean more work. They mean a great deal of hassle. They mean the loss of time and money, moments of embarrassment, and moments of high stress. Things like "Mom, I need to go back to school to get my science book for the test tomorrow." Or "Mom, I need to go to the craft store for a project that was due yesterday, and btw, can you help me with it because it's 50% of my grade and I don't understand how to do it because I wasn't paying attention when they gave the instructions, so can we call someone to find out how to do it maybe? Oh, yeah--sorry about the fact that it's 7:00pm." These kinds of things will happen a lot and will feel very, very frustrating.

But at that moment, your kid is likely feeling horrible inside, and what he or she needs is for you to understand why this has happened. He or she needs you to say, "it's okay. You can do better at remembering next time." Certainly, let your kids suffer consequences sometimes. Certainly a balance must be achieved between natural consequences and giving a child help in things they truly can't do. But more than anything, understanding what is happening and why it's happening, and being nice in the humiliating moment of revelation, is something that will help your kid maintain the self-confidence to transform his or her behaviors.... eventually.

3. Recognize the positives.

This is getting down to basic cognitive behavioral science, but affirming your child when he or she does remember to take out the garbage, or does get a good grade, or does wash the windows before leaving to play with friends will do far more in helping repetition of said behavior than criticism during the moments of lapse ever will.

These three things are very basic. I feel that I could go on and on (and perhaps I will). But this is what came to mind in answer to Marcia's excellent question.

All right, gotta get on with my day.



Friday, February 26, 2010

I almost forgot!

But I didn't. And that's what matters, right?

Relevant thoughts before going on a date with my wife:

1. I am going to review some books soon--have one I've been reading which I think is pretty good. I'm excited to do that.

2. I am going to do a third diagnosis post.

3. This blog is really lacking in practical solutions. That will be remedied soon, methinks.

Have a great Friday night!

Thursday, February 25, 2010

Today is one of those days...

I can't get "it" to happen.

Not sure why.

Time is like a slippery eel, evading my every grasp, and it passes and passes and I can't seem to get done what I need to get done.

I really need to get out the door. But I'm stunted--action paralysis.

I think things will feel better once I'm on the bus on my way to campus--I'll read, and center myself, and feel okay.

But getting out the door? Let's hope that several hours don't slip past me while I try to do that.

I can do this. All I have to do is go. Take one step at a time. Run, shower, drive to the park & ride. Do not get distracted. Go from one thing to the next to the next.

Snapshot into some subconscious part of my brain: "You're lying to yourself. You're just being lazy. If you chose to focus your attention, you could. It's all a matter of choice. You're living a self-fulfilling prophecy. You're talking about this right now as an excuse. This entire blog is a big, huge lie--an excuse to justify your laziness and wretched bad habits. You just want to not have to work. You hate work. You're the laziest person on earth. It's all a work-avoidance technique. If you weren't so lazy, you wouldn't have these problems. All you need to do is develop a work-ethic. Stop avoiding work. If you just made wiser choices, you would be able to get everything done. Everyone can do this. You're lying to yourself if you think you can't. You're acting like a five-year-old who needs his Mommy to push him. Get over yourself. Get a clue."

Somehow, I need the voices like that in my brain to shut up. Surely they stem from childhood, and all the messages I so often received.

I need to be nice to myself.

And I need to start this day by taking the first step.

I guess I'll go run now.

Wednesday, February 24, 2010

A brainstorm on my lunchbreak, and a clarification

So, here on my lunch-break, I'm thinking about the idea of increasing the awareness of what students might be struggling with ADHD-I.

First though, I've wanted to clarify for a while (and just keep forgetting) that "ADHD-I" stands for "Attention Deficit Hyperactivity Disorder--Inattentive." I've seen a lot of people writing ADHD-1 (with the number one). Probably that's how it looks in this font. I could see how that would seem really technical and confusing, so I wanted to clarify that it's not a number, it's a letter: the letter "I" for "inattentive." (Some people write it ADHD-PI for "primarily inattentive," but I think that's even more confusing.) So, the breakdown, for the purposes of this blog, is ADHD-I for "inattentive" ADHD-H for "hyperactive" and ADHD-C for "combined." Hopefully that makes more sense than the vague and arbitrary sounding ADHD-1 I've seen here and there.

Anyway, my thoughts regarding identification during elementary school age are actually just some questions to be asking:

--First and foremost, how does your child feel about studying? Is it a frustration?
--When given a homework assignment, can he or she finish? How much time does he or she spend on it?
--Does your child often lose things like lunch-boxes, lunch-money, notes to have parents sign, etc.? Does his or her backback feel like a black hole where things magically disappear? Do you sometimes get questions asked by the teacher about feedback sent home, either good or bad, that you have never seen?
--Has your child ever missed a fieldtrip because they didn't get the slip to you to sign? Have there been close calls in this area? Has it happened more than once?
--How is your child's desk? Is there so much junk that it's bursting at the seams?
--Has your child gotten feedback about "being more responsible" or "paying more attention to details" on a consistent basis?
--Has a person of authority called your child lazy or commented on a lack of work ethic?

None of these questions mean anything definitively. They are just good questions to be aware of as they might be indicitave of symptoms. There are probably a lot of things I'm not thinking about at the moment--this post is more of a brain-storm for me than anything else, so if anybody has any thoughts or ideas, I'd be happy to hear them.

Tuesday, February 23, 2010

ADHD Anecdote--From a teacher's perspective

High angle view of students sitting in a classroom


As a junior high teacher, a lot of one's time is spent controlling the room. Finding the perfect balance between strict and "cool" (always favoring strict over "cool" is the way, fyi, but this ain't a teaching blog, so I won't expound) is not an easy thing to achieve when you're standing in front of that sea of faces.

It was always amazing to me how one student--one kid--had the power to completely change a room. There were certain classes where I had one student I dreaded to see--not because I didn't like him or her, but because with that student in the room, the net learning achieved in the classroom diminished dramatically.

In other words, a lot of a teacher's job is crowd control. It's taking the big personalities, squashing them effectively into obedience enough that information can be shared with the masses, and then after all that is said and done, it is assessment in order to re-evaluate your material.

Because of this, when there is a student who truly has the hyperactive subtype of ADHD (and trust me, as a teacher you begin to tell a distinct difference between correct diagnoses and bogus diagnoses--the ones that really have it, poor kids, very genuinely cannot control themselves or their impulses), much of that teacher's time is spent corralling that one kid. It's not fair. It's not right. It's not cool. But it is reality. And it's not the kid's fault. And it is necessary in order for learning to happen at all on a broader scale.

I remember, midway through the school year one year, getting a new student into one of my favorite, hardest working, most obedient classes. I had long heard the stories about this kid. He was big and intimidating to some of the teachers. He was loud. He was belligerent. And other kids loved him and his rowdiness.

When he came into my class, I was prepared. I had him sit in the front row in the corner, where I could have total access to him. I was not going to let him bulldoze the entire classroom experience.

I remember spending the entire first period he was in the room standing literally by his side the entire class. Every time he turned to say something to someone else, I motioned for him to turn back around, standing directly over him. I lectured like that the entire period, trying to not let it distract as much as I could. While it felt a little over-the-top, my ploy worked, and we got through the class having covered all the material.

Several weeks in, I had him somewhat trained. Some days were still bad. One day in particular, I turned to him and said "before you got here, this class was able to learn great things without interruption. When you monopolize my time like this, you take away my ability to teach all the other 30 kids in this room, and frankly, you just aren't that important." Then I sent him down to the office (which is actually not a really great thing to do as a teacher, so I did it very, very rarely.) My message to him was: you are not the center of the universe, and my job is not to babysit you. It is to teach the entire class. As time passed, the message was understood, and my relentless discipline made some headway. The class was never the same as it had once been. But learning did take place, and much more often than not, he didn't dominate the room at all (which left to his own devices, he would have.)

The thing that chagrins me, though, is that now, several years later, he is the kid I remember. I have vague recollections of a few of the kids in that group--I more just remember the good feeling I got with them. They were a good class. But, besides him, the rest have already vanished into the ether of my memory.

So, what if there was a student in that class, on those days that I was so entirely focused on controlling this kid's behavior so that I could access the attention of the largest number of students possible, who was sitting near the back, unable to focus on anything I was saying? What if there was a student, a girl perhaps, who wasn't failing, but wasn't doing great nor reaching her intellectual potential? Who was really bright, made good comments, but didn't consistently get her work done because she couldn't focus on it? A girl who had the inattentive subtype of ADHD, but wasn't receiving the help she needed?

The fact is, I bet my bottom dollar this kind of thing happened in my teaching career. And that sucks.

What does this mean? Honestly, I don't have the answer here. I mean, I think people need to be more aware in general of this issue, and of the prevalence of students (especially girls) who have ADHD-I and fall between the cracks in our educational system. I think parents need to be educated and pick up on signs and advocate. I think teachers should too.

But having been both the teacher as well as the poor ADHD-I student being ignored, I must admit that I can't entirely blame the teachers--even my own teachers--for not seeing what, in an ideal world, should have been seen. They have to focus on what directly impacts, positively or negatively, the highest number of students at any given moment. And unfortunately many times, that's the really hyperactive kid who can't help but distract the entire class.

It isn't cool. But it is the reality.

Tomorrow, I think I'll talk about some of the signs parents and teachers should look for to try and ferret out the kids that have ADHD-I.

Monday, February 22, 2010

ADHD Pop Quiz-the ignored population

Graded math homework and grade book

To anyone who has researched ADHD, what I'm about to ask will not be difficult. To others, it might be surprising. (And a little infuriating.)

Statistically, there is a group of students that have ADHD that is highly under-recognized. I'll give you three guesses as to what makes this particular group of students susceptible to being ignored. (It's two basic things. I won't give any further hints.)

I'd offer a prize to the winner, but probably someone will get the answer right off the bat, and also you really, really don't want a handcrafted item made by me. I promise.

And.... GO!

(I'll be back after seeing my clients today to reveal the answer. I know the tension is killing you.)

Sunday, February 21, 2010

Inspirational Quote for ADHD--Sir Matthew Hale

The more business a man has to do, the more he is able to accomplish, for he learns to economize his time.

--Sir Matthew Hale
While I disavow Hale's views on rape, I've gotta give it to the guy: this quote is perfect for somebody with ADHD.

I have found many times in my life that the more responsibilities I have, the more I'm able to accomplish. I'm not exactly sure why this works for me. Maybe it's because the more there is to do, the more frequently one experiences the adrenaline of an impending deadline.

Businessman on cell phone

Whatever the case, I find that loading my days with blocks of time devoted to many different activities provides me with the ability to focus on more things for more time. It seems a little counter-intuitive to me at times--it would seem that someone unable to focus would do better with more time to do the things that need to be done. But I can't deny it: when my schedule is chock-full, it invigorates my mind and I'm actually able to focus more than when I have gobs of time.

Conversely, if ever I have a full, empty day, and only a few projects to do in that day, you can pretty much guarantee that I will not finish any of them.

So, thanks Sir Hale. In this thing, you have given good advice. (Too bad many abusive husbands have been vindicated by your ridiculous views.)


Saturday, February 20, 2010

How an ADHD-I person gets something done (and maybe everybody else, too?)

Just went to lunch with a friend of mine who is having me come in to the psychology classes he teaches and present on marriage and family therapy.


Here is what this presentation thing will look like for me. Though I will want to work on this long ahead of time, any time I actually open my material to work on it, I will become distracted by any of 40,000 things, taking my brain away from the necessity of active cognition. Hours will pass, and nothing will get done even though I'm "putting in the time," sitting there looking at my materials, probably all alone. This will be very frustrating, and I will wonder what is wrong with me, and (as always) why I just can't focus. On approximately the day before (or being more honest, the day of) , I will finally get the surge of fear that will allow me to focus on what I need to do enough to figure out what I will present. The work will be very quick, my focus will be incredibly intense for a short period of time (thanks, adrenaline!) and I will accomplish in record time what should have taken me hours to do. In a bad case scenario, that moment of focus will never come, and I will look like a complete fool.

This is the summary of my entire academic life. Whenever I talk about this, people tell me that they know exactly what I'm talking about, and that they do the same thing. I'm always shocked by this, because I never see anybody going through it. Is that true? Is this kind of thing really that common? Is this not a part of ADHD-I at all, and I am misguided?

Any insights or experiences to help clarify this for me?


Friday, February 19, 2010

I'm tired

I've sat here thinking about what to post today, and the fact is, I'm ridiculously tired right now. I don't got nothing. And I'm also really hungry. And Anna, my oldest, is saying "I wanna watch Friller (Michael Jackson's "Thriller") one time." And because I haven't been home to hang with her all day, I'm gonna do that now.

(And talking about her here leads me to wonder if she'll have to deal with ADHD-I as well--it's appeared in every generation of my dad's side of the family that I know of. That would be a bummer.)

Have a good Friday night.

Thursday, February 18, 2010

The good (as opposed to the bad, and the ugly)

So far, this blog has chronicled a little dose of the "bad and ugly" components of living life with the inattentive suptype of ADHD.

But, the thing is, that's absolutely not a reflection of my life as a whole. Contrary to what one my think reading my 12 (Yeah, that's right, 12) posts so far, I am actually not experiencing co-morbid depression alongside my ADHD symptoms.

I am a happy guy. And my life is good. Really, really good. Some of the reasons why include:

--I have two amazing daughters who are adorable
--Lolly, my wife, is my best friend, and she is beautiful, and she helps me so very much when it comes to all this ADHD-I stuff (and lots of other stuff) and I'm gonna have to do a post detailing her awesomeness because seriously folks, she is more amazing than you could ever know.
--I'm going to have a Master's degree in June.
--I love my internship. I love counseling. I love teaching. I love music. I love writing. Pretty much all the stuff I do vocationally and avocationally, I love.
--The sun is shining outside right now. And it's February, in Seattle.

That's only a beginning of the reasons why when you see me, I'm in a pretty good mood most of the time. My point is, while the very nature of this blog is to point out some of the hardships that come with living with the inattentive subtype, I never want to give the impression that I am not happy. Nor that I feel that this particular challenge is any more or less challenging than the other very, very difficult things that people face in life, all the time.

It's just different. And often mis-understood. And often put under scrutiny. And I want people to be able to come to a place and see for themselves why certained pre-concieved notions about "laziness" and "ADD kids" and the like might be... well just that. Pre-concieved notions.

Anyway, here's to a very, very good day. A day where I got to play with my little girls in the morning, then got to read great stuff on the bus, then got to campus in plenty of time to do my Important Things (like this post), and am going to get to class on time, and am going to finish that paper that was due last week and turn it in so that I can ensure an A in my final three-credit class in grad school. (At least this round of grad-school.)

Really, my life is so happy it verges on nausea-inducing cheesiness frequently.

And I wouldn't want it any other way.


Tuesday, February 16, 2010

Medication?

Thinkstock Single Images

After yesterday's posting debacle, I'm taking it a little bit easy today. So, here's an interesting article from 2003 discussing kids with ADHD-I who use smoking as a self medication.

This brings me to an interesting thought. Medication for Josh?

To do or not to do. That is the question.

I've often wondered how I would respond to medication. There have been times when I've been very close to visiting a psychiatrist for this purpose. (My first year of grad school was one of them--I just wanted to find relief.) But the thought of it brings some interesting questions to the forefront, such as:

--would the side-effects of taking medication to pay attention prevent me from engaging in the creative activities I need to do (like writing)? Would I become robotic?
--is taking medication a kind of "giving up"? I've fought for a long time to get where I am, so would I be throwing in the towel?
--what if I love it? Will I feel that I'd squandered years of my life without it?

I realize that these thoughts might seem really lame--it's a topic that makes me a little nervous. But the fact is, I'm really toying with the idea of trying something. I'd just like to know what it feels like. And who knows? Maybe it would be awesome.

Thoughts?

Monday, February 15, 2010

Diagnosis--Do you have the inattentive subtype of ADHD? Part II

Stressed Schoolgirl Taking an Exam

In case you were wondering, it has taken me hours of distraction to write this stupid little post, and I'm not even done yet. This hasn't been fun. This is officially a molasses day. They come and go. This one's here with a vengeance. (It's weird to talk about it in this way--in kind of a public confessional. But whatever. It is what it is.)

I'm tempted to post it as is just to get it over with and get on with my day, but instead, I want to finish. The deal I'm making with myself is that I'm going to keep trying until 1:00pm, and once there, I'm just slapping up whatever I've got.

So, you've taken a gander at part I and feel that the things you've seen might fit for you or someone you know. Now what?

Well, first let's cover the remaining criteria.

Okay, the symptoms that cause impairment need to have been present before seven years of age, right? But that's not all. In addition to that, it's necessary that they be present in two or more settings (e.g. work or school or home.) This prevents somebody from assuming their child had ADHD-I when, in reality, the symptoms are the result of a poor relationship with a teacher, or some other factor not related to inattention. Also, the symptoms need to show clear evidence of "significant clinical impairment" in social, academic or occupational functioning.

What is significant clinical impairment? you ask. Well, that's a really good question, and I think it's probably the most subjective part of diagnosis. Here are a couple of articles about "clinical impairment" that might be helpful.

The role of impairment in making a diagnosis of ADHD
This article makes a case for the symptoms of ADHD-I as being significantly impairing, even if they don't compare in quality to the impairments of other subtypes (see the final portion of the second paragraph).

This article addresses some of the possible changes in the DSM-V regarding the issue of significant clinical impairment.

My take on all of this is the following: if you meet the diagnostic criteria in the different quadrants of functioning, this means that something "not right" is happening. Clearly, you are impaired, otherwise you wouldn't notice a problem. So, I tend to agree with the camp that finds this requirement a little bit redundant, even though I do recognize the importance of what they are trying to accomplish in having included it.

Furthermore, technically one might say that I am not "clinically impaired" because over the course of decades I have come up with coping mechanisms that allow me to conform to mainstream ideals for the most part. Does this mean I am not impaired? No. It means that I have, through years of practice, learned how to compensate for my impairment. And such a view doesn't take into account the many moments in which my defenses fail, and I end up looking like a five-year-old amongst peers and colleagues.

Anyway, the point is (as demonstrated by the first article I shared), significant impairment might simply mean "I want to pay attention as I write a blog post, but I can't." (It's now 2:41, btw. No joke.)

Okay, I'm done. Those are the criteria. Oh, also make sure these symptoms don't actually stem from another disorder whose criteria fit better (like a mood disorder, or an anxiety disorder), and make sure that the symptoms don't occur exclusively during the course of schizophrenia, a pervasive developmental disorder, or a psychotic disorder. (You would be seeing other symptoms that alarmed you besides the ones outlined in these posts were any of these things the case. If you have any specific questions about this, feel free to ask, and I'll do my best to clarify.)

Blah blah blah wrap up tidily blah blah blah.

The end.

Sunday, February 14, 2010

Inspirational quotes for ADHD--Napoleon Hill

Every adversity, every failure, every heartache carries with it the seed of an equal or greater benefit.

--Napoleon Hill

ADHD-I is not an easy thing for anyone to confront. (Neither is depression, or alcoholism, or obesity, or divorce, or grief, or any one of many many potential challenges in life--I definitely don't mean to imply that it's any more or less difficult than any other challenge.) However, I have found the above quote to contain truth.

I can't say that I have fully achieved what I want to achieve in my personal pursuit of organization, calendaring, and punctuality. But I can say that having ADHD-I, and trying day after day to combat its effects, has yielded many positive things in my life. Some of those things are easy to see--college degrees, awards, etc. Others are less apparent, and are more internal.

I haven't gotten to where I want to be. I feel that there is much left for me to do. However, I truly believe that by the end of my life, I will have overcome this stuff. I feel like there is this thing inside me that will not stop until I have mastered this component of my life.

It's why I get up every day desiring to work as hard as I can at the things I do.

It's why I will never stop trying to structure my life in a way that works for me--item by item, little by little, getting things under control.

It's why I write here.

It's why I will never ever stop pursuing my dreams, even the really terrifying ones, until I see them realized--even though the odds are stacked against me, and anybody who knows what having ADHD-I means might say "listen, maybe such and such is not for you..."

I refuse to accept that answer. And the above quote is, at least in part, the reason why.

Have a nice Sunday night, and Happy Valentine's day.


Saturday, February 13, 2010

For what it's worth, it seems to be working

I definitely just squandered some of my writing time before I have to go to work. (I work as a Spanish speaking group facilitator teaching marriage classes based on the research of John Gottman.) However, I'm here now, and I'm doing my thing.

I don't really know how to explain it, but writing this blog seems to be doing something good for me. When I opened it in the first place, I intended for it to be a place to kind of list my daily tasks (perhaps in just unpublished posts) and then try to hold myself accountable to them. But, it immediately became something else, and I'm really glad. Somehow talking about the inattentive subtype in this way--addressing it day by day and defining it and pinning it down and telling my story, knowing people could read it--really has affected my functioning.

This week was particularly good for me. Where I might have been distracted in past weeks and months, somehow focusing on getting a post out there has added an edge of diligence to my life, which has then allowed me to do other things in a more organized way. I don't know if this makes sense to anybody but myself, and have no idea if it will last, but the point is that I'm excited because I really feel like this thing is helping me.

I've been toying with the idea of setting an ambitious little goal for myself. A goal like: write a post every day for an entire year. Would we say that that's little too ambitious? Perhaps. But I'd really like to do something like that, and at the moment I'm filled with hope that I could make that happen.

I think for the moment, I'm going to do something a little more attainable and see how it goes. It's not that I don't want to "think big" or that I don't believe in myself. I think taking smaller bites on the way to something as huge as a year of consistency might be the better way.

So, today marks my seventh post--one week. Let's see if I can do it for a month. One whole calendar month. Every single day. So, March 7th, you are my goal. When I get to you, I will have to find a way to celebrate.

Maybe I'll take a day off.

j/k

Friday, February 12, 2010

Diagnosis--Do you have the inattentive subtype of ADHD? Part I

Audubon Society Sponsors Annual Christmas Bird Count

A'ight. Let's break this thing down.

First off, though, let's just be real. Self-diagnosis is a tricky thing. It's hard to be objective, and everyone experiences a dose of "med school syndrome" at times where any disorder we hear about, we find the parts we can relate to. By the same token, though, if you're like me, self-diagnosis will be an instantaneous revelation, like having your entire childhood and present life summarized in a one page list. To do it the right way, though, you need even more than that. You need to be able to provide substantiating evidence for what you claim, and you need to pay attention to ALL of the criteria, not just the ones that you feel connected to, or that support your hypothesis.

That being said, let's move forward with the actual criteria. First, to have ADHD-I, you need to have six of the following symptoms apply to you (this is actually just one criterion). Now, the DSM doesn't necessarily say this, but I'll just interject that the six that apply shouldn't be "sometimes" or "kind of" or "well, when I'm really tired." These should be absolute truths to who you are as a human being, and should describe you now just as they described you in every year of your life. They are:


1. Often does not give close attention to details or makes careless mistakes in schoolwork, work, or other activities.
2. Often has trouble keeping attention on tasks or play activities.
3. Often does not seem to listen when spoken to directly.
4. Often does not follow instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions).
5. Often has trouble organizing activities.
6. Often avoids, dislikes, or doesn't want to do things that take a lot of mental effort for a long period of time (such as schoolwork or homework).
7. Often loses things needed for tasks and activities (e.g. toys, school assignments, pencils, books, or tools).
8. Is often easily distracted.
9. Is often forgetful in daily activities.


There is a reason that someone with ADHD-I needs to clearly demonstrate six of those behaviors. (Most sub-criteria requirements aren't nearly as rigorous.) It's a tall order, and not a lot of people can legitimately claim to have experienced six or more of those things on a daily basis in a debilitating way since before age seven.

Oh yeah, did you hear that? The next criterion I'll share is that it has to have been happening since before age seven. This is where a lot of people get some clarification. If, as a child, you were really neat and organized and tidy and always did your homework, and didn't lose things, then what's probably happening to you now is not ADHD-I.

This is where I would recommend finding substantiating evidence. A lot of us don't remember life before age seven. Substantiating evidence could be talking to your parents and getting their assessment of what you were like and whether you fit the criteria. That's somewhat weak, but it can serve to bolster one's case. For me, I wanted to be really, really sure I was correct in my diagnosis. So, I actually busted out old report cards and looked at behavior comments. Of course I remember the words teachers said, and the behaviors I exhibited at that age. But there's now no disputing the very obvious running thread I found, documented year after year, of me having the above symptoms.

Sorry, don't mean to make this a cliff-hanger, but I've gotta run to a meeting, so I'm going to do this in two posts. But, you've gotten most of the meat of the DSM diagnosis--definitely enough to sink your teeth into if you suspect you might suffer from ADHD-I. Tomorrow we'll talk about the remaining criteria, as well as any rule-outs that might apply.

May your day be merry and bright.

Thursday, February 11, 2010

Housekeeping

I have pretty much no time before I go to practicum. (Practicum is where we sit and talk about cases in my grad-school program--I graduate in three months.) In fact, let's be honest. I'm going to be late. I'm going to own that.

But it's important to me to get something out there today, even if it's simple.

So, housekeeping.

First, I'm changing the color scheme of the blog because I've heard that it's overwhelming to read the blinding white text against a black backdrop. I'm going to try lessening the intensity of the white first, and then will switch things up more if that doesn't have the desired effect.

Second, this is going to sound needy, and I hesitate to say it, but I'm just throwin' it out there. My poor little posts feel very lonely without comments on them ;-) I've gotten various comments on the facebook links I've posted, and they have all been awesome and very encouraging. Seriously, thanks guys for your feedback. If you have the time and the inclination, feel free to also leave feedback on the blog itself so that it's more permanent, and more conversational. Anyone can post--you can even be anonymous if you want.

Third, I'm not going to have time to upload a picture. Lo siento.

Fourth, I was going to stop doing links on facebook for a while, but I've had numerous people tell me that it's just easier for them to get here that way, so I'ma keep going with that. Feel free to "hide" me if you get tired of my daily postings.

Fifth, I'm officially late. So I've gotta run. Tomorrow I'm going to do my post on the criteria for ADHD-I, so look forward to that. And I also had something interesting happen to me at work (my internship is as a therapist at a local agency), so I may or may not talk about that, too.

All right. Adieu.

Wednesday, February 10, 2010

ADHD Anecdote--My solo

Children Prepare For Central Conservatory of Music Practical Examination


We interrupt this regularly scheduled classroom experience to bring you, instead, a brief anecdote. This anecdote is brought to you by Josh's running late and needing to spit something out there with brevity, Josh's sad, sad collection of past embarrassing ADHD experiences, and the number four (that's right. It's day four. JSW FTW!).

As a caveat, I want to point out that part of what makes these stories so traumatic for someone with ADHD-I is the frequency with which they occur. I'm really hoping that over time, the cumulative effect of these anecdotes will help to demonstrate why this whole thing sucks so much--but just as with any disorder, most people will get a sense of "I've been there before" because they have experienced similar situations (just like, even though you probably don't have clinical depression, you've most likely felt depressed, and even though you probably don't have Generalized Anxiety Disorder, you've probably had a nail-biting, stomach-churning, anxiety-ridden day or two in your life, and even though you don't have Obsessive Compulsive Personality Disorder (qualitatively different than OCD btw), you've most likely caught yourself counting sidewalk cracks or checking "one more time" to see if the car door really locked.)

I look back on my childhood and get the sense that, a lot of the time, I was a space-cadet. This is one example of that.

So, I play the violin. I started at age 10, which is fifth grade. Of course, having my instrument at school when it was time to be taught by the lady that came in to teach us was a ridiculous comedy of errors, but somehow I had it there enough that I was really learning. I couldn't pay attention enough to read music yet, but I had a good ear and high confidence, so when the teacher gave us a new song, I'd say "can you play it for us once?" and then be able to duplicate it well enough that she never realized I couldn't read the notes during the two years she taught us.

By sixth grade, I was one of the strongest players. Possibly the strongest player (I can't remember anymore). This was rewarded by my being invited to play a solo in a concert: it was a one octave D-major scale, but I owned that thing. I was to play my triumphant solo at a concert at another school. Some kind of invitational or something. Not a big deal to anybody but me, I'm sure. But I was excited.

The day of the concert finally came. I felt nervous as I got on the bus, thinking about playing in front of a crowd of non-peers. I always loved bus rides during a school day--watching everything pass in the daylight, wondering what the other kids in my class were having to do while I was away.

When we arrived at our destination, everything was chaotic. The moms that came with us were buzzing around, setting up music stands and the kids were milling around, waiting. My orchestra teacher was very preoccupied setting things up, and I was feeling some sensory over-stimulation, not really understanding the minutiae of what was going on, and not sure what I should do next. Then one of the moms said "all right guys, go ahead and get set up."

That's when the panic hit me like punch in the gut. I had forgotten my violin.

Yes, of course this was an orchestra concert, and of course I wanted nothing more than to have my moment in the spotlight. I wanted to feel the pay-off of the practice I had done at home, and I wanted to show off the songs I had learned. But somehow, for reasons I had no way of comprehending, I had forgotten the one thing I needed to remember. The one thing that was so obvious that nobody would even think to remind me of. And there it sat, in my classroom, by my backpack, while I was there at another school.

I couldn't have felt more stupid. And I had no idea what to do.

I tried talking to my orchestra teacher, but she was no help. She was upset, and deferred me to one of the moms while she figured out how to restructure the program without my little solo. At that point my sole aim was to get a violin. "Is there one here I can play?" I asked.

"I don't think so," the mom sweetly said. "I'm so sorry." I remember being so relieved that she was nice to me.

She invited me to sit with her, and I squirmed in my seat a little as I watched my peers play our concert, wishing I could be playing with them. I don't remember now if somebody else played my solo, or if it just wasn't in the program that day. But I didn't play it. I just had to sit and watch, and then field questions from my peers all about "why didn't you play with us?" and "you forgot your violin?!" on the bus-ride home. I was humiliated.

I wish I could say that I "learned my lesson" and that after that, I never did anything like it again. But the thing that's hard to remember about ADHD-I is that experiences like these aren't cautionary tales. They aren't "lessons." They are symptoms. And just like any other symptom of any other disease or disorder, they will be seen over and over and over again until they are successfully treated.

My ADHD-I never was.

Tuesday, February 9, 2010

The Basics--A class on why it's not "ADD"

General Election - Education
Teacher
:

Okay class, today we're going to talk about a confusing topic--we're going to talk about the different subtypes of ADHD. Take good notes. You'll be expected to turn them in at the end of class for credit.

So, here's the breakdown. ADHD is a disorder with three basic subtypes. First, there's the hyperactive subtype (ADHD-H). Then, there's the inattentive subtype (ADHD-I). Finally, there's a combined subtype where someone has features of both disorders at the same time. (This is probably the suckiest subtype, I would think, and it's abbreviated as ADHD-C).

*Susy raises her hand*

Yes, Susy?

Susy: But teacher, I always thought that ADHD meant someone was hyperactive, and that ADD means the disorder you're writing this blog about--you know, the one without hyperactivity. Isn't that why ADD has no "H"?

Teacher: Great question Susy. Lots of people get confused on this point, and there is a good reason why. It's kind of technical, but it is interesting. Here it goes: the DSM, or the Diagnostic and Statistical Manual of Mental Disorders (don't ask me how they distilled that to three letters), is the manual put out by the American Psychiatric Association that provides diagnostic criteria for (surprise) mental disorders. It's what clinicians use to assess a client and say "hey, your symptoms mean that you have Generalized Anxiety Disorder" or "hey, the reason you can't pay attention in class is because you meet the criteria for one of the subtypes of ADHD" or "hey, your flat affect and strange symptoms mean you have Antisocial Personality Disorder, which basically means you're a sociopath and might kill me without remorse. I am now afraid of you--please get out of my office." (Just kidding about that last one.)

Anyway, Susy, to answer your question, there have been four versions of the DSM since it was created. We are now on the DSM-IV. In this version, the disorder is broken down like I described above (ADHD-H, ADHD-I, and ADHD-C). However, in the DSM-III, the version of the DSM that was used from 1987-1994 (i.e. the time period when a lot of us first heard of this disorder), it was differentiated as ADHD being the equivalent to ADHD-H, and ADD being the equivalent to ADHD-I.

Am I making sense?

Susy: I think so. So, in other words, when I tell somebody who says they have the inattentive subtype of ADHD that what they actually have is ADD, instead of looking knowledgeable, I actually look like I'm stuck in the mid-90's?

Teacher: Well, I suppose so. But it's an easy mistake to make when you haven't actually looked at the DSM-IV breakdown.

*Billy raises his hand*

Yes Billy?

Billy: So what you're saying is that the term "ADD" kind of doesn't even exist anymore? So nobody should be using it to describe any subtype of ADHD?

Teacher: That's right Billy. Except in studies published in journals over 15 years ago, the term won't be found in any research. It is outdated and no longer used by clinicians (unless those clinicians haven't cracked open their DSM-IV in a while.) So, we as the general public should follow their lead and use the correct terminology.

Billy: But it seems like such a large number of people know the disorder as "ADD" that it would be impossible to expect them to change.

Teacher: You make a good point. A lot of people use the blanket term "ADD" to refer to all subtypes of the disorder. In this sense, because it's common parlance, "ADD" might be an acceptable thing to say. But for the purposes of this blog, errr, classroom, I'll probably always refer to it as its specific subtype to avoid confusion and to be more accurate.

Billy: What about when they come out with the DSM-V? What will happen then? What if it's different??

Teacher: Well, Billy, we'll just see what happens when that time comes. The new version of the DSM is slated to appear in 2013, so for at least the next three years you're safe using the terminology described above. It's possible they change it. Heck, I'd love to see ADHD-I taken out of the ADHD family--I feel that it's a totally different disorder worthy of its own title--but we have to work with a common language, and so following whatever the DSM proffers is one's best bet.

Billy: Oh, okay. That makes sense.

Teacher: Any other questions? No? All right, well, everybody go ahead and pass in your notes so you get credit for today's class.

*the class passes in their notes*

Teacher: Hey, wait a minute. Jason, I see I didn't get any notes from you. Did you forget to turn them in?

Jason (sheepishly): Uh, I didn't take any notes...

Teacher: You didn't? Well, then what were you doing during our class discussion?

Jason: Uhhh, I was mapping out the entire blue-print of the giant snow fort I'd build if I were dropped off alone by plane in Antarctica.

Teacher: So you didn't hear anything I was saying, yet you sat pleasantly looking as if you were taking notes?

Jason: I didn't mean to. I'm really sorry... it was a really big snow fort. *Jason bows his head in shame*

Teacher: It's okay! Don't be embarrassed. You've helped us out a lot. You've actually just demonstrated one of the main symptoms of a kid with ADHD-I. Good work, Jason. We'll talk more about your snow fort and what it tells us next time we meet.

Monday, February 8, 2010

Every Day

That's right. That's how often I want to post here.

When I randomly started this thing yesterday, I was looking for a zone of accountability. And maybe of continuity. Somewhere where I could air my woes, and maybe reference a triumph or two. But then, suddenly it all became more personal. I realized I had some stories to share--some memories that are so pathetic that they're almost funny--and other thoughts on this subject that might lead to a project a little bit more meaty. I started to think through the possibilities and got excited.

And then I got scared. Here I want to do this project--a blog about a subject I care a lot about. A blog that will require consistency and flow and stamina if I want it to be what I want it to be. And the subject of the blog is the very reason I might stumble after two entries and never come back if I'm not careful.  The subject makes my success here improbable, if not quite impossible  

The irony made me smile. It reminded me of the time a few years ago when I was teaching 8th grade English and I stumbled upon a support network for moms whose kids have the inattentive subtype of ADHD while looking for teaching resources online. I read the accounts of lost lunch money (again!) and crumpled homework (found in jeans pocket after doing the laundry!) and these moms' devastatingly frustrated desires to see their kids succeed, and I wanted to reach out.  I wanted to say "It's okay.  Your kid can be successful.  I'm proof!"  I opened a comment box and started writing about myself--how I had finished college, how I was a teacher, and was doing well, and being able to make deadlines and keep track of things. How things were different in some ways for me than they were when I was a kid and my poor mom, like them, must have worried if I'd ever make it. Except, while trying to write this simple email, I kept finding myself doing or thinking other things--"coming to" in my brain, and realizing I hadn't finished yet.  I was having trouble slogging through the molasses that encases me whenever I try to get anything done. And then, before finishing the message and pressing send, I somehow lost complete track of what I was doing, and my mind went on to something else. So, it never got sent.   

Later that day, I could only laugh when I realized what had happened.  The former "kid just like theirs" with the inattentive subtype couldn't even finish an email message of hope to these poor moms without getting so distracted that it never got sent, all because of the disorder. 

Shocker.

But, there is some hope!  I am almost done with this post, and I haven't had too rough a time.  It really does seem to be phasic to me at times--the level of distraction I feel.  (Let's just ignore the fact that I lost track of time while writing this post in a very classic ADHD-I way and will now be late getting to an appointment.)

Anyway, all of this is to say that with this blog, I have hopes to be consistent.  I have hopes to go forward.  To be daily.  To not get distracted.  To have this be one thing that I can do every day without fail.

Every morning.  I'm going to write here in the mornings.  First thing.

We'll see how it goes.



Sunday, February 7, 2010

Okay, I admit it. I have ADHD.



All right.  

So, I've had a blog or two in my day.  Some have been public.  Some have been private.  Some have been really personal.  Some have been really superficial.  Some of my writings have attracted thousands of readers.  I have other blogs that literally have never been seen.  Some are old relics of my past.  Others capture the continuity of my life, and I still write in them though they started years ago because I've made friends there and I don't want to lose the community. 

I don't know what I want from this blog except to communicate my feelings about a particular difficulty I face in my life.  I suffer from the inattentive subtype of ADHD.  

I avoid talking about this a lot.  It's embarrassing.  Because ADHD is the disorder du jour of my generation, there is a lot of baggage and assumption when one admits "hey, btw, I have ADHD."  Many people think it's not real.  Many people immediately think of the hyperactive subtype (which, I admit, is a really confusing thing) and assume that it only means that someone is off the walls and can't sit still.  People have little tolerance for this label anymore--they've known somebody who used it as a crutch for bad behavior, or they've known somebody who seemed fine yet claimed to "be ADD."  I cannot begrudge those perceptions, and I understand where they come from.  Before I realized what I was experiencing, I had some of the same misconceptions and biases myself.  

Thankfully, I am a mental health professional.  I know very well what it means when I say the words "I suffer from the inattentive subtype of ADHD."  In fact, I know it so well that I diagnose this in others.  I'm the one that can decide--can mark a client forever with that label, and say "You.  You have ADHD.  Let's work on it together."

The impetus for this post, though, is the urge I have to say that above all else right now, I am tired.  I am tired of trying with all of my might to focus on the things that are important to me, and not being able to.  I'm tired of coming up with schedule upon schedule, with back-up plan upon back-up plan, intended to help me focus and accomplish my goals and be productive, only to have those plans and schedules crumble under the weight of my heavy, heavy inadequacies.  I'm tired of being disappointed in myself.  I don't want to be maudlin, here.  I don't want to portray myself as having low self esteem.  But it is just a fact: when a person wants to do nothing more than learn how to focus, and that goal remains largely unattainable, he feels a level of frustration that is difficult to describe.  The shame--a shame that has made me so embarrassed that I've broken down and wept in public--is not something easy to explain.

And that's why I'm here.  I want to talk about this.  I want to give it a coherent voice, from someone who is living life successfully, but still struggles with this every single day.  And I want to get better.  

I will chronicle my efforts here.