ADHD vs ...me

October 20, 2008 11:09 PM

How can I tell whether I have adult ADHD or I'm just lazy and disorganized? (Do you think ADHD is real?)

I'm a reasonably intelligent female college student. I just started going to therapy (am two sessions in) and my therapist has suggested to me that I may have ADHD without hyperactivity (formerly called ADD). I've already been diagnosed with general anxiety and possibly mild depression (still talking about that). He gave me some websites to look at, and so that's what I've been doing.

The symptoms for ADHD without hyperactivity sounds SO much like me. Disorganized; forgetful; distracted; messy. Anxiety, low self-esteem, a bit passive but pretty sensitive and nice to others. I have trouble keeping a schedule; I'm terrified of responsibility these days; I'm always late or missing appointments or losing my keys or my cell phone. I space out in conversations, and I am terrible with names. I have trouble getting to sleep at night, and I definitely struggle to get through homework assignments. I've been wondering if I have ADD at least since I hit high school, but no one else has really suggested it to me, so I've continually (pondered and) dismissed the idea. I've been reasonably successful in college but only with great amounts of effort and stress that are really getting to me.

The thing is, I'm really embarrassed to talk about this with other people. I'm pretty sure most people would just think I'm coming up with excuses for my shortcomings. Like I just don't try hard enough, like I just have disordered priorities. I'm worried my therapist is just throwing out diagnoses because that's what therapists are paid to do.

So how can I figure out whether I have ADHD (inattentive) or just personality flaws? What's the difference, and how likely is it that my therapist is just on an arbitrary diagnosis spree?

posted by Alligator to health & fitness (21 answers total)

You could always get a second opinion. You could also try the therapy/treatment for adult ADD to see if anything changes over a period of a few months or however long it's supposed to take for things to get back to normal.

As far as your therapist is concerned, I doubt they are on an arbitrary diagnosis spree. They are paid to listen to and diagnose your problem based on the facts and symptoms provided them not to throw out diagnoses willy nilly.
posted by robtf3 at 11:31 PM on October 20, 2008

Therapists are paid to listen to you and make things that should be obvious to you NOT obvious to you. Is your therapist a neuropsychologist? Does he/she have an MD or are they just a certified counselor?

Personally, before accepting a diagnosis of some sort, I would work on a behavior modification plan. A behavior modification plan builds skills in kind of a pyramid (familiar if you've ever planed an RPG) so that they build on top of one another. A behavior, what reaction has been, and what my reaction should be needs to be written down for each line item. For me, my behavior modification plan includes things like:
- Problem: I get anxious about events that are far in the future. I need to reduce my anxiety level. Solution: Don't worry about events that are more than a week in the future, tell yourself "That's far enough away that I don't need to work on it yet."
- Problem: I procrastinate on big projects. Solution: Break things into small, easily digestable chunks and do a small bit every day.

I then keep a diary that includes notes on how often I have to correct myself in a day.
posted by SpecialK at 11:33 PM on October 20, 2008

SpecialK>> My therapist is a clinical psychologist with a Phd who cites 20 years of experience.
posted by Alligator at 11:36 PM on October 20, 2008

How do you handle caffeine? I'm a woman with ADHD, and caffeine drastically increases my concentration for a couple of hours, at least. It also makes me slow down. That paradoxical reaction to caffeine and other stimulants is one of the hallmarks of the disorder.
posted by spinifex23 at 11:55 PM on October 20, 2008 [3 favorites]

You sound a lot like me and I've been diagnosed with it.

Do you find yourself noticing (and being distracted by) things that other people don't? (For example, a funny noise that's just loud enough that it wrecks your ability to concentrate, but when you point it out to people they say something like, "Huh, oh, yeah, I hear that. I guess I was just blocking it out.")

There is a lot of PET scan data out there that argues for real. That being said, real or not is not that same thing as overdiagnosed or not.
posted by Kid Charlemagne at 11:59 PM on October 20, 2008

If your therapist who has experience in this area thinks this is an issue and you have suspected it for years, starting with a general practitioner might be good, particularly if they already have experience working with people with the disorder. If you can be diagnosed there, it will be simple to be treated by her/him also...If it seems more complex to the doc, you can be referred to a psychologist for testing. Another tack might be to go to your school's disability services dept. and ask them if they do screening for learning disabilities or can suggest someone nearby who does.

I don't think people will " just think I'm coming up with excuses for my shortcomings." And if they do, they are uninformed. I think, in fact, you'll find many people are informed and understanding and not judgmental. My daughter has ADHD, and we just see it as a difference, not a flaw...she has learned to advocate for herself to get the help she needs. She has another learning disability also and without her ADHD meds she would not have made it past 9th grade. Please be bold and follow your therapist's instinct and look into a diagnosis and treatment if it is in order. I applaud you for working so hard despite the great difficulties you have faced.

Best!
posted by mumstheword at 1:25 AM on October 21, 2008

In a sense it doesn't matter if you have ADHD and it doesn't even matter if ADHD is real (whatever that would mean). What matters is that you have these problems that are bothering you and you want to look for a solution. Blaming everything on ADHD without looking for a solution to them would be excusing your shortcomings, but it doesn't sound like you're doing that at all.

So whether these are shortcomings you want to address or an illness that you may need medication for, you're going about it the right way - asking questions and taking charge of finding solutions.

My own opinion is that mental health diagnoses aren't something to seek out lightly and psychiatric medication isn't something to take unless you have to. Despite the existence of diagnostic criteria, diagnoses aren't a matter of checking off a list of symptoms - there's a huge amount of personal judgement involved. This means that yeah, one doctor (or therapist) might think you have ADHD and another might not. Or they might be part of the depression and anxiety. There's no definitive test and no sharp line dividing personality flaw from mental illness.

There's definitely nothing wrong with deciding, for now, that you possibly have ADHD and seeking out treatment for the problems you've identified. This would probably be talking therapy of some kind (likely to be CBT). If it doesn't help as much as you'd like, that would be the time to start pursuing a diagnosis (which would then open up medication as a treatment option).
posted by xchmp at 2:16 AM on October 21, 2008 [1 favorite]

Re spinifex23 - 'Paradoxical effect':
Nope, outdated, misleading, and incorrect urban legend. There is no paradoxical effect in stimulants for ADHD.
It's ok, I read that all over the damn place too, and was damn annoyed to find out it's a lie - well, older books were just misintentioned, but I still see it in newer books - more accurate books have just 'left out' that little piece of received wisdom, but I've yet to see one that points out that widely parroted bit of info is untrue.

Basically:
Amphetamines etc are performance & concentration enhancers, for most people, with the same effects ADHD groups (perhaps that should be in quotations), and normal/control groups. That is why the military give amphetamines to fighter pilots in wartime etc. Why students who don't have ADHD use other peoples meds.
Cites here - http://www.hhs.gov/ohrp/panels/jreview01/proref.pdf

And from this http://www.netwellness.org/question.cfm/63684.htm:
2/3 of all people who take a given stimulant will respond well, and 2/3 of the remaining group will respond to a different one.
(not responding well is stuff like getting jittery etc - which means if you've tried an ADHD medication (aka stimulant or stimulant-like) and got jittery, that doesn't rule out 'ADHD'.

So how can I figure out whether I have ADHD (inattentive) or just personality flaws?
You can get a diagnosis of ADHD if you report you have the basic symptoms AND you had them in childhood.
The only things that would rule it out would be other medical or mental conditions that are causing the same effects - so if you're healthy, and can't think of any other personality disorder etc that would cause all the same symptoms (eg your generalised anxiety - but actually, that's easy to get around too, as long as someone decides it's 'co-morbid').

Basically, there's no such thing as 'personality flaws' when it comes to ADHD diagnosis. The definition of the disorder is having that set of symptoms, if you fit those symptoms without other cause, ergo, you have it.

(In the US, anyway - other countries may pay somewhat less lip to the DSM-IV, or at least portions of it).
posted by Elysum at 2:20 AM on October 21, 2008 [2 favorites]

Ooooh, that's ugly.
Sorry... *wince*

Anyway, that was informational - my personal opinion is ADHD is roughly equivalent to defining a 'Muscular Deficit (with/without) Extra Adipose* Disorder' but being a 90 pound weakling in regards to willpower. ;P
That may be regarded as a useful medical definition for many people.
(*Fat)

But, in my snarking, I really didn't clarify that symptoms looking like 'ADHD without Hyperactivity', are alsoregarded as the result of many other disorders - including depression, generalised anxiety, even addiction problems. Trouble paying attention, feeling lethargic and foggy, avoiding thoughts of things that are stressing you and thereby totally losing the plot, etc...

Sorry, this probably hasn't made it any clearer for you, but it's what I've got. Hope you figure it out and come up with something that works for you.
posted by Elysum at 2:41 AM on October 21, 2008 [1 favorite]

Yeah, if it shows up on a PET scan, I'm not sure how much more real it needs to be. It looks like it might have some genetic markers. I'm not sure exactly what "real" means to other people, but that is at least as good as the standards we have for other mental illnesses.

My guess is that you'll see what happens with a lot of mental illnesses: first recognition, then diagnosis, then quack treatments, then overdiagnosis, more quack treatments, and finally it will settle down to something reasonable. Right now, it's at the "just smile harder!" stage, the way depression was some time back. It especially pushes reflexive buttons for industrious Americans, who believe that pure willpower can get them through anything, and that most faults can be attributed to the lack of same.

That having been said, a diagnosis without the use of a CPT or a TOVA (just ask for them) is useless. A questionnaire is not good enough, you want actual machine testing of your attention, with repeatable results, for a true assessment. A good practitioner will hook you up with a psychiatrist and will titrate your medication until you can get the optimum scores you can manage on whichever of those two tests.
posted by adipocere at 2:57 AM on October 21, 2008 [1 favorite]

To build on what xchmp said, I share a number of the same symptoms / challenges that you have. I've been told that I don't have adult ADHD. That's of no consequence to you - follow your own instincts, and the advice above, until you're satisfied one way or another.

But I've found that following the advice for people who do have it has been immensely helpful in building the controls and discipline that I need in a busy self-employed adult family life. This isn't self-diagnosis - it's simply using practical tools that get me the results that I need and want.

So read THIS. Print it out, break it into manageable chunks that you can concentrate on, and highlight all the little strategies that could help you day to day. You might be able to integrate this into your therapy - they're all little behaviour modifications that you could focus on to build better and more productive ways getting everything done.

Building on what Elysium said, I also had mild depression and anxiety when all this came to a head. I worked on those first, and working on all the rest got a whole lot easier afterwards. You might also find it best to focus on the anxiety and depression first, as well.
posted by dowcrag at 5:05 AM on October 21, 2008 [2 favorites]

I lived with someone with (diagnosed) ADD for several years and it was really clear that he had some traits that were absolutely impossible for him to separate from himself that were undermining his life. The example that I heard of the difference between ADD and just being inattentive is that if you had someone with ADD and you held a loaded gun to their head and said (for example) "stay standing in this one place or I'll shoot you" the "neurotupical" person would be able to stay put until they collapsed. The ADD person would at some point eventually forget about the gun, move and suffer the consequences.

Sorry about the graphic metaphor, but it helped me understand my partner more and also the severity of what he was grappling with. He couldn't do simple things like follow a recipe, do the laundry or be somewhere on time, anything that involved a schedule and "counting backwards" to start something at the right time. That said, he graduated from law school but it took every bit of effort both he and I had at the time. He was also embarassed to discuss it with anyone and I always thought he would have had an easier time being more open about it, but anxiety and embarassment about ADD is, ironically, a trait of people with ADD so keep that in mind.

So, as far as suggestions, the classic book about this is Driven To Distraction and it's available just about anywhere. It makes a good case that the traits that come along with ADD are a mixed bag, some good and some not so good -- my ex was one of the sweetest good natured people I have ever met, for example -- and is a positive look at maximizing the good and trying to constructively grapple with the bad. I also found help via the CHADD forums, a lot of good talk there. At some level there will always be people who say that ADD isn't real but if the treatments for ADD actually help you manage your life and get a grip on your anxiety/depression/other sysmptoms, it doesn't much matter at all. Best of luck.
posted by jessamyn at 5:58 AM on October 21, 2008

Is there any way you can be clinically tested for ADHD? I thought I had it and went through a half day's worth of tests with a psychologist, only to be told that my problem was severe generalized anxiety disorder.

Honestly, your list of symptoms could mirror mine when I thought I had it, but they can all also be symptoms of anxiety and/or depression.
posted by sugarfish at 6:21 AM on October 21, 2008

You sound anxious (maybe depressed) to me, personally.

I would say that ADD is a real thing, but rather unimportant in the large scheme; there are many professions and parts of life in which being scattered is mildly useful. (This is of course based on my own experience and not meant to diminish any issues other people have with ADD or ADHD--it's a very personal thing.) If i were you I'd focus on the anxiety first, and then figure out if you even have ADD/ADHD, and if it requires therapy or any medical intervention.
posted by shownomercy at 6:30 AM on October 21, 2008

I've been diagnosed with ADHD (inattentive) and I take stimulant medication for it. (I also did all kinds of therapy in school to help with my executive functioning, which was equally as helpful.)

I can't tell you if ADHD is "real" or not or speak to your therapist's qualifications, but I went through all kinds of testing--like, several days worth--looking for learning disabilities when I was diagnosed. (One such test--that I failed spectacularly--involved hitting the spacebar on a computer whenever a certain word came up, and another involving reading either a word or the color it was written in off of an index card.) It also involved taking questionnaires and talking to my parents and teachers. I'm not saying you do or don't have ADHD, but "Adult ADHD" is not ADHD that suddenly appears in adulthood. It's totally possible to have ADHD your whole life and not be diagnosed until you're an adult; there are many who argue that it's under-diagnosed in girls in particular (I was 16 and flunking out of high school before I was diagnosed).

Whether or not you decided to seek treatment is up to you. The medication I take makes it possible for me to have conversations with other people in public places, where before it was extraordinarily hard for me to filter out background noise. I can sit through a movie longer than 45 minutes and follow the plot. It doesn't, however, do my homework for me or make me an incredibly organized person. It just allows me to make the same kind of concentrated effort that other people can without thinking about it.
posted by cosmic osmo at 6:43 AM on October 21, 2008 [1 favorite]

ADHD is real, but it probably is over diagnosed as well.

One of the important critera of ADHD is whether the effects were present in childhood. With most adults over 25 or 30, ADHD wasn't really well understood when we were children. People who were typical hyperactive cases might have been diagnosed, but the Inattentive subtype almost always wasn't. So we grew up believing that we had failed somehow, that if we simply just tried harder, we would be successful. But in reality, the Inattentive subtype is just like the Hyperactive one, except that the "hyperactivity" manifests itself in the mind instead of the body.

My belief in regards to the so called "paradoxical effect" is that if you compare the effects of amphetamine in people with the disorder and without, the people with the disorder are able to concentrate and perform effectively, where the people without the disorder start to get distractible and figety. They both are equally affected by the organic stimulant side effects.

Just like someone suffering from say, anxiety, versus someone not. Give them both valium and they will both slow down. The "normal" person will slow down below their effectiveness, the anxious person will slow down to their effectiveness.
posted by gjc at 6:52 AM on October 21, 2008

Yes, it is very real. My experience with him has been similar to what jessamyn described with her ex. He spent years castigating himself (and being castigated by others) for being lazy, stupid, etc. He got a diagnosis and was prescribed medication, and the difference in him is immediately apparent.

Someone who puts forth a great amount of effort to succeed in college is, by definition, NOT lazy.

I can be disorganized and messy and occasionally forgetful, but I don't have ADHD. The difference is, as I see it, that it's a choice for me. I don't have to be messy; I can keep my things organized and tidy if I want to. It's not a herculean effort. I just let other things (like metafilter!) have higher priority. It's not a choice for my husband; he feels like he's climbing a mountain each time he cleans the bedroom. I'm far lazier than he is; he's always doing something, just not necessarily what he's "supposed" to be doing. He's also got freakishly good long-term memory (he can discuss in detail things he learned 10 years ago) but he loses his [keys/cell phone/wallet/glasses] on almost a daily basis.

The medication has made so much difference, though, because it's allowed him the mental space to begin to form good habits. The keys/wallet/phone/glasses go in the same place every day (theoretically) so he's less likely to lose them. He uses a smartphone that syncs with his Outlook calendar and has reminders for everything, including walking the dogs and spending time with me. There are lots of coping tactics, and the medication, from what I've observed, helps them to "stick." Plus it honestly just makes him easier to be around, because he can be fully present to our conversation, and not go off on a tangent.
posted by desjardins at 9:48 AM on October 21, 2008 [1 favorite]

Try self-medicating by drinking more coffee for a week or so; many ppl with ADD or ADHD find caffeine helps them focus. If it works, problem solved!

(Data point: I believe ADD and ADHD exist; I know people whose difficulty in focussing goes far beyond anything anyone would consider "normal", despite obvious ntelligence and talent.)
posted by pseudostrabismus at 10:20 AM on October 21, 2008

Elysum,

It's OK. Thanks for the updated information. I just mentioned it because that's one of the signs my doctor looked for when he diagnosed me. But, ADHD isn't his specialty (he's a general Psychiatrist), and he may have been using outdated info as well. Sorry for the potentially misleading answer.
posted by spinifex23 at 10:29 AM on October 21, 2008

gjc:
From what I've read, and seen myself - It really does have the same effects on ADHD populations, and non-ADHD populations. Giving it to non-ADHD people will also make them focus better (And lo, why 'speed-like' drugs tend to be the favoured choice in both play & work for stock brokers etc).
For 1/3 of both groups, it may not work or have negative side effects.

Re: PET scans, and iffyness thereof
The length of time you've been a London taxi driver can also cause brain changes which show up on MRI's etc - http://www.theness.com/neurologicablog/?p=375
So, is it a chicken or egg scenario?
Averaged 'between-group' differences for ADHD are being (predictably) found, general 'sluggishness' in frontal cortex etc, but it is generally not recommended as a suitable tool for diagnosis.
(That could just be health organisations, groups of medical professionals being staid etc, but I do pretty much only ever hear of the Amen Clinic using them).

I do recommend, not just if you think you have ADHD, but for anyone who has suffered mental conditions like depression, anxiety, and is struggling with concentration and work-habits, or even just keeping up with standard time management approaches, to look at organizational resources aimed at people with ADHD.
These books have tips that may actually be workable, and on level for what you/we can cope with:
eg http://www.amazon.com/ADD-Friendly-Ways-Organize-Your-Life/dp/1583913580/
posted by Elysum at 1:29 PM on October 21, 2008

I have the Inattentive type myself (formal diagnosis and all) and would NOT recommend trying to self-medicate with coffee or anything else. If you are really adventurous, you can use it as an informal litmus test to see what your reaction is. Even that's kinda sketchy though.

I concur with everyone else that if you've been wondering since at least high school, you probably have it. Your description of yourself reminds me a lot of my own experience. I've always been the quiet smart girl who was always late and underperformed. The intention was there, but somehow it never quite happened for me. Unless you damn near staple something to me, I'll probably lose track of it within seconds of picking it up. Then I'll find it months later under a pile of stuff while looking for something else. If you want me to remember a particular piece of information (birthdays, appointments, contact info, etc), make sure I write it down before you walk away. Because it will probably be forgotten as soon as you do.

This doesn't happen because I don't care. I feel awful when I'm reminded of it later. I won't get into all the lost time I have going on with the various distractions when I could be doing something more productive.

Medicine-wise, I've had much success with Ritalin. My psychiatrist doesn't think the long-release form will work, so I'm on a 3-dose schedule. The third dose (taken at about 5 or 6 pm) is optional. This helps me out if I have a late class that runs until about 10 or I need to stay up until about that time on off days to do homework.

Behaviour-wise, I try to consolidate as much as possible. My iPhone takes care of dealing with schedules and contacts. I have MobileMe activated as well, which eliminates the need to plug it in to my computer for every little update to my schedule or contacts. I also usually keep short notes and lists on the iPhone. For everything else, I have my little Moleskine that I keep in my bag at all times.

It all falls down, of course, when we get to my wallet. I tend to keep only enough cash to get me through the week and the credit/ATM cards I use the most in whichever pair of pants I'm using that day. This has worked mainly because it's now a ritual for me to just transfer them every morning. It beats the days that I decide I won't need my bag for that quick errand and end up with no money if I need it.

I'd go back to your therapist and see if you can get a letter to take to your school's disabilites coordinator so you can get whatever help available from them. This could help a lot when it comes to relieving some of the stress of it all. The support group suggestions are also good. You can also feel free to get in touch with me if you feel so inclined.

Good luck!
posted by arishaun at 2:09 PM on October 21, 2008 [1 favorite]