Measuring improvement in ADHD symptoms

July 6, 2009 1:52 PM

I have begun treatment for adult ADHD. What things can I do during the next several weeks to objectively measure my progress?

I've started taking Strattera, which often takes up to six weeks after reaching one's target dose to see significant results. My doctor suggested keeping a daily journal in which I record how I feel about my focus, concentration, forgetfulness and so forth.

I am doing this, but I feel the need for some strategies to measure my progress in a quantifiable way, if such a thing is even feasible. Since my attention frequently wanders, I can track discrete events like "remembered to take the trash out this week" but have trouble keeping track of things like "worked for 30 minutes without fidgeting or getting up from desk."

Any and all suggestions are welcome. The other ADHD threads have some great ideas, but they seem focus on tips for dealing with symptoms rather than measuring the effects of those symptoms on a daily basis.

Possibly relevant details:

- I'm 30 years old
- I've had the usual ADHD symptoms my entire life but have never been treated before now
- I work from home at a job done entirely by computer
- My primary goal right now is to finish my CS degree when I return to school this fall (I dropped out due to my inability to study effectively)
- I use a Windows PC, if there are software recommendations
- My wife is willing to assist with any strategies that work better with the aid of another person

Thanks in advance!

posted by [user was fined for this post] to health & fitness (7 answers total)

roughly the same story here, different age, treated longer than that. buy a timer, to see how long you can stay focused before getting distracted again.

I'm taking Concerta myself so I'm not an expert for your round-the-clock Strattera.
posted by Baud at 1:59 PM on July 6, 2009

I work from home, too, and the lack of structure an office might impose had me seeking medication for ADHD. I'm one of the "primarily inattentive" types, so I don't have much insight into what it's like for people with the more physical symptoms. Anyhow, I kept a journal twice a day:

Morning entries were for the day's game plan: I'd write a rough todo list that helped me get a sense of what it was important to accomplish above all else, and I'd include notes about things that represented bad attentional triggers and how I planned to deal with them. For instance:

I edit for web publications, so one of my triggers proved to be Ruby hacking. I'd come across some odd piece of idiosyncratic HTML from one of my authors, or I'd stumble upon some task that would benefit from automation, and I'd get lost in hacking up something to make it all better. Three hours later, the morning's gone and I know a ton more about some HTML scraping library or how to code up a quick Twitter bot, but nothing's actually gotten done. So I'd note in my journal that no matter how badly something cried out for a bit of scripting, I'd aim to not succumb to the temptation to do that until a given point in the day.

The morning journal entry would also include a copy and paste of that particular weekday's "first things" list. Every day has some hard deadlines unique to it: This site's newsletter, that site's weekly review, reports for the boss, etc. So those things got put in the "first things" list, to be done before anything.

The morning journal also documented any attentional aids I was trying out--egg timers and assorted digital variations on them, for instance--and how I planned to use them.

Once the morning journal was done, I'd start working, checking things off the list as I went and pausing at noon to reflect on the morning. Then I'd jump back in. At the end of the work day, I'd make a few notes, then write a longer reflective entry before bed. I'd go over where I'd done well, where I hadn't done well, and I'd make sure to capture anything I thought of that belonged in the next morning's entry.

It really helped me to keep everything in that journal form, including todo lists. The thing I noticed most during the time I was using medication to control my ADHD was that reminding myself of the condition went a long way to letting the medication help. Having the journal entry open for consultation during the day kept helped keep me aware of the context that made the journal necessary.

It sounds like you'd prefer something more quantifiable, but since fiddling with things that provide close quantifiability is one of my attentional escape hatches, I found the journal helpful on two levels:

First, it offered very little to fiddle with.

Second, it helped give me an insight into how I perceived time. The journal represented an investment in a future self I'd never really considered very carefully before I started writing him notes each morning and night. The journal helped me think about that future self. That was something of a breakthrough, because as much as I'd learned over the years to control my more severe flights of impulsivity--the kinds of things where consequences arrive in the span of minutes or hours, a month at the most--I'd never really figured out why I couldn't handle the stuff that involved consequences that arrived in a year, or five years.

The journal also connected me to a past self. I wrote to myself in the second person, so going back and re-reading entries had a very personal edge to it, as if to say "this is you from last night, really hoping you don't screw this up" instead of my usual dealings with a "me" that never really managed to escape a continuously unfolding present of failure and frustration.

If I'd spent my time documenting my progress in a more checklist-y way, I don't know if I would have managed to connect something I thought of as a problem with short-term behavior to something with much more life-altering ramifications.
posted by mph at 2:52 PM on July 6, 2009 [7 favorites]

You need IEP goals!

Would setting a schedule work? You'll be at your desk, breakfasted and caffeinated, by 9:00 am. You won't read Metafilter until your scheduled break at 10:30 am, and you'll be back to work by 10:45 am. That sort of thing. You try to stick to it, and keep track of if you do or not.
posted by The corpse in the library at 5:18 PM on July 6, 2009

That's inspiring, mph. Clearly I have underestimated the potential of the journal, and you've laid it out very clearly. I like the technique of writing in second person as well. Many thanks.

As for timers, schedules, checklists and so forth, I've tried many of these (sans-meds) in the past and never been able to use them consistently. Either I forget to set them up regularly in the first place or my attention fails to catch hold when they prompt me. The goal with the medication is not so much to become Super FocusMan as it is to reach a point where I can use these things effectively to arrange my life and start working toward longer-term plans.
posted by [user was fined for this post] at 8:55 AM on July 8, 2009

My wife is willing to assist with any strategies that work better with the aid of another person

I'm married to a guy with ADHD (who's on Concerta). I notice the difference more acutely than he does. Mainly, he does what I ask him to do around the house (he'd forget or get distracted before) and he's less sensitive/overreactive to everyday disagreements. Ask your wife for a progress report each week.

Also, WHY did you seek treatment? Was there something specific that prompted you? How did it impact your life? Has that specific impact been mitigated?
posted by desjardins at 8:53 AM on July 9, 2009 [1 favorite]

You might also want to use some standardized neuropsychological test of attention like the d2 test. For a brief overview on different tests, see the following book.
posted by jfricke at 6:11 AM on July 26, 2009

Belated follow-up: Strattera had undesirable effects on my energy levels and mood that did not abate over time, so my doc switched me to Vyvanse. We're still working out the optimal dosage, but my wife and I noticed improvement in focus and forgetfulness almost immediately. (Someone was kind enough to send me a MeFi Mail sharing a similar experience, which I really appreciate.) I'm still doing the journaling and finding it very useful.

Desjardins, thanks for your comment, and also for the many insights you've shared in other ADHD-related posts. My wife has indeed noted improvement in my ability to remember household chores and other tasks, which was part of my motivation for seeking treatment. The other part is that I'm going back to school this fall, which I've tried and failed more than once before; it's too soon to tell how that will go, but I'm optimistic.

Thanks again to everyone for your thoughts and suggestions.
posted by [user was fined for this post] at 8:35 AM on August 7, 2009