I think I have ADHD

August 24, 2009 5:41 AM

I think I may have adult ADHD. Help me make the most of my visit to a doctor.

I think I have inattentive-type ADHD. I have a doctor's appointment in a few days to talk about it, and I'd like to go with as much preparation as possible so I can focus on what's relevant. My experience with doctors has been that they best help those who work really hard at being helped, so I would like to know: what should I talk about to have the best chance of a useful diagnosis? (be it ADHD, all okay, or something completely different.)

My main problem is sleepiness. I get into a meeting at work and within ten minutes my mind starts wandering and it becomes physically impossible to keep my eyes open. Then I start hallucinating. It's not sleep deprivation or general tiredness - I can be completely alert one moment but as soon as I'm in a situation where I'm relaxed and not completely mentally engaged, my attention drifts uncontrollably into a sort of meditative trance state and I'm gone. It was the same at school and uni.

I've been tested for sleep apnoea and narcolepsy, but no. I've tried everything I can think of: sleeping lots, not sleeping so much, caffeine, exercise, eating, not eating, exclusion diets, sitting facing the sun, heat, cold etc etc but nothing works. I used to think that the sleepiness thing was inconsistent with ADHD, but I recently heard that a friend of a friend had problems very similar to mine and was cured completely when medicated for ADHD. And I'm willing to try most things.

Other details:
I have basically no memory. I can keep logical structures (things like computer programs) in my mind, but facts disappear as soon as my attention wanders away from them for a moment. Things like people's names, where I left the keys, what I just walked for a quarter of an hour to the supermarket to buy vanish instantly. I deal with this by leaving sticky notes lying around everywhere, but this isn't ideal.

I've never been able to concentrate. At school and uni I never did any work, but managed to cruise through on luck and the small amount of cramming that I could handle. At work I find myself constantly distracted. When I'm not falling asleep, I'm finding it almost impossible to stay sitting in my chair. The Internet is a curse. Somehow I've managed to cruise through this as well, but it's getting worse and it's going to cause real problems for me one day. Actually I'm surprised I've gotten away with it so far. Despite all of that, though, I do have pretty decent videogame skills.

I was horribly hyperactive as a child. Really unmanageable. I would run around screaming, bite other children, plough into my teacher's legs with my fists. I calmed down a lot at about 6 but was still kind of ratty for a few years after that.

I can't drive. I mean, I can operate a car and steer it down an empty street, but as soon as there are a few other vehicles on the road my brain gets overloaded with information and I pretty much rely on luck to avoid hitting things. I wrote off my first car when I was 19 and almost killed myself.

In fact any kind of multi-tasking is right out. I can't do anything productive if there's music on, for example - the music steals enough of my attention that there isn't any left to do anything useful with.

So.
So far, everything in my Internet Doctor self-wikidiagnosis seems to fit with inattentive-type ADHD. But I'm worried about one of the diagnostic criteria, which is clinically significant problems in two areas of life. Despite my issues with sleepiness and distraction, I managed to do okay at uni and I've never been fired from a job. I think I hide my problems pretty well. But there does seem to be something wrong with me, even if it's not ADHD. Most people can drive a car, for example, and although I can deal with the distraction thing to some extent with self-control, I can't stop myself falling asleep.

Damn, that's long. Sorry. A few quick details: 30 years old, male, Australian, no other relevant health problems. I have read this and this.

Any help would be great, thanks.

posted by A Thousand Baited Hooks to health & fitness (8 answers total)

I was diagnosed a few months ago with ADHD and they put me on Ritalin. It will make an enormous difference in your life, trust me on this. A lot of what you describe I have gone through prior to diagnosis.

What you need to concentrate on with your doctor is being as specific as possible about these instances in your life. More than likely if you're going to a PCP, they'll refer you to a specialist for the actual prescriptions. So be prepared to make more than one visit over this issue.

I can't stress enough how important it is for you to see someone. You will notice an immediate change, at least I did. A lot of what you're going through now will go away with the proper meds, and you'll be amazed at how different your world will become.

But to stay on topic here - be as specific as you can about everything you've posted here, and be prepared for visits to a specialist. Also - there most likely will be a trial-and-error period while you, your body and your specialist get used to the meds. Pay attention to how your body feels after you've been given a scrip, because it's quite possible some adjustments will happen until you get to a stable place.

Good luck, though - there is help and you're spot on for getting in to see someone.
posted by Lipstick Thespian at 6:25 AM on August 24, 2009

Absolutely insist on the use of a CPT (Continuous Performance Test) or a TOVA (Test Of Variables of Attention) in titrating your medication to an appropriate level. Basically, these computerized tests (rather than personal inventories, questionnaires, etc.) test your attention (which has multiple dimensions to it) in an abstract manner.

By adjusting the type, amount, and release pattern of your medication in conjunction with these tests, you can find the best bang for your buck. Too little medication and you're not helped. Too much and you have side effects. These tests can help you find the top of that inverted-U curve and stay there.
posted by adipocere at 6:34 AM on August 24, 2009

My PCP was no good at doing any of this.

It was *only* once I actually saw a psychiatrist that is was given any real attention. If you're going to a PCP, it might just be best to ask for a referral straight off to a specialist.

The trial-and-error aspect is important: the first drug I took had an immediate positive effect, but nasty side-effects that built up during the third week. The second drug has the same positive effects but without the same side-effects. I have also had to learn how food, exercise, etc. alter the release of the drug.

But my life has been revolutionized.
posted by blue_wardrobe at 6:48 AM on August 24, 2009

...oh, and sorry to get off track (doesn't seem like my morning dose kicked in yet!), but sleepiness was a major issue for me too, somewhat similar to what you describe, with what I describe as 'waking dreams' during meetings, etc. and almost narcoleptic tendency to drop off to sleep in the late afternoon and early evening.

All now gone.
posted by blue_wardrobe at 6:50 AM on August 24, 2009

1. Definitely go right to a psychiatrist who has experience dealing with adult ADD. Any doctor who doesn't will likely have misperceptions or incorrect information about how to treat your symptoms.

2. Read this.
posted by Citrus at 7:48 AM on August 24, 2009 [1 favorite]

Yes, a psychiatrist who has experience is good. Very, very, good. If you can get a referral to one that's what I'd aim for. I have had no luck with primary care doctors.

Keep emphasizing that it is affecting your life and you need a solution. Don't be rude, but make sure that the doctor doesn't brush you off with "it doesn't sound that bad" or "you did okay in school" or "get more sleep".

You sound like you have identical symptoms to me, by the way, I don't drive either. That in and of itself has a huge impact on more than one dimension of my life. Less so now that I live in NYC.

You don't mention your social life--how are you doing making and keeping friends? Losing touch with people because you forget to call them back? Piss anyone off lately by forgetting their birthday or that they got laid off? Forget to go to a metafilter meetup (heh)? Start to drift off in the middle of a conversation?

I think a lot of ADHD diagnosis and treatment is focused on work and school, but your social life can be affected too. Maybe that's the other dimension you're looking for.
posted by kathrineg at 9:52 AM on August 24, 2009

My social life is okay, although it certainly suffers from my general issues with procrastination and forgetfulness. I'll try to think of some examples I can take to the doctor (and to a follow-up with a psychiatrist, which sounds like it will be inevitable). Thanks for the answers, everyone! It's good to know that there might be a solution out there.
posted by A Thousand Baited Hooks at 2:26 PM on August 24, 2009

Good luck, glad we could help.
posted by kathrineg at 2:28 PM on August 24, 2009