ADHD diagnosis: not an end, but a beginning
October 9, 2010 12:26 PM   Subscribe

How did you react just after you were diagnosed with adult ADD/ADHD? MUCH more inside.

I'm female, 40s, and in my adult life I've been employed as university faculty and administrative staff. Parents/teachers/therapists missed my ADHD (inattentive type) because my general academic success, good memory, and co-morbid anxiety covered it up. Also I self-medicated with nicotine for many years. A lot of my problems showed up about 5 years ago after I kicked cigarettes and then nicotine gum for good. I was diagnosed about two weeks ago.

My special snowflake symptoms are the following: being unable to get started on a task, project, or piece of writing. Sometimes I am unable to take up something I've already begun. It's like being a car engine with a faulty starter. The problem is beyond simple procrastination--sometimes when I'm under the gun I can get moving, but occasionally not even then, and of course a big mess results, bureaucratic or otherwise.

I can sometimes get going on a project for a while but then I get what feels like a brick in the brain . . . I can't organize my thoughts any further in order to finish what I began. I feel like I'm exploring the jungle, but I was never issued my machete.

I'm ABD (and will stay that way) and am now struggling with writing a book that means much more to me than my dissertation ever could have.

After initial relief at identifying the problem behind the underachieving, frequent sensory overload, and epic procrastination, I'm feeling kind of scared and freaky. Like: can I really, finally, get some important things done? Work up to my potential?

FYI, my anxiety has been treated successfully with an SSRI.

Complication: I've got an Adderall prescription, but my doctor said to get my blood pressure down before trying it, and tweaked my BP meds. So far, so good, but it may be a little longer before I can try the Adderall.

My question: I'd like to hear from other adults diagnosed with ADD. How did you feel at zero hour--after you were diagnosed but before anything really changed for the better? Maybe I'm in the grieving stage or something, I don't know.

And if anybody out there is a writer with ADHD, what's helped you be productive? What helps you apply ass to chair and get it done? If you find yourself upside down in a net of sentences that resist organization, how do you find your way out? (BTW I have Scrivener, and love it.)

And if you've read this far, thanks.
posted by sister nunchaku of love and mercy to Health & Fitness (22 answers total) 20 users marked this as a favorite
"A-ha! I knew it!"
posted by Sys Rq at 12:50 PM on October 9, 2010 [1 favorite]

Sys Rq: ""A-ha! I knew it!""

posted by dzaz at 1:08 PM on October 9, 2010

Writer with ADHD, here, and the only thing that works for me is deadlines.
posted by The corpse in the library at 1:19 PM on October 9, 2010

Pretty much what Sys Rq said, as well as an immense sense of relief.
posted by spinifex23 at 1:42 PM on October 9, 2010

I also recommend reading Driven to Distraction.
posted by Phredward at 1:58 PM on October 9, 2010 [2 favorites]

I'd suspected it for years so the diagnosis was no surprise, but the feeling I had the first time I took Adderall was one of absolute relief.

I still have problems taking projects to completion, and not starting one project before another one is finished. But it's nowhere near as bad as it used to be, and the important shit always gets done.
posted by elsietheeel at 1:59 PM on October 9, 2010 [1 favorite]

I'm still figuring out what works for me. While I'm relieved that there's an answer to this vague malaise that's plagued me for so long (also Inattentive), there's no magic cure, and do sometimes resent the fact that I'm essentially fightng myself. So amidst the relief, some melancholy and frustration. You're not alone.
posted by canine epigram at 2:09 PM on October 9, 2010

I had known all my life that something was wrong with me. Terrible family life and being excused early from middle school class every Wednesday to take a taxi to a psychogist for depression certainly confirmed that I was defective, in my mind.

Adulthood crept in, and June (or maybe July) of last year saw me in my psychiatrists office, explaining that I thought I needed to take half my ssri dose in the morning and then the other half at lunch time. Because when I woke up in the morning and took my meds, I didn't loathe myself. But around lunchtime, I looked around meat all of the things I wanted, no, desperately needed, to accomplish? I wanted to crawl into a hole and die.

So my doctor listened patiently while I told about all the things I wasn't doing, how I'd always been too depressed to get things done, but now that the depression was lifting I could see that I can do things, except I wasn't doing them. If I was happier, I'd be more motivated.

This all made sense in my mind at the time.

He askede a lot of questions about my childhood - not about how other people had treated me, we'd gone over the trauma stuff thoroughly. He seemed to be askingnhow I had treated myself. Never able to clean/keep clean a space, constantly missing the school bus, decades of lost homework made up for by stellar exam scores, removed from gifted program due to lack of ambition, &, &, &.

So before the dx, I was feeling desperate and ashamed. Why couldn't I be a happier person inside? Hesaid, 'I thought this when you first came in, but this is a diagnosis we don't take lightly here, so I needed to be sure before I said it. Based on your reaction to the ssri and what you're telling me about how you've always reacted to certain situations, I think you have ADD.'

And you know what I said?

'That's not possible. I read books.'

So, denial. Coupled with not understanding what I was being told. He asked me, 'have you ever read a book in one sitting?' and I snorted. I snorted at my shrink! And I said, 'duh, I've always been a total dork. Even when I can't get up and tale a shower, I can still read all day.'

AND, we had a winner right there.

I left the office feeling a lot of things. Relief. Fear. Shame. Determination. Anger. Lots of anger - how had everyoneissed this? The short answer? I'd always had bigger emotional fish to fry. I had survived extraordinary things.

It's been more than a year and I'm still not pulled together. But I got a full time job after 18 months of looking and I've strengthened and clarified my coping skills. I'm not fearful any more.
posted by bilabial at 2:53 PM on October 9, 2010 [9 favorites]

I was so relieved. I had a ton of coping skills, and I could hyperfocus, but I had a lot of trouble with maps, directions, instructions and finishing projects. I was thrilled to tiny bits to learn I wasn't bad or mad.

Cut a pill in half and try it out. You won't have a heart attack. For me, the Adderall would trump BP pills. I write, in addition to other work, and the meds help me to sit down, look at my notes, and GET ON WITH IT. I don't "just love" to write, but I love to have written. Adderall keeps me focused and I can block out the dog's noise, the music next door, etc.

And in your 40s? You don't want to go through menopause w/o Adderall. Estro-brain fog is no fun. Adderall beats HRT.
posted by Ideefixe at 3:03 PM on October 9, 2010

I am just going to go down this road, and I plan on SysRq'ing myself, at least I hope so. I can see where some scariness would come into it, I mean, like Ideefixe just above, I've spent the lion's share of my life like this and I'm gonna have to unlearn a lot of crap, including being used to failure. There's a whole world out there beyond actually finishing stuff (for my example), and that is a great unknown.
posted by rhizome at 3:11 PM on October 9, 2010

What works for me on projects that involve a long stretch of effort is to

1. Involve other people. if you're writing a book, have someone who you meet with regularly ("once a week, wednesdays, at this coffee shop/office/etc") to review work you did that week. A colleague, someone who's qualified in some way to help you and knows what you're trying to do. I can easily let myself down, but I am an anxious person too, and I never want to let another person down or waste their time. The work gets done.

2. Also have someone who is more of a cheerleader friend. Someone who's into what you are trying to accomplish that you can send pages, ideas, etc. that you are (and sometimes were) excited about and get an encouraging response from. This person doesn't have to be as qualified as the first, just someone who you can share your genuine excitement with. You'd be surprised how that gets you diving right back into your work.

3. Anxiety is a huge thing. I think read it in DTD (linked above) but there's a process in ADD brains of "scanning the horizon" for potential threats/things to worry about with no sense of proportion. If all is good, your anxious brain is working overtime to find something to be anxious about. Knowing that this is happening is sometimes helpful when your brain finally finds something to worry about and tries to trump up the urgency of it. Start to notice when you're "scanning the horizon" in the back of your mind and take a few breaths. It's absolutely natural, and more common than you think, for nothing to be wrong.

4. Writing your thoughts down without judgement and editing is extremely important. If your thoughts are disorganized, get them down anyway. You can always organize them later. Take time to alternate between organized and unorganized writing, and allow for both. They're both really useful, whether you're writing academic, non-fiction, or fiction work. Just get it down. You can always come back to it.

5. Have a certain, regular time scheduled for ass-in-seat writing and keep your ass in your seat for that specific time, so that when you're deep into a movie and a bottle of wine later that night, you don't have any nagging disappointment ruining the enjoyment of your wholly appropriate down time. In fact, you'll feel pretty good because you wrote for the time you allotted. It always feels great to tick a box. Keeping my ass in my seat is a hard thing to do sometimes. The only thing I can say is ride out the initial urge to do something else. If you make it past that, you're home free.

6. I have a tendency to minimize my accomplishments and inflate what I have yet to do. Try to push the trend in the opposite direction. You've done a lot to figure yourself out at the very least, which is a gargantuan accomplishment in its own right. It gets easier when you don't look ahead and flip out about everything left to do, but keep tasks specific and manageable.

I've heard it said that "Worry is just the misuse of an imagination" and after years of worrying, I'm starting to understand that. I hope this is useful in some way.
posted by ambulance blues at 3:36 PM on October 9, 2010 [5 favorites]

I was very happy to finally have a context in which to understand myself, my motivations, and my actions. Just being diagnosed was 50% of a cure, for me.

From there, I have spent a few years learning organizational techniques and other work-arounds to help me function better in society despite the ADHD. I haven't perfected this yet, but I can look at each year of my life and point out significant improvement -- as long as I am improving, I am happy.

The only medication that has helped me is Adderall, and it is a huge help. You should indeed be wary of it if you have known cardiovascular issues, though -- listen to your doctor and let them monitor your progress closely.

Best of luck!
posted by teatime at 4:23 PM on October 9, 2010 [1 favorite]

I was glad to find out I had something treatable. My doctor prescribed Dexedrine, and it worked for me, but it was a huge hassle. I could only get 30 days worth at a time, and I had to have a written prescription every time, no refills, and if my doctor was going out of town I had to plan ahead. I ended up not using it on the weekends so I could save up for emergencies.
posted by Bruce H. at 4:29 PM on October 9, 2010

Really? I must have lucked out. I get Adderall from my mail order pharmacy; a 90 day supply at a time. The only hassles are having to go to my MDs office to pick up the prescription, mailing it in, and signing for the package.

Although every time it happens I'm amazed that they're sending me 2000 mgs of amphetamines IN THE MAIL.
posted by elsietheeel at 4:49 PM on October 9, 2010

I am about to start getting diagnosis and treatment on Monday, so I won't be able fully answer your question till then. But through my past experience of being diagnosed with other related conditions I think it is important to emphasize that on it's own a diagnosis changes nothing.

One important thing having a diagnosis does do, however, is help you figure out what is not the diagnosis. That is it starts you the path of untangling what directly stems from your condition from what is ingrained habit or coping mechanism, from what is personality quirk and from the things that are a result of the condition but not part of it (for instance feeling useless because people have always told you are useless, rather than recognizing the difficulties you face as a result of your condition). This is not something that a diagnosis can do by itself though, and it is not easy, though it is exactly the kind of thing therapy/counseling is made for.

One thing that struck me about what you have said is that your story appears to be you got a diagnosis, your doctor gave you a prescription and that is it.

I have been through a fair amount of therapy, and have worked with a number a different people through this, and I tend to be very particular about who I will work with as a result of this. When it came to Adult ADHD I was looking for someone who would take the multi-modal approach* I wanted and which all my research has suggested is the best approach. *Combining medication with evidence based therapies i.e. CBT as well as general counseling.

One of the reasons I chose my practitioner (not my doctor) is as well as experience in treating ADHD, is that he was upfront that while he can and does prescribe meds he wouldn't do so straight away, seeing it as a decision to be taken in conjunction with the patient in a wider context. Our initial talk focused on setting up a program that combines CBT to directly tackle the symptoms of ADHD with work on issues that identify as things I want to work on (in my case this will include sitting up a proper writing habit. He was also very happy to take up my suggestion of some sessions of couples counseling so my wife and I can work on how this might affect our relationship) as well as tackling some of the wider, general issues that arise such as what comes after diagnosis.

While I think meds can be an important part of treatment they are not going to help you learn good habits on your own. In addition diagnosis can bring all sorts of issues to the surface and its always good to have someone to guide you through the post-diagnosis period until you are ready to strike out on your own. If you have not already done so finding someone with specific ADHD experience to work with (on a therapeutic program) might be a very useful step.
posted by tallus at 4:54 PM on October 9, 2010

>> I must have lucked out.

Dunno. Maybe my doctor was simply lying to me. Although I don't know what he could have gained. He didn't charge me for the monthly prescriptions. Or maybe the rules have changed. I quit using it about six years ago.
posted by Bruce H. at 5:14 PM on October 9, 2010

i wasn't diagnosed until my late 30s, and there was an element of relief when i read that my lifelong failures were typical of people with the condition--this after years of beating myself up for being lazy and stupid. starting ritalin was a revelation in terms of focus and comprehension.

along with that, though, i was really disappointed over the many years wasted and the directions my life could have taken, and the depression that could have been avoided, had i been diagnosed earlier--along with the frustration over having decent intellectual potential going wasted in the fog of inability to handle some of the most fundamental aspects of adult daily life. i'm not a genius or anything, but i'm smart enough to know that i was capable of something more.

my mistake in the first few years after this was to try to make up for lost time, putting pressure on myself to accomplish something more; what i hit up against was realizing that while medication can help in day-to-day focus, it doesn't really do anything for higher-level, longer-term executive functioning. this put me into an all-new cycle of failures even more frustrating in that i could recognize and understand my inabilities and their potential solutions and yet not overcome them.

now at 43, the struggle is over whether, at this age, it is better to continue fighting to be something more, or to gain some peace and happiness by accepting myself as i am. (however, this questioning is likely more midlife universal than associated with adhd specifically.)

so overall, i would say prepare to embrace the things that you might see improving, but temper any life-changing expectations until you see the other side.
posted by fallacy of the beard at 6:01 PM on October 9, 2010 [1 favorite]

elsietheeel: "Really? I must have lucked out. I get Adderall from my mail order pharmacy; a 90 day supply at a time. "

It depends on your state's regulations, if you're in the USA. Here in Washington I can't get a three-month supply of my stimulant of choice, and have to get a written prescription every month. As if I'd be selling it -- it's mine, all mine!
posted by The corpse in the library at 6:40 PM on October 9, 2010

I was terrified that I would STILL be a huge failure (I'm not a failure, it just felt that way). I was scared that I was making excuses for myself. I was scared that people would judge me as stupid if I told them about it, or think that I was being lazy or being misled by big pharma. I was mad that I hadn't had this opportunity before.

I was hopeful that things would get better but that hope was definitely mixed with some excitement, some fear, some sadness, and some overwhelmed...ness.

There were some obvious changes right away, not as many as I would have liked. After being on stimulant meds for a while I noticed a long-term difference in my confidence, I was able to fulfill my basic duties at work and around the house, and most important, I became much better at making and keeping my commitments to the people I love.

That ended up being a lot more important to me than the bigger projects I'm working on--the little day to day things I'm more consistent with.
posted by the young rope-rider at 8:15 PM on October 9, 2010 [1 favorite]

Response by poster: Thanks for the helpful and enlightening responses so far. I feel a lot less strange now.

tallus, I agree that medication is just part of treatment, and I'll be receiving further support in therapy. I'm also hoping to get a writing coach at some point. It could be that with my BP and anxiety issues I won't be able to rely on meds, so I do want to get all the behavioral/cognitive help I can. For sure I've got some unlearning to do as well as learning after 40+ years of coping without knowing what the problem really was!
posted by sister nunchaku of love and mercy at 8:43 PM on October 9, 2010

This turned out kind of long, but that's the nature of this thing ...

I actually went to a psychiatrist knowing I had ADD but needing a diagnosis for confirmation. I had all but one of the ... 19? 23? classic symptoms and was a dead certainty once I took Adderall. My anxiety vanished instantly. I had also been using nicotine and caffeine, but once I quit smoking it only took a couple years before I knew something wasn't right, and then it was only a matter of time before I did some research and ended up at the doctor's for a professional diagnosis. I also have the inattentive type.

So, Adderall is great and it's terrible. It's not quite as good with anxiety as it used to be for me, but man it does help with being productive at tasks that require organization and quick decision making, both of which I suck at profoundly otherwise. I used to go into stores as a kid and be totally paralyzed by the choices, taking hours to buy clothes for the new school year, or trying to pick out Christmas presents. One time when I don't like it is when I'm trying to interact with someone. It makes me kind of robotic sometimes, not so great for socializing- I tend to get more talkative than usual ... which is a lot. It also causes problems for me sexually, but Cialis works for that. Unfortunately, none of those drugs are off-patent yet and are not covered well by insurance. It also makes my insomnia worse, which doesn't help focus. I also take bupropion (Wellbutrin) and gabapentin, which help moderate some of the harsh effects of Adderall. I'd like to do without it but may always need it, or something like it.

There is nothing to be ashamed of if you need medication or if it helps you function. Don't let anyone tell you otherwise. Be aware but don't fall into the trap of being negative about it just because some other people might be. Your treatment is your business and yours alone if you choose, and there's really nothing to be gained by listening to people's pet theories about the subject when discussing your condition.

By the way, you can consider ADD to be a strength, if you learn how to work with it. It's not all negatives. I like being able to hyperfocus and can really dig into something for prolonged periods, like reading, research or some skilled task which requires a lot of concentration. I'm creative and intuitive and fairly intelligent, and I'm good with language and music. These are all common traits.

I am currently in talk therapy but am not thrilled with the results so far. I am making progress, but my therapist is rather new and has no prior ADHD experience, so a lot of my progress is on my own. Therapy is good for dumping all my crap on the table, but it hasn't been all that useful otherwise. Traditional therapy can potentially be counter-productive if you have ADHD. Unfortunately, in my location there aren't many choices. My psych does have a lot of ADHD experience, but the clinic requires you get therapy through them if you go to a psych. They mostly deal with substance abuse and crisis and don't have a lot of resources, but it's better than not having the resource at all. I am interested in working with cognitive behavioral therapy, and my therapist has been kind of helpful in that regard but doesn't know quite how to do the work with a patient.

One thing therapy has been very useful for is untangling all the guilt and pain that gets tied up in it. I wasn't diagnosed until my late 30s (which is sort of the age when it happens for a lot of us), and my parents were great but did not at all understand my lack of motivation or seeming never-ending battle with organization and procrastination. I can't blame them but I did carry a lot of guilt about my problems, which I thought were intractable after a while. I drank to ease my social anxiety, which eventually caused a lot of other problems and derailed my life for some time. I have been able to let go of a lot of that just by knowing my issues are not a character flaws but due to something that has an actual medical diagnosis and treatment.

However, after decades of confusion, untangling it all can take some time. I still have social anxiety and am terrible at dating, at least parts of it, but I try. I'm still not that interested in a lot of social activities and am content to be alone most of the time, but there is a limit to that, too. I am in the wrong career, totally the wrong one, although it might seem to be just right, but for a million reasons it's not. So, I have to change careers soon. This is not something I relish and so have been putting it off for a while. I have no idea what I'm going to do. So, there's that ...

Have I told you I'm terrible at dating? How about, have I told you I repeat myself and tend to talk a lot? I'm smart but damn I'm not all that bright a lot of the time. Nothing wrong with that.
posted by krinklyfig at 11:58 PM on October 9, 2010

I went to my psychiatrist because I felt like I was depressed. Then he started asking me all these weird questions, like he was going down a checklist. "Do you ever say stuff you shouldn't?" Check. "Do you interrupt people when they're talking?" Check. "Do you start stuff you don't finish?" Okay, yes, check, what the hell is the point of this? Then he told me he thought I had ADHD.

My first thought was, "Thank god there's something officially wrong with me. I thought I was just obnoxious."

I started taking Adderall and it was like night and day. I worked at the same place two summers in a row and started taking it in between. The second summer, people kept coming up to me and saying how much more mature I seemed, how much more laid back I was. A couple people thought I wasn't feeling well, just because I seemed so much less thrummy.

But what I really wanted to tell you is that, every few months, I get this weird thought where I'm convinced that I'm basically a crystal meth addict and my doctor is a drug pusher with a prescription pad. I read articles that say everyone who takes Adderall is more productive on it, whether they have ADD or not.

But then I talk to my friends who have known me since before I started taking it and they remind me that, before the drugs, I was a very sweet girl who was incredibly difficult to be around for more than an hour or so.

And then I feel better.

That might just be me, though.
posted by missjenny at 5:20 AM on October 10, 2010 [1 favorite]

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