Inattentive ADHD
December 12, 2012 7:44 AM   Subscribe

I have a friend who has ADHD primarily inattentive type and struggles with multitasking in both work and home life. Rather than being the hyper person that most of us visualize, he is the exact opposite, very slow and methodical with some rigidity to how he must follow certain rules. My buddy has been struggling in his work place, because he constantly feels overwhelmed. He does see a therapist, but it doesn't seem like any of his issues (at least in the work world) are getting any better. He told me yesterday that people are constantly telling him that he is not present even when he is at work or at home with his wife. It must really be frustrating for him because I know him to be a good guy with good morals. From a brain perspective, it's kind of a bummer because he does take adhd meds, but he is constantly overwhelmed by everything and he tells me that people seem to get frustrated with him even though he is trying. When we hang out, I mainly validate and offer him some understanding. Any suggestions on how to help my friend?

I personally believe that if he could get his work life in order, that he would be more present, but he is constantly worrying about whether he's doing enough and whether people are getting frustrated with him in his office. I keep recommending books like Getting Things Done and other organization books, and his therapist brought up that Executive Functioning Issues are definitely a problem for someone with ADHD. Does anyone have any experience with this and how can I best help my friend? Are there things that others have tried that might be helpful to him?
posted by nidora to Health & Fitness (12 answers total) 9 users marked this as a favorite
posted by jaguar at 7:55 AM on December 12, 2012 [1 favorite]

IANAMHP (I am not a mental health professional) but it doesn't sound as if his meds are working. It sounds like either he's been misdiagnosed, or he needs to change either the type or the dosage of whatever he's on.

If I was him, I'd be getting a referral to a psychiatrist other than the one who originally diagnosed & prescribed.
posted by Salamander at 8:01 AM on December 12, 2012 [4 favorites]

Having ADHD doesn't always mean you are hyperactive and can't ever concentrate. Hyperfocus is something people with ADHD have the ability to do.

Honestly, if I were you I would stop suggesting books and ways to manage his life. For one thing, what works for you is probably not going to work for him because his mind works differently from yours. I got similar suggestions from well meaning friends and family my whole life. It was a frustrating experience because I would try things and then beat myself up because they never worked for me, further reinforcing the idea that nothing was going to work and I was just going to be a messy, disorganized person forever.

If his medication is not working, and it sounds like it isn't, and his therapy isn't helping, he should be talking about this with his doctor and his therapist. Being a supportive and understanding friend is probably the best thing you can do for him.
posted by inertia at 8:21 AM on December 12, 2012 [3 favorites]

Accountability and structure can help A LOT when coping with ADHD. You can't forcibly implement these things in your friend's life, but you can certainly be there to encourage him to do his own planning along these lines, and then you can offer your services as an enforcer/ a second set of eyes to help him maintain that structure.

How well this works may depend on the intimacy of your relationship with your friend, and also on how touchy he is personally about letting other people be involved in his life. You'll probably have the best luck letting him plan out his own structure, then inform you of the ways in which you might be able help with accountability/ ongoing enforcement. It could be as simple as, for instance, your offering to expect his emailed to-do list by 9:30 every morning (and calling at 9:45 to check if it hasn't appeared), then having a regular 5-minute phone chat on the way home where he reports which items he's finished. Or his giving you $200 plus a detailed plan of the steps + deadlines for his next project, with the understanding that you'll be donating $10 to a political group he hates for every mini-deadline he misses. Or whatever.

Basically, you can't really help fix this for him from start to finish (because of the differing ways brains work, as inertia mentions). But because executive function is related in important ways to "willpower," you can offer your functioning willpower to help shore up his glitchy willpower as needed. It's just that he should probably be the one to say how that support needs to happen, and when.
posted by Bardolph at 8:42 AM on December 12, 2012 [2 favorites]

Your friend has the same kind of ADHD I have and the same issues. They are worse when I am unmedicated, undermedicated, and/or stressed out.

He may be caught in an anxiety feedback loop that's causing performance anxiety. I get that way sometimes when I am afraid of disappointing people.

I am not good at multitasking. For that reason, I have tended to avoid jobs in which this is a requirement.

Here is what I would suggest: he should talk to his shrink to see if he's on the right meds and dosage. (I take Ritalin, 60 mg/day in divided doses of 10 or 20 depending on my energy level).

He should consider working with his ADHD instead of against it. Refer him to the books of Dr. Edward Hallowell for some great advice on this. Most importantly, we neuro-atypicals need to find our work niche. Being a writer and editor works great for me because it involves focusing and completing projects. It's also interesting. Being bored will make the ADHD mind wander.

Computer programming, architecture, design, and other careers involving working alone and seeing a project to completion may be a good match for your friend. (If I'm reading the question correctly, it sounds like he's in some sort of admin position, amirite?) Jobs involving attention to detail, like administration, accounting, food service, etc. have been really, really bad fits for me and he may face the same problems.

ADHD-ers are anxiety-prone in general, so curbing that is paramount. Reducing stress and designing a life that doesn't try to force you to be a non-ADHD person are very important.

Also, having supportive people in your life is very important (for everyone, but especially ADHD-ers). It's great that you are there for him. His wife should be there for him too. If she hasn't read any of the Hallowell books, they'd be really helpful in terms of her understanding him.

It sounds like maybe a lot of people in your friend's life aren't being accommodating re the ADHD. If it's bad enough to create a disability at work, your friend is covered by ADA and can request accommodations (if he wants to stay at this job). There is nothing wrong with your friend for having a brain that works differently. It's not like he can "just try harder" or whatever. It doesn't work that way. But it sounds like maybe he has internalized that it's a matter of willpower or something. He would be perfectly in his right to request things like a prioritized list of tasks from his boss, or to be allowed to work on one thing at a time, or to be able to take his work to a quiet area to focus on it...things like that. (He should talk to HR before asking for these things, though).
posted by xenophile at 9:17 AM on December 12, 2012 [6 favorites]

I think there's more going on that ADD. I'm ADD, and I don't have anxiety issues. I think he might try to get a better diagnosis and treatment. I'm not a mental health pro but sounds like a tinge of OCD, esp. if he's got rules and patterns that he must follow.
posted by Ideefixe at 9:23 AM on December 12, 2012

Agreed with the others that he needs to switch up his meds or possibly look into additional/different/comorbid conditions that he may have - I'm ADD primarily inattentive and it manifests for me as brain constantly hopping from random thought to random thought when I'm not trying to focus, and brain being extremely easily distractible by the tiniest things when I AM trying to focus. It's possible that he's so reliant on routine/structure because that's a common "self medication" kind of thing that ADD people tend to do; they can just kind of go on autopilot that way and it can make them more productive than they would be otherwise. But IANAD and not everyone experiences ADD in the same ways.

But yeah. He should really bring these ideas up with his doctor to consider alternate/additional diagnoses or at minimum a med change. As for you, as his non-ADD friend, just be as patient as you can reasonably be with him, and definitely don't try "I know how you feel, I get overwhelmed too" because it's really a whole different ballgame for ADD people.
posted by agress at 9:48 AM on December 12, 2012 [1 favorite]

He might consider coaching so that he can relearn life skills in a way that works with his ADHD. Imagine that Executive Function is a muscle. ADHD makes you ignore that muscle. Medication takes away that blindspot, but you still need to do considerable work to create muscle memory and learn when to switch tasks.

The executive function is the part of your brain that tells you to start and stop.

Hyperfocus is as much a failure of the executive function as the other symptoms. But unlike the procrastination or easy distraction, it feels great. It feels like it's the one bright spot in ADHD. Sure, I might not remember to clean the apartment for months. But give me one day, and I'll tackle ALL OF IT. I can fix problems at work that nobody can, because they burn out at the two, three hour mark. I'm still chewing on it at two am.

And it's so scary to give up. That's why anxiety disorders and ADHD are highly correlated. If something isn't right in front of me, unmedicated, I will never think about it again. So I don't want to move on to the next thing. I need to finish this one thing, and finish it so perfectly that it will justify the fact that I've spent two weeks on a three day project.

It took a long time for me to walk away from work without that fear that I'll forget everything by the next morning. I would go home and remain obsessed with various tasks, because if I take a minute to pay attention to my boyfriend, I might forget. Now I try to wrap up at night and take ten minutes to write down everything. I imagine that I am passing it off to Future Politikitty, and it's permanently out of my hands.

So long as he is giving into the anxiety and relying on hyperfocus, medication will be of limited use. He's purposely recreating that blindspot and refusing to engage his executive function. And as you're noticing, while he's hyperfocused, he's incapable of starting new things.

Offer to hold him accountable, and offer to listen to his struggles. But please be aware that he is struggling with a medical issue. Create strong boundaries so that you do not become an alternative to medical care. And he might want to consider finding a therapist who has more experience with ADHD and workplace issues.
posted by politikitty at 1:04 PM on December 12, 2012 [2 favorites]

And it's so scary to give up. That's why anxiety disorders and ADHD are highly correlated. If something isn't right in front of me, unmedicated, I will never think about it again. So I don't want to move on to the next thing. I need to finish this one thing, and finish it so perfectly that it will justify the fact that I've spent two weeks on a three day project.

Right on. RIGHT ON. Anyway my anxiety dropped dramatically when medicated (properly). Turns out the anxiety was entirely related to my issues with timely task completion at work.
posted by murfed13 at 4:05 PM on December 12, 2012 [2 favorites]

ADD & me often equals overwhelmed. Well, not as much these days.

I learned about chunking: breaking tasks/projects down into bite-sized morsels. If I estimate something will take > 2-4 hours, then I know it needs to be broken down into smaller pieces.

Often I would be overwhelmed by complexity and large numbers of details and trying to hold all of that in my head. Getting it outside of my own brain in to some type of storage (paper, digital, whatever!) and chunked into small bits helps me deal.
posted by trinity8-director at 4:31 PM on December 12, 2012 [2 favorites]

IANAD, but have anxiety, anemia, sleep, dietary, or endocrine problems (and so on) been ruled out yet? Lots of things look like ADHD, but have a different cause.

He'd likely be experiencing other symptoms if that was the case.

ADHD plus something else (notably anxiety) could also create chaos in your friend's life.

I can completely empathize with your friend - I struggle with ADHD, anxiety, and other stuff all at once. The medication I take only treats the "tip of the iceberg" in my case (YMMV - for others it seems to work much better). Neither my doctors nor I really understand what is going on.

Nevertheless, I strongly benefited from the book Delivered from Distraction by Hallowell & Ratey.

I have heard many good things about meditation, too, though I have no experience with it.
posted by Seeking Direction at 4:54 PM on December 12, 2012

Sometimes the job situation can be the thing that aggravates the ADHD and anxiety to a point that they become more noticeable and less tolerable.

Is this new for him? (He may be identifying his entire personality with how work is going right now, but that might not be accurate). If he's had other work situations that were more successful, it might be worth it for him to do some thinking about what would make his work situation less difficult.

I took on a position a while back which played directly to my ADHD/anxiety weaknesses. I was overwhelmed, miserable, stressed and very anxious. I tried to fix my ADHD, anxiety, and depression, but the thing that helped the most was changing my job.

Now I'm in a position where my work is interesting and has enough variety that I am not bored, but there are fewer moving parts and less scrutiny, and I am happier. My mental health is much, much better now. ADHD is always an issue for me, but there are jobs in which it is less of a liability, and where I can add a lot of value without fighting an uphill battle against myself every day.

You could ask him if he's thought about changing jobs, and what would make his job situation better. And if he wants to change jobs then there's probably a lot of help and support you can offer. Really though - unless your friend has asked for advice, I'd be cautious about how you approach it. You might have to let him find his own way and just let him know that you're happy to help in any way you can.

The issue of being present is complicated, and might not be addressed by addressing the work situation.
posted by bunderful at 9:02 PM on December 12, 2012 [1 favorite]

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