I want to fix my head
April 27, 2013 5:41 PM Subscribe
At 41, I feel like my brain problems are becoming serious enough that I need professional help. I'm forgetful, I procrastinate, and I... SQUIRREL!
Superficially, I feel like I have the stereotypical diagnosis of ADHD: I'm absentminded, easily distracted, have trouble concentrating for any length of time on anything serious, and generally do well only to the extent that I'm working on something right in front of my face.
Knowingly or not, I've actually structured my life in this way to cope: I keep things right in front of my face. As a freelance web developer, I use todo lists full of bite-sized tasks. As a work-from-home, I do a lot of housework just by handling whatever chore obviously needs doing. For the most part, I live pretty well and successfully.
That said, I feel very limited by what I perceive to be obvious mental deficiencies. I really do drift off easily, whether I'm reading something or talking to my wife. I use a very clearly articulated inner monologue to keep on task. I can pledge my brain to remember some detail that I've forgotten five minutes later. More often now, I simply stumble trying to recall words or details that are tantalizingly close. I retell anecdotes that my wife has heard many times already.
More tellingly, perhaps, I can easily kill an hour or two on shallow attention span tasks like clicking through Imgur; but I have great difficulty concentrating on deep attention span tasks like reading technical documentation.
Thinking back, I've always been this way in some degree; it just seems to be getting worse now as I age and, well, nothing works quite as well as it used to.
I plan on making an appointment with my doctor this week to discuss my issues generally. What should I ask? What should I not say, to avoid looking like all I want is a prescription for Ritalin? If you've dealt with similar issues as an adult, did you just continue to cope, or was medical treatment generally successful, and if so, was the treatment pharmaceutical or more lifestyle oriented?
Recommendations for books or websites are welcome. I've tried mindfulness meditation in the past and hated it. I'm sleeping relatively well these days due to aggressively dealing with stress-related sleep issues from a year ago. My diet is excellent, I get daily exercise, and my life feels pretty good. I just feel like this is something that can be addressed.
Superficially, I feel like I have the stereotypical diagnosis of ADHD: I'm absentminded, easily distracted, have trouble concentrating for any length of time on anything serious, and generally do well only to the extent that I'm working on something right in front of my face.
Knowingly or not, I've actually structured my life in this way to cope: I keep things right in front of my face. As a freelance web developer, I use todo lists full of bite-sized tasks. As a work-from-home, I do a lot of housework just by handling whatever chore obviously needs doing. For the most part, I live pretty well and successfully.
That said, I feel very limited by what I perceive to be obvious mental deficiencies. I really do drift off easily, whether I'm reading something or talking to my wife. I use a very clearly articulated inner monologue to keep on task. I can pledge my brain to remember some detail that I've forgotten five minutes later. More often now, I simply stumble trying to recall words or details that are tantalizingly close. I retell anecdotes that my wife has heard many times already.
More tellingly, perhaps, I can easily kill an hour or two on shallow attention span tasks like clicking through Imgur; but I have great difficulty concentrating on deep attention span tasks like reading technical documentation.
Thinking back, I've always been this way in some degree; it just seems to be getting worse now as I age and, well, nothing works quite as well as it used to.
I plan on making an appointment with my doctor this week to discuss my issues generally. What should I ask? What should I not say, to avoid looking like all I want is a prescription for Ritalin? If you've dealt with similar issues as an adult, did you just continue to cope, or was medical treatment generally successful, and if so, was the treatment pharmaceutical or more lifestyle oriented?
Recommendations for books or websites are welcome. I've tried mindfulness meditation in the past and hated it. I'm sleeping relatively well these days due to aggressively dealing with stress-related sleep issues from a year ago. My diet is excellent, I get daily exercise, and my life feels pretty good. I just feel like this is something that can be addressed.
Best answer: When I explain to new psychiatrists why it is that they really shouldn't just take me off my ADHD meds (which every new doctor of mine will probably want for the rest of time,) I describe my actual problems in extremely concrete terms, for example:
- I use five alarm clocks, not just because I will turn them all off but because I can never be sure that I've turned any one of them on.
- In order to keep myself from forgetting my work ID badge, I attach it to my bag with my ID and my debit card and everything.
- Because I kept losing my shoes and my keys, they all have permanent homes right by my door (the keys are hung from hooks that are ON the door) and I have a sign that reminds me that I promised I wouldn't do anything else after I got home until I took off my shoes and put them and the keys where they belong. This has reduced the lost-keys/lost-shoes incidents to one or two a week, from three to five per day.
- There's a sign in my bathroom that reminds me of all the tasks you have to complete before you go to bed. It includes the words "wash face" and "put dirty clothes in hamper." I sometimes forget to not only do those things, but check the sign to be sure I haven't forgotten anything. But I wash my face more than I used to.
- If I need to bring something to work in the morning, I put a weight on my bag with a note reminding me exactly what it is I need to bring - and that doesn't always work.
- I've left my home for work without locking the front door six times in the last two months.
- I put reminders up telling me to set timers when I cook, and I've reduced the number of dinners I've burned from five per week to one or two per week.
And then I stress to them that this is with medication, and that before I was on medications, I had been contemplating putting up notices to remind myself to use timers when I cook but could never, ever manage to actually follow through on the task. I tell them how it feels like I've gained an extra six hours in a day, and that I can often make promises to people and actually keep them. I tell them that I only forget one or two doctor's appointments in any given month, and that usually I catch those before the appointment has come and gone because I've managed to follow through on my intention to write down the appointment times, and managed to not lose the (bright red) planner I bought to not only write the appointments down but actually tape the reminder cards I get for each appointment into.
I also bring examples from my past, like the "homework cards" we had when I was in elementary school - if you forgot to turn something in or finish it, it got put on the card. Then, if you finished your assigned tasks early on a given schoolday, you had to check your card to see if it was "clear" before you could do anything fun like reading comic books. My card was never, ever, ever clear. I used to cry and think I was stupid because I couldn't seem to keep up on my homework even though everyone agreed I was brilliant and I always did well on tests and my work was good as long as I did it all; it gave my dad serious anxiety for years because not a single gimmick or motivational technique or punishment had any actual impact on my behavior.
posted by Fee Phi Faux Phumb I Smell t'Socks o' a Puppetman! at 5:57 PM on April 27, 2013 [8 favorites]
- I use five alarm clocks, not just because I will turn them all off but because I can never be sure that I've turned any one of them on.
- In order to keep myself from forgetting my work ID badge, I attach it to my bag with my ID and my debit card and everything.
- Because I kept losing my shoes and my keys, they all have permanent homes right by my door (the keys are hung from hooks that are ON the door) and I have a sign that reminds me that I promised I wouldn't do anything else after I got home until I took off my shoes and put them and the keys where they belong. This has reduced the lost-keys/lost-shoes incidents to one or two a week, from three to five per day.
- There's a sign in my bathroom that reminds me of all the tasks you have to complete before you go to bed. It includes the words "wash face" and "put dirty clothes in hamper." I sometimes forget to not only do those things, but check the sign to be sure I haven't forgotten anything. But I wash my face more than I used to.
- If I need to bring something to work in the morning, I put a weight on my bag with a note reminding me exactly what it is I need to bring - and that doesn't always work.
- I've left my home for work without locking the front door six times in the last two months.
- I put reminders up telling me to set timers when I cook, and I've reduced the number of dinners I've burned from five per week to one or two per week.
And then I stress to them that this is with medication, and that before I was on medications, I had been contemplating putting up notices to remind myself to use timers when I cook but could never, ever manage to actually follow through on the task. I tell them how it feels like I've gained an extra six hours in a day, and that I can often make promises to people and actually keep them. I tell them that I only forget one or two doctor's appointments in any given month, and that usually I catch those before the appointment has come and gone because I've managed to follow through on my intention to write down the appointment times, and managed to not lose the (bright red) planner I bought to not only write the appointments down but actually tape the reminder cards I get for each appointment into.
I also bring examples from my past, like the "homework cards" we had when I was in elementary school - if you forgot to turn something in or finish it, it got put on the card. Then, if you finished your assigned tasks early on a given schoolday, you had to check your card to see if it was "clear" before you could do anything fun like reading comic books. My card was never, ever, ever clear. I used to cry and think I was stupid because I couldn't seem to keep up on my homework even though everyone agreed I was brilliant and I always did well on tests and my work was good as long as I did it all; it gave my dad serious anxiety for years because not a single gimmick or motivational technique or punishment had any actual impact on my behavior.
posted by Fee Phi Faux Phumb I Smell t'Socks o' a Puppetman! at 5:57 PM on April 27, 2013 [8 favorites]
Best answer: None of the nutrition/exercise/mindfulness/wellness crap has done a bit of good for me on the ADHD/attention/executive function front, by the way, but both ADHD meds and anxiety meds have been tremendously helpful in terms of making me less stressed out when things go wrong, and helping me to remember to do the things I intend to do.
Adderall has been truly amazing in terms of getting me out of bed in the morning, so much so that my only real assignment (read: agreement with my therapist) when the alarms go off is to find the meds box for the day and take the Adderall; by the time the Adderall kicks in I have invariably "magically" decided I feel like getting up, taking my other meds, taking a shower, getting dressed, going to work, and solving the problems I have at work. And I manage to sustain that thought longer than the time it takes for me to take my meds, take a shower, get dressed, go to work, and start solving work problems.
It's an extremely small dose of Adderall, also; I rely primarily on Vyvanse to sustain attention & intentions throughout the day. Also, the Adderall doesn't seem to do jack when I'm actually depressed or sick; I still end up stuck in bed for the most part when it gets bad. Though the Adderall does help me think clearly enough to try and fight the desire for sleep, try and drink some OJ, etc.
When I'm not severely depressed, etc., it works great. The Adderall and Vyvanse today got me to spray my yard for bugs, do grocery shopping, cook and eat lunch, deposit a check, turn off the computer and leave the house, decide not to do a thing until another thing had been finished first, and keep (as of 9pm EST) from doing the thing I'm not going to do until the other thing (which is halfway done) is finished. Before that, though, I spent five hours awake in bed drifting mentally before I realized I really needed to take my meds, because I didn't get up to take my Adderall when the alarms went off, because I decided to turn the alarms off and give myself a break for once. One of the biggest costs of ADHD: slipping up on your coping system is a major stopping point on the path to total disaster.
I am on multiple psych meds and have a few chronic medical conditions of a non-psychiatric nature, which is one of the reasons new doctors always want to take me off my ADHD meds. My ADHD symptoms, and the havoc they wreak on my life, are, per the consensus of my treatment team, a huge factor in the severity of my anxiety, bipolar disorder, etc. Depression and anxiety are often caused in part by the relenting struggle/failures for people with ADHD, and there are days when I wonder if a bit of Ritalin in the 1980s would have saved me from needing Lamictal in the 2010s.
Oh... and I will freely admit I did not give a scientifically rigorous effort at the nutrition/exercise/mindfulness/wellness crap. It stresses me out enough and annoys me enough that I have decided any such efforts will likely do more harm than good. Reducing stress should definitely reduce any extra difficulties you have with executive function - they've been reluctant to do anything with my ADHD or anxiety meds in the last few months due to the major stressors in my work and financial situation. So, you know, "eating right," if you don't already and it's not incredibly hard for you to change it, is probably going to be a net positive factor. Changing my nutritional habits (in a way that anyone who thinks would help reduce ADHD symptoms) would be roughly as hard for me as marrying a perfect stranger and moving to a foreign country. It's possible, meanwhile, that adding my Vitamin D and/or fish oil supplements may have helped. I just didn't notice it, or try anything harder.
posted by Fee Phi Faux Phumb I Smell t'Socks o' a Puppetman! at 6:16 PM on April 27, 2013 [2 favorites]
Adderall has been truly amazing in terms of getting me out of bed in the morning, so much so that my only real assignment (read: agreement with my therapist) when the alarms go off is to find the meds box for the day and take the Adderall; by the time the Adderall kicks in I have invariably "magically" decided I feel like getting up, taking my other meds, taking a shower, getting dressed, going to work, and solving the problems I have at work. And I manage to sustain that thought longer than the time it takes for me to take my meds, take a shower, get dressed, go to work, and start solving work problems.
It's an extremely small dose of Adderall, also; I rely primarily on Vyvanse to sustain attention & intentions throughout the day. Also, the Adderall doesn't seem to do jack when I'm actually depressed or sick; I still end up stuck in bed for the most part when it gets bad. Though the Adderall does help me think clearly enough to try and fight the desire for sleep, try and drink some OJ, etc.
When I'm not severely depressed, etc., it works great. The Adderall and Vyvanse today got me to spray my yard for bugs, do grocery shopping, cook and eat lunch, deposit a check, turn off the computer and leave the house, decide not to do a thing until another thing had been finished first, and keep (as of 9pm EST) from doing the thing I'm not going to do until the other thing (which is halfway done) is finished. Before that, though, I spent five hours awake in bed drifting mentally before I realized I really needed to take my meds, because I didn't get up to take my Adderall when the alarms went off, because I decided to turn the alarms off and give myself a break for once. One of the biggest costs of ADHD: slipping up on your coping system is a major stopping point on the path to total disaster.
I am on multiple psych meds and have a few chronic medical conditions of a non-psychiatric nature, which is one of the reasons new doctors always want to take me off my ADHD meds. My ADHD symptoms, and the havoc they wreak on my life, are, per the consensus of my treatment team, a huge factor in the severity of my anxiety, bipolar disorder, etc. Depression and anxiety are often caused in part by the relenting struggle/failures for people with ADHD, and there are days when I wonder if a bit of Ritalin in the 1980s would have saved me from needing Lamictal in the 2010s.
Oh... and I will freely admit I did not give a scientifically rigorous effort at the nutrition/exercise/mindfulness/wellness crap. It stresses me out enough and annoys me enough that I have decided any such efforts will likely do more harm than good. Reducing stress should definitely reduce any extra difficulties you have with executive function - they've been reluctant to do anything with my ADHD or anxiety meds in the last few months due to the major stressors in my work and financial situation. So, you know, "eating right," if you don't already and it's not incredibly hard for you to change it, is probably going to be a net positive factor. Changing my nutritional habits (in a way that anyone who thinks would help reduce ADHD symptoms) would be roughly as hard for me as marrying a perfect stranger and moving to a foreign country. It's possible, meanwhile, that adding my Vitamin D and/or fish oil supplements may have helped. I just didn't notice it, or try anything harder.
posted by Fee Phi Faux Phumb I Smell t'Socks o' a Puppetman! at 6:16 PM on April 27, 2013 [2 favorites]
Best answer: Oh, and advice about appointments, if you tend to forget them: write down (in your bright-red planner, in which you have taped the appointment reminder cards) that you do NOT have an appointment with so-and-so this week, in the weeks where you don't have an appointment. Ten or fifteen lost appointments can make a person a little bit obsessive about these things.
(I did not read that in a book, I came up with it myself after having a near-complete meltdown looking for something that I thought I needed for an appointment that turned out to not be happening for another ten days.)
As for books and stuff, there are many. I sort of like this one, except that some of the lifestyle changes it seems to insist upon are really just inacceptably limiting in my view (basically, I just will not have only one or two magazine subscriptions.) This is one of the big problems I have with books for ADHD; the ones that are written by adults without ADHD tend to infantilize adults with the disorder, and be very tough-love and it-has-to-be-this-way-because-you-are-incapable-of-handling-things-any-other-way. This happens a lot in psychology settings in my experience (at least, anyone who runs behavioral therapy programs tends to do it,) but it doesn't seem to come out so strongly in other self-help book categories because the authors want you to buy more of their books. For whatever reason, folks don't mind being jerks to people who have a diagnosed disorder. See, also, the behavior of the organizing teams on shows like "Hoarders."
I mean, I accept that there are things I really can't handle in a different way, but the books tend to be exactly as arbitrary about what they think anyone with an ADHD diagnosis can handle as new-diet fanatic books are about what is and is not right to eat (and they frequently do not notice the dramatic differences between any two people with this diagnosis, or often even differentiate amongst the three ADHD types.) Honestly, in many cases (paging Dr. Edward Hallowell,) the author's background is primarily focused on treating pre-adolescents and their families - but then they write books with advice for adults with the disorder. Dr. Hallowell's top treatment recommendation is literally "love sustained over time."
For this reason, I suggest you read the "how to deal with your life" books with a shaker of salt in hand, unless the author makes it really plain that this is not how they see you. If you were a woman I'd be asking you why you haven't already read Sari Solden's stuff, for instance. Dr. Hallowell's first book isn't that bad, either; he's a bit too woo for me on the treatment side; loves mindfulnes & alternative treatments. But, his book and Solden's were the two that made me sure I had ADHD and that it wasn't that I was lazy, stupid, or crazy after all.
The caution about being looked down on also applies to much of what you see from CHADD, which after who knows how many years still feels like a group mostly for parents of kids with ADHD (I get the same funny taste in my mouth from them as I do from Autism Speaks, honestly.)
posted by Fee Phi Faux Phumb I Smell t'Socks o' a Puppetman! at 6:48 PM on April 27, 2013 [3 favorites]
(I did not read that in a book, I came up with it myself after having a near-complete meltdown looking for something that I thought I needed for an appointment that turned out to not be happening for another ten days.)
As for books and stuff, there are many. I sort of like this one, except that some of the lifestyle changes it seems to insist upon are really just inacceptably limiting in my view (basically, I just will not have only one or two magazine subscriptions.) This is one of the big problems I have with books for ADHD; the ones that are written by adults without ADHD tend to infantilize adults with the disorder, and be very tough-love and it-has-to-be-this-way-because-you-are-incapable-of-handling-things-any-other-way. This happens a lot in psychology settings in my experience (at least, anyone who runs behavioral therapy programs tends to do it,) but it doesn't seem to come out so strongly in other self-help book categories because the authors want you to buy more of their books. For whatever reason, folks don't mind being jerks to people who have a diagnosed disorder. See, also, the behavior of the organizing teams on shows like "Hoarders."
I mean, I accept that there are things I really can't handle in a different way, but the books tend to be exactly as arbitrary about what they think anyone with an ADHD diagnosis can handle as new-diet fanatic books are about what is and is not right to eat (and they frequently do not notice the dramatic differences between any two people with this diagnosis, or often even differentiate amongst the three ADHD types.) Honestly, in many cases (paging Dr. Edward Hallowell,) the author's background is primarily focused on treating pre-adolescents and their families - but then they write books with advice for adults with the disorder. Dr. Hallowell's top treatment recommendation is literally "love sustained over time."
For this reason, I suggest you read the "how to deal with your life" books with a shaker of salt in hand, unless the author makes it really plain that this is not how they see you. If you were a woman I'd be asking you why you haven't already read Sari Solden's stuff, for instance. Dr. Hallowell's first book isn't that bad, either; he's a bit too woo for me on the treatment side; loves mindfulnes & alternative treatments. But, his book and Solden's were the two that made me sure I had ADHD and that it wasn't that I was lazy, stupid, or crazy after all.
The caution about being looked down on also applies to much of what you see from CHADD, which after who knows how many years still feels like a group mostly for parents of kids with ADHD (I get the same funny taste in my mouth from them as I do from Autism Speaks, honestly.)
posted by Fee Phi Faux Phumb I Smell t'Socks o' a Puppetman! at 6:48 PM on April 27, 2013 [3 favorites]
Watch the video "ADD and Loving It?" I watched it *after* being diagnosed and it was still eye opening for me. If you don't identify with much of that, especially from a school age, then you've got something else going on. The hyper focus aspect of it was particularly enlightening.
When you are going over your personal inventory of stuff, concentrate on your school years. When did you have trouble, what kind of trouble was it, how did you cope with it, what were some successes and failures you had in your schooling. This is the key- ADHD can be dealt with many different ways, but everyone's story is somewhat similar.
The other thing about ADHD is that it leads to codependence quite like some addictions do.
If you do end up having it and decide to get medication, be prepared to tear apart a lot of your preconceptions about yourself and how you work. Every thing you have tried in the past to "get organized" that didn't work, you have to start trying again.
posted by gjc at 7:08 PM on April 27, 2013 [2 favorites]
When you are going over your personal inventory of stuff, concentrate on your school years. When did you have trouble, what kind of trouble was it, how did you cope with it, what were some successes and failures you had in your schooling. This is the key- ADHD can be dealt with many different ways, but everyone's story is somewhat similar.
The other thing about ADHD is that it leads to codependence quite like some addictions do.
If you do end up having it and decide to get medication, be prepared to tear apart a lot of your preconceptions about yourself and how you work. Every thing you have tried in the past to "get organized" that didn't work, you have to start trying again.
posted by gjc at 7:08 PM on April 27, 2013 [2 favorites]
I'd definitely recommend that you see a psychologist and undergo some psych tests to determine exactly what's going on in your head - the tests are excellent at identifying ADHD as well as other causes for similar behavior. For instance, they can rule out organic brain disorders, which I would consider pretty important if I were in your shoes. If you get the right diagnosis, you're more likely to get the right treatment. Good luck to you.
posted by aryma at 8:24 PM on April 27, 2013
posted by aryma at 8:24 PM on April 27, 2013
Seconding Dr. Hallowell mentioned above, but I need to add some (unpopular on AskMe) recommendations, too. Whether ADHD is a disease or a neurological phenomenon or not, at this point in your life, it is integrated into your personality and your way of thinking about yourself and the world. Taking a pill is rarely sufficient to undo the integration of coping strategies and denials that have built up over time. Thinking of ADHD as something separate from you, like, say, chicken pox, which can be cured/removed leaving the rest of you unchanged is illusory. You need to own it and make efforts to change your behavior as well as any other treatments you may try. You also need to recognize that everyone has at least some degree of these tendencies and you're just further along the spectrum than many (yet less than some others)
posted by Obscure Reference at 6:45 AM on April 28, 2013
posted by Obscure Reference at 6:45 AM on April 28, 2013
I plan on making an appointment with my doctor this week to discuss my issues generally. What should I ask? What should I not say, to avoid looking like all I want is a prescription for Ritalin?
I think that this kind of appointment tends to go best when the patient goes in and describes his symptoms, and the doctor makes the treatment recommendation. I think it's very unlikely that you will be labeled a drug-seeker if you go in to the appointment and your general attitude/ statements are "I'm having some problems - I'm not sure what the cause is, I don't know what the appropriate treatments are, can you help me figure out how to solve these problems?"
From your question, I do not get the feeling that you are seeking stimulants. I get the feeling that you would like to fix some attention problems that are interfering with your life. If the fix is stimulants, fine, if the fix is something else, that's fine too. If you can communicate this clearly to the doctor, I think you will be fine.
Since you have some trouble with memory, I would write down a short list (perhaps with your wife's help) of your symptoms to read to the doctor or give to the doctor - something like:
- I tell stories multiple times and don't remember that I have told them
- I have trouble recalling words
- I have trouble focusing on (THIS KIND OF) task
- I sometimes spend two or more hours doing (THIS KIND OF) thing
- These problems have existed my whole life, but are getting worse with age
- etc
posted by insectosaurus at 8:56 AM on April 28, 2013 [3 favorites]
I think that this kind of appointment tends to go best when the patient goes in and describes his symptoms, and the doctor makes the treatment recommendation. I think it's very unlikely that you will be labeled a drug-seeker if you go in to the appointment and your general attitude/ statements are "I'm having some problems - I'm not sure what the cause is, I don't know what the appropriate treatments are, can you help me figure out how to solve these problems?"
From your question, I do not get the feeling that you are seeking stimulants. I get the feeling that you would like to fix some attention problems that are interfering with your life. If the fix is stimulants, fine, if the fix is something else, that's fine too. If you can communicate this clearly to the doctor, I think you will be fine.
Since you have some trouble with memory, I would write down a short list (perhaps with your wife's help) of your symptoms to read to the doctor or give to the doctor - something like:
- I tell stories multiple times and don't remember that I have told them
- I have trouble recalling words
- I have trouble focusing on (THIS KIND OF) task
- I sometimes spend two or more hours doing (THIS KIND OF) thing
- These problems have existed my whole life, but are getting worse with age
- etc
posted by insectosaurus at 8:56 AM on April 28, 2013 [3 favorites]
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posted by xingcat at 5:45 PM on April 27, 2013