Coping with possible adult ADHD without a diagnosis
March 31, 2018 3:49 PM   Subscribe

What kind of coping strategies can I use for managing adult ADHD if it's extremely unlikely I'll ever get a formal diagnosis?

I've been reading people's accounts of living with adult ADHD for years and found very specific things extremely relatable, to the point that I've been trying to get assessed for it for a while now. (This was sparked in part by working with a tutor at my grad school who primarily worked with students with ADHD; her descriptions of the way her other students worked fit me eeriely.)

For some reason, though, I'm having a really hard time getting anyone here in Melbourne to assess me. I've been seeing a couple of psychiatrists at a local hospital here (referred to me in conjunction with some gynecological matters I'm also working with) and they both seem to think that because I wasn't diagnosed as a kid I definitely don't have it. I grew up in a country that doesn't really recognise mental health as a thing that exists - getting a diagnosis for anything as a kid would have been nigh impossible. I've been asking around, and have a referral to someone else that may be more helpful, but even my GP and my therapist didn't quite know where I could go to get assessed for adult ADHD, and I can't tell if either Medicare or my private health insurance covers an assessment, let alone treatment.

I have real problems with focus, executive dysfunction, and sticking to anything long-term. Part of it may be situational (for most of my life I've not been able to consider anything long-term due to visas, but this has changed) but part of it is likely brain-related. I'm currently being treated for depression/bipolar/PMDD, so adding new meds to the mix may be tricky anyway even with a diagnosis. So I'd be interested in learning about non-medical coping strategies, particularly stuff that's more specific than just "exercise and hydrate!" since those apply to any sort of mental health issue.

I've been following How to ADHD, which does have practical strategies. Most of the other stuff I've seen has been "hey I have this symptoms how about you" but not so much about "and here's how I deal". I've somehow still managed to get some things done, but I can see how it's hindering me and I'd like to change that.

(Also if anyone actually knows how in Melbourne you can get assessed for adult ADHD that would be handy!)
posted by divabat to Health & Fitness (18 answers total) 43 users marked this as a favorite
I read an article on Additude - I think - about a guy who was able to handle his ADD with intense, regular cardio-vascular exercise. He found that exercise worked better for him than meds.

Meditation can also be helpful. And I believe on the green I've seen comments from at least one person who found that drinking quite a lot of coffee was a game-changer.
posted by bunderful at 4:04 PM on March 31, 2018 [1 favorite]

Well I am not in Melbourne and know nothing of that scene, but a quick Google search uncovers quite a few resources including for example this specialist clinic.

But then you say it’s not as simple as finding someone who can assess and treat you, but also whether the treatment is covered or you’d have to pay for it. I know nothing of the Australian system. I will say I had to pay for my own diagnosis as the NHS wasn’t (I assume still is not) able or willing to deal with mental health conditions this complex. I paid for my initial diagnosis and followup and my GP at the time, who was quite vindictive, required me to have six-month checkups at my own expense. My current GP only requires annual checkups, which in practice means two years.

This is obviously somewhat tough to pay for, as it’s £160 a visit, and the early diagnosis stages will cost more if in fact you have to pay for them. However I like being able to drive, read, do each piece of work without requiring three redundant checks, and hold down a job that has something to do with my talents and preferences. So, I pay the cost the same way I pay for my dental checkups and glasses. There will come a point when I can’t afford dental checkups or glasses or ADHD checkups, and I will just have to live with severely curtailed quality of life when that day comes. Until then I pay for my healthcare needs as best I can.
posted by tel3path at 4:21 PM on March 31, 2018

-Regular physically exhausting exercise, like weight lifting. (This sounds like general well being advice, but in terms of adhd management, it's definitely one of the most helpful things that you can do.)
-Fish oil/Omega oil supplement. (Adhd brains require double the reccomended amounts.)
-Phone reminders for like everything.
-If you can't get meds due to no diagnosis, ephedrine hcl taken with caffiene does help symptoms much in the way that the meds do. Bonus effect on mood, energy and weight loss.
posted by OnefortheLast at 4:59 PM on March 31, 2018 [1 favorite]

Best tip I know for cleaning up a room: Think of the room as being a clock face. The kitchen, for example: Designate the kitchen sink as 12 o'clock and start there, working around the room from 12 to 1, 1 to 2 and so on. I find this helps with the overwhelm because it specifies a starting place and a system for moving ahead, broken down into small chunks.
posted by MonkeyToes at 5:22 PM on March 31, 2018 [6 favorites]

I know you asked for strategies beyond exercise, but exercise really is a wonder drug for me. I also walk as much as possible beyond the exercise sessions. Walking and moving help focus my brain and allow me to think clearly.

I don't know if this is just a quirk of my physiology and unrelated to the ADHD, but I avoid the hell out of simple carbs and it makes such a difference. So much of the brain fog I used to experience was brought on by sugar, refined grains and other high-carby things. While I don't have a low-carb diet, I do hold off on eating even complex carbs and fruit till late in the day, when I don't have to be as focused.

Caffeine is good, being careful not to overdo it and trigger insomnia. I stick to tea because coffee amps up my anxiety.

I take full advantage of my tendency to do nothing...DO ALL THE THINGS. Some days I get a kick in the pants out of nowhere and I'm able to burn through everything that's been hanging out on my to-do list. It doesn't stop me from feeling guilty and haunted when I'm not actively working on things, though.

Related to the above, I try to gamify things to get through tedious shit. I make bets with myself to see whether I can finish x boring thing before the top of the hour, for instance, and that makes it into a fun race (sort of) rather than a slog.

Calendar reminders are a good thing, multiple alarms are a good thing, clocks in every room of the house so I don't lose track of time (someday I'll get it together enough to get a watch).

I've never been able to tolerate stimulant meds, and these are my coping strategies. Good luck!
posted by whistle pig at 5:38 PM on March 31, 2018 [10 favorites]

As someone who was screened and diagnosed with ADHD in my 40s, who took medication for a year and then stopped taking it, I would say the following:

1. Medication is useful, but it is not a magic bullet. In my personal experience, I found that the coping strategies I have adopted over time are more effective for managing my daily life. Medication allowed me to focus and stay on task with much less mental effort, but it wasn’t exactly good habits in pill form—I still actually had to stay on task and maintain a reasonably disciplined routine. Medication didn't magically grant me motivation.

I stopped taking medication for that reason, because the cost of the pills and the effort it took to get each month’s prescription—and the side effects, mostly muscle tension/stiffness, headaches and some other stuff—honestly outweighed the benefit. I can get much of the same benefit from caffeine.

2. I use whiteboards, lists that break down large tasks into small ones, and a lot of visual and auditory reminders to cue me. I have a whiteboard on my fridge, several reminders on Google Calendar, and I have to say I’ve found Amazon Alexa to be shockingly beneficial as well. I use Alexa to set reminders and timers, to play music and audiobooks while I’m working on things so I can keep my mind busy while I do tedious things like housework, and to manage my to-do and grocery lists.

All of these were learned over time and kind of out of necessity, but those are the things that keep me the most organized.
posted by Autumnheart at 5:55 PM on March 31, 2018 [2 favorites]

Also, a high protein diet. There's lots of research backing that up to look into as well. If you're finding it hard to manage that every day (I do), a protein powder helps.
posted by OnefortheLast at 7:53 PM on March 31, 2018

Legal pads and sharpies. One in every room in your house, one in your car, one on your desk. Fresh page every day with the day and date written at the top. Write down notes to yourself constantly.
posted by KazamaSmokers at 8:01 PM on March 31, 2018 [4 favorites]

Agreeing that caffeine, in whatever form you tolerate best, can be a helpful OTC workaround. There tends to be a sweet spot for this; a lot of people, anecdotally, seem to do best with around 250-300mg, or between 2-3 cups of coffee. You may do better with more, or with less. Depending on your treatment strategies for your comorbid stuff, this may or may not work. Consider broaching the topic with the person you're seeing for depression, maybe?

Specific life-strategies are going to vary a lot, and take a lot of experimenting. Try setting aside a day where you just keep a giant running list of all the things you feel like you need help with. Get super-granular with it! Everything from "life path" to "getting the dishes done." Then google "ADD Strategies" + [each single entry on your list] and make note of two or three approaches for each specific thing that seem most helpful for you. Then look and see if you notice a pattern emerging. This may help you narrow down what strategies to try first. Accept that this is going to be a process, though! The first two, three, or six things you try may not work. That doesn't reflect poorly on you! That just means you haven't hit on the right strategy set.

Some people thrive with lists. Some people (like me!) get anxiety about lists. Some people lose their lists or forget to keep them. Some people like gamified approaches like Habitica; others find them stressful. I have a friend who is doing really well by outsourcing a lot of mental load through Google Assistant (phone + a Home Mini device for timers and reminders and daily schedule check-ins); some people don't like that set-it-and-forget-it approach or find it invasive or don't like the privacy implications.

Focus and procrastination are two big issues for me. A combination of an organizer tab in my browser and a procrastination blocker help me. If you find visual tracking helpful, consider investing in some peel and stick chalkboard wall decals. You can't lose them when they're stuck on your wall, and you can find them formatted into calendars, or just blank for lists.
posted by halation at 8:27 PM on March 31, 2018 [3 favorites]

The "Eisenhower Matrix" + Trello have been life-changing for me since I discovered both a few months ago (via this comment).
posted by naju at 11:42 PM on March 31, 2018 [1 favorite]

(long shpeil ahead...)
While my situation doesn't exactly mirror yours, it's probably close enough for my input to be applicable. I'm bipolar depressive and have thought I have ADD because of major focus, concentration and cognitive problems; i was on disability and even applying for permanent disability because I struggled with even holding a job selling petfood, so I feel your pain on this one. It's very worrisome and embarrassing and blows overall.

There's a few things to consider, one is that even if you get a diagnosis of ADD or ADHD, the doctor may refuse to put you on ADD meds since they're usually basically speed, which can tip you into mania. I was desperate for something and my pdoc flat out refused to put me on Nuvigil or anything like it. OTOH, my friend who is bipolar did get an Rx, however, she was pretty tweaky and wired on it, so it was a mixed blessing.

Also, beware of excessive caffeine; it made me quite ragey and even manic (two double espressos a day so maybe that was it) but partly because it screws with your sleep.

One thing that you might consider is that anxiety and depression could be affecting your focus, concentration and cognition. Or your meds. Latuda supposedly has cognitive benefits, while Topomax is notorious for affecting cognition negatively; also some of them make you fuzzy, like Lithium. Also, for me, anxiety was really impairing my ability to think on my feet & recall even the simplest things; it's easy to overlook because it's not the panic attack variety with hyperventilating/heart attack sensations, but an overall baseline of chronic anxiety, which is common with both bipolar and depression. The good news is that it's easily remedied; Buspar made a world of difference. (Avoid benzodiazipenes like Xanax and Klonopin, they will make you spacey and can be addicting). For me, chronic anxiety would make my brain lock up under the slightest bit of pressure, and it also revs up my thinking so I'm not following trains of thought well.

Hypomania can be similar when your brain starts to move too fast and flits around. While I haven't been diagnosed as ADD, I do things like interrupt my own trains of thought! So while it's not official, clearly something's going on there, but I don't think you need an official diagnosis to address the symptoms, apart from a prescription for the condition. You can even just ask your doctor about treating the symptoms without expecting a diagnosis; they may just adjust your regimen just the same. And look up side effects for all your meds; doctors don't know everything about every med and they miss a lot, in my experience.

Also, while this isn't good news to hear, both depression and bipolar can affect cognition and concentration. It's not talked about much, but it could be a side effect of the illness itself. In that regard, just increasing an antidepressant (carefully of course) with a cognition-neutral stabilizer like Latuda might be good.

A couple of other remedies are nootropic supplements, but always run them by your doctor first; many have ingredients that can cause mania (if you're bp 1 you should probably avoid this stuff altogether). I used this one and while it's not a wonder drug, I did notice a difference.

I'm also trying this workbook on living with ADD that has exercises to help work around it. I haven't really applied it yet so I can't say if it works or not but it looks like a non-risky strategy, as your bipolar will be tricky to work with in terms of chemical solutions.

Another thing to consider, especially if you have bipolar one, is that cognition can be affected pretty heavily after an episode. So there's that fun fact, too.

When I was recovering after a particularly bad spell of under-functioning, one thing that helped me get my focus into better shape was reading easy material like children's books, or easy to follow stuff like Stephen King. It gave my mind an easy task to follow so I could retrain it and feel less overwhelmed by more demanding material that I couldn't follow, thus increasing the anxiety that probably caused it in the first place.

But hopefully, as you address some of these situations individually, things will improve overall since there is so much overlap & interplay between factors, ie depression makes you foggy, which makes your concentration and performance suffer thus you feel even worse about yourself, etc etc. Some of these things are a slippery slope but hopefully with a multi-factored approach you can get things under control.
posted by GospelofWesleyWillis at 11:56 PM on March 31, 2018 [2 favorites]

Ways to treat your ADHD brain chemistry without a prescription:


3g/day omega 3, preferably with a high EPA:DHA ratio

Moderate amounts of caffeine

Generic modafinil from an online pharmacy
posted by Jacqueline at 2:06 PM on April 1, 2018 [2 favorites]

A smartphone was a revelation for me. Google calendar, GMail and Wunderlist particularly are useful as records I have on me at all times, on my phone and on any other device. Any time I make an appointment, it goes in the calendar. Any information in any email I've ever had is accessible. Anything I need to do goes on the to-do list.

The things I've found most useful are essentially plotting against myself. I know I'm good at forgetting things, so I set myself up so that it's impossible. Anything I might need goes in a bag that I take everywhere. If I can't remember things in my brain, I can remember them with my phone.
posted by spielzebub at 2:38 PM on April 1, 2018

Something that's worked really well for me is a fitbit with silent alarms turned on. I have silent alarms to remind me of such mundane things as my bus leaving in the morning or that it is lunchtime. It's super easy because it doesn't require active management.
posted by sometimesmasc at 9:58 PM on April 1, 2018

Something else I've seen recommended by people who say it works for managing their ADHD is a regular practice of meditation. Which makes sense: it's basically regular practice in actively focusing. It's on my list of things to day...when I remember to...
posted by telophase at 10:10 AM on April 2, 2018

If you've been watching the How To ADHD videos you've probably seen this suggestion, but maintaining a bullet journal has been a low-key game changer for me in terms of not forgetting as many things and being able to see my monthly and daily to-dos in a better context than a traditional calendar. Don't let the internet trick you into thinking it has to be fancy--the basic structure is fairly easy to set up and maintain. This works well for me because writing things down helps me remember them, but if that doesn't sound like you, a phone calendar or habit tracker app may work better.

Also, when I actually remember to do it, the Pomodoro Technique does a pretty good job of helping me stay on task at work. There are a load of websites and apps for this, but really all you need is a kitchen timer.
posted by helloimjennsco at 11:23 AM on April 2, 2018 [3 favorites]

I'm struggling with this now myself. I've started a new job that seems to push all my ADHDish buttons, where in the past I've been able to cope reasonably in my professional life, at least, even if my personal life is a garbage fire.

Here is what seems to help for me...

1. Pomodoro Technique. I use this website. If I have to, I start the working phase a bit shorter than default, and the break phase a little longer, then gradually lengthen the work and shorten the break.

2. Writing important tasks down, obsessively. Every time I am assigned something or need to do something, I write it down and then carry the task forward to the next week if it doesn't get done. I use this book. I think a nice book with a nice pen makes this more appealing. So I have a bunch of pens that like scattered everywhere, that way I can always find one. This practice keeps me from feeling overwhelmed, since I can crack open my book and know exactly what I'm dealing with any given day.

3. Mediation seems to help me re-focus when I start freak out / feel overwhelmed / can't get on task. I use this app. This is kind of new to me but I think there's a lot of evidence backing it up. The app makes it feel more approachable / doable to me, and also prevents me from procrastinating by poring through different meditation options.

4. Going for a walk outside. Not a long one, just 10-15 minutes outside around the block a few times. No music.

5. This isn't strictly non-medical, but I feel like I'm having success with L-Theanine + Caffeine. I am taking it in capsule form, but L-Theanine (and caffeine) are also found in tea, especially black tea. The magical ratio for this seems to be 2:1 Theanine:caffeine. I expected the amount of caffeine in this to make me jittery and cranky, but somehow the Theanine seems to moderate the effects of the caffeine, so I'm left with a feeling of alert focus and the drive to do something, without feeling shaky and irritable. Again, if you don't want to actually supplement you can just drink lots of black tea and see if that does anything for you!
posted by ZeroDivides at 5:51 PM on April 5, 2018 [2 favorites]

Response by poster: Update: I saw a new psychiatrist a couple of days ago (needed to anyway as my current ones were only meant to be temporary) and she gave me a basic ADHD screening test, which she then replied with (paraphrasing) “no shit Sherlock”. (Apparently just my history was enough to convince her.) We’re trialing Ritalin - she wanted dex, but I was cautious as I’m very sensitive to medication and Ritalin’s a bit easier to get in this country compared to dex.

So much of the above is helpful, thank you! I swear by Google Calendar and go on and off with todo lists (they’re most useful for me for specific multi-step projects like travel; otherwise I’d Do The Thing but not remember to check it off).
posted by divabat at 5:17 PM on April 18, 2018 [2 favorites]

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