My Blog: ADHD Since 1978-

A new definition of ADHD?

I don’t I think we have an understanding of what ADHD is as a culture. It is the rare disorder that is named by its symptoms. I believe this falsely leads people to believe that its name encompasses all of its symptoms. This couldn’t be further from the truth. Or, perhaps, we just need to have a broader sense of what attention is. I find that most people think of attention as sitting still and paying attention to a lecture in school or getting through a meeting at work. But it is so much more complex than that. If you take into account the neurobiological underpinnings of ADHD, we could redefine it as a disorder of under stimulation. We are constantly at war with our intentions. We often lack the ability to execute on those intentions because of our lack of ability to focus on what we call non-preferred tasks. In other words, being bored is our kryptonite. it is hard to even explain to neurotypical people what boredom is like for the ADHD brain. Frankly, it is not unlike trying to explain what it is like to be chronically inattentive. Both of these facets of ADHD are also parts of the human condition. But there is a clinical and practical difference between how we as ADHD people experience them and what they’re like for the general population. Literally, when we are not stimulated, our brains shut off in certain meaningful ways. it can be a Herculean effort to simply do the normal everyday things that we find boring but neurotypical people take for granted. And that can significantly deplete our resources for the rest of life. so, as ADHD people, and for ADHD clinicians, I would suggest that a good metric for the severity of a person’s ADHD as…

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Owning my ADHD anger.

This is going to be a weird post, so buckle up. On the upside, I’m not sure anybody reads this after I switch platforms. So perhaps I’m just yelling into the void. I had a very interesting session with a younger client today. She’s a rising senior at a very prestigious university. One that I did not get into, I might add. She’s at somewhat of a crossroads in terms of trying to figure out what she wants to do with her life. In order to protect your privacy I won’t go into details. But I’ll say that she was planning to go into a certain profession. And I’m recently sure she’d be good at that profession. But I’m not sure she could survive all of the school necessary to get to the end result of being in that profession. the reason I bring this up is that it touched on a nerve for me. I don’t want to sound self-important or egotistical. But I have several rounds of neuropsych testing to prove how smart I am. And I’m considerably smarter than the average bear. But what does smart mean, if school is really hard? What does it mean if sitting still is not what you’re good at? What does it mean to understand things at a high level if you can’t produce the amount of work that’s expected of intellectually advanced students? What good is it to get a political science degree if you don’t want to sit behind a desk? Coincidentally, that last question is part of why I freaked out when I was at UMass many moons ago. And that’s also why I ended up pursuing culinary arts. Not that there’s anything wrong with pursuing that. And one could argue it was right for me at the…

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Reminder fatigue

We live in an amazing technological time. The tools that are at our disposal to help manage our lives and our ADHD are unprecedented. But, they don’t always work. Usually there’s a behavioral reason behind it. Or we may be using the wrong technology for the wrong purpose. Today I want to talk about reminders on your phone. Our cell phones are amazing tools to manage our ADHD and our lives in general. Possibly the best feature of having these amazing pocket size computers with us all the time is the ability to set reminders. And when I mean reminders, I’m talking about calendar reminders. Alarms are also useful. But I’ll probably talk about those in another post. When I think about reminders, I’m thinking about something very specific. I’m thinking about a specific event on your calendar, a thing that you’re going to do at a specific time, and the reminder for you to do that thing. When I talk to newer clients and suggest they set reminders for certain things they often tell me that they have lots of reminders but they just ignore them. Of course, some of this is behavioral. And that’s something we work on. But almost always there is a problem with how my clients are interacting with the technology that doesn’t set them up for success A reminder should be specific to the event/activity and should be customized to just the right amount of time before the event. This is the most important feature of reminders. Here’s are some examples from my life. My default reminder setting for work events is only 3 minutes. This makes most of my clients’ heads explode. But here’s why I have such a short reminder. For all my clients sessions, I’m at home working from my office.…

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Paralysis by analysis

You might find me to be one of the most thorough planners on the planet. Despite being a pretty emotional guy, I also very analytical. I rarely, if ever, make a move without planning, scheduling, and considering the consequences. But the reality of living on this planet is that we can’t always know everything we need to know to make “the best” decision. Furthermore, we can, especially in this day and age of having the entirety of human knowledge… and then some… at the tips of our digital fingers, very easily over research a decision. I know I’ve written about decision making in the past. Here’s a quick refresher of my feelings on the topic. Making any decision, large or small, is the perfect storm of Attention, Anxiety, Impulsivity, & Executive Functioning, particularly Working Memory. In short, everything that we suck at! Particularly of interest for today’s topic the the intersection of Anxiety and ADHD. The more afraid we are to make the “wrong” decision, the more we are likely to go down and endless rabbit hole of research or perseverate indefinitely without doing anything. I think it is really important to know that, for any decision, there may not be a right answer. Or there may be several. Regardless, we will come to a point where continued (productive) thought and research will either not yield anything helpful, will confuse the issue more, or will throughly demonstrate the concept of the law of diminishing returns. In short, we have to have the confidence to gather the information that we can, what is reasonable at least and then “pull the trigger.” We have to trust ourselves to make the best choice, given the options, given the information available. And we have to accept that it isn’t always going to work out…

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How to handle, “What to do now?”

I am happy to report that life has started to lighten up a little bit, finally, after 3 or 4 years of intense challenge. Not that it’s Sunshine rainbows and unicorns. But things are good. Most of that has to do with my kids being reasonably stable. Or at least feeling like there’s a path for them. I spent a lot of the 6 months previous not posting very often. And part of that was being completely overwhelmed by what was going on with the kids. Businesses also been going well. Which is a good thing. But it’s not so much that I didn’t have the time to bang out a quick blog post. It’s more that I didn’t have the bandwidth. I continued to schedule blog posts while I wait in the car for my son at dance class. But I stopped doing it. I just didn’t feel up to it. but, as things have gotten better, and being the constantly introspective guy that I am, I realized that there’s more to why I’m not posting. So even now that things are better and I’ve got more bandwidth, I realize that I don’t have as much to say. I think when I logged in today it showed 467 posts. That is a lot of mostly unique ADHD content with a little bit of repetition, some intentional, some probably not intentional, and with some thoughts on other issues mixed in. I’m certainly not saying I know everything about adhd. But I am saying that I know a lot and I’ve written a lot. It’s not that I don’t have any new ideas. I have some ideas that I save for my clients and don’t post on my blog I have a lot of ideas about co-occurring conditions. I’ve done a…

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Success, failure, progress, learning experiences & a positive mindset.

Nothing gets us moving faster than running away from something. But in my experience, as soon as the scary monster over our shoulder isn’t right behind us, we ease up on the gas and don’t push much further. To really achieve your goals, I think it’s particularly important to have a vision of what you’re pushing for. This might sound like a semantic distinction. But I swear to you it’s important. And it helps create a positive growth mindset. I was working with a client today who had made a lot of progress in two specific areas over the previous week. Yet, when I asked her how she was going to maintain her progress and maybe take it to the next level, her answer was, “Don’t F*** it up.” In this one simple phrase she managed to wipe away the good feeling of her accomplishment this week and frame her success only in the negative idea of screwing it up again. When I pressed her on this negative outlook, she managed to say something positive briefly and then circled back to, “not doing anything stupid.” That negative mindset born out of frustration, fear, failure, and less than stellar self-confidence was really entrenched. And this is after she had a really good week! I can only imagine how down she gets on herself when it’s a rough week. I’m not suggesting that we should be pie in the sky optimists. But when we want to make a behavioral change, it seems to me that the best course of action is to develop a picture of what we want and work towards it slowly but steadily. Of course slow and steady isn’t a straight line. But if you pull back and look at the world view consistent progress over time is pretty…

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Overlapping symptoms.

First, I’d like to apologize to my regular readers for being MIA for a bit. The reason will become apparent during this post. Second, I will admit that I have lost track of a lot of the topics that I’ve written about. I think I’ve been writing this blog for about 7 years. So I’m probably going to start repeating myself. I don’t think anyone is quite avid enough of a reader to notice. But I wanted to name my own anxiety about treading the same ground, which is probably been one of the reasons that I’ve struggled to post lately. Based on many reliable studies, up to 80% of ADHDers have been shown to have at least one comorbidity. If you have ADHD you are more likely than general population to have asd, depression, anxiety, tourette’s, bipolar, and pretty much any other diagnosable psychiatric condition you can think of. Not to mention other things that are psychiatry adjacent like sleep disorders. The most common are depression and anxiety. Though they don’t always come together, they very often do. The problem is that the symptom sets overlap quite a bit. It can often be difficult to tell what psychiatric conditions someone is suffering from as well as to tease out how effective treatments are when you know you’re dealing with more than one. Let’s take anxiety, for example. We know that ADHD and anxiety are very often comorbid. But, we also know that untreated ADHD is likely to make a human being anxious. Untreated ADHD is also likely over the long term, to make a human being at least mildly depressed. So how can you tell if the anxiety is caused by the ADHD or a separate condition? The same for depression? Of course, there’s no cut and dry answer…

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under selling attention as a society as it relates to the stimulant shortage crisis

I have seen a lot of things change in the almost 35 years since I was diagnosed with ADHD. Almost all of them have been for the better. There was a lot of, “I don’t believe in that, that’s not a real thing.” When I was younger. Seriously, people would have no problem telling me that to my face when I was like 13 years old. I think this is one of the reasons that I so strongly identify with lgbtq+ folks. Despite growing up white, suburban, and reasonably privileged, I was pretty consistently and fundamentally told, “No, you’re wrong. You’re not actually right about what your experiencing. I know better than you. As a matter of fact, in fourth grade, one of the two teachers had a master’s in special Ed. So they gave her all the kids with adhd. The first week of school in an IEP meeting she told my parents she didn’t believe in it. That was one of the worst years of my life. I still get a lot of, “I think we all have a little bit of that.” And this is progress. But it’s kind of sinister in its own way. It’s really a way of unpathologizing a legitimate medical issue to a matter of severity of something normal that everybody deals with. That would be like if you told someone you were clinically depressed and their response was, I know everybody gets depressed sometimes. No. Everybody doesn’t get clinically depressed sometimes. Everybody gets sad sometimes. Everybody gets anxious sometimes. Everybody has a hard time being in charge of their attention sometimes. But that doesn’t mean they have clinical depression, generalized anxiety disorder, or adhd. There are clinical standards for these particular psychopathologies. When we don’t distinguish them from everyday feelings we do…

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ADHD & Anxiety & Depression

I subscribe to an ADDitude newsletter for ADHD professionals. It’s not super sciencey. Frankly, I often wish it were more in depth and cited the actual papers so I could at least read the abstract, conclusion, or methodology. But, I guess it is what it is. But the thing that baffles me is how little new is reported from reportedly new studies. I’ve been an ADHD professional for 12 or so years. I’ve been a person with ADHD for 44 years. I’ve know I had ADHD for about 34 years. And, I’ve done my best to learn about ADHD in one way or another for about 20 years. And I’ve taken part in studies on ADHD since I was 12. So, I know a lot about ADHD. I keep reading article that announce finding of stuff I already know like it’s new news. I understand that we need to build a concensus in science and medicine. But, maybe use the word “confirms” instead of “determines?” Today’s take away from January’s ADDitude for Professionals: “As many as 80% of adults with ADHD have at least one co-existing psychiatric disorder.2 According to a recent ADDitude survey of 1,500 readers, anxiety and depression are the two most common comorbid conditions diagnosed alongside ADHD in adults, with co-diagnosis rates of 72% and 70%, respectively.” I’ve been telling my clients this for over a decade. There have been scores of studies to prove it. Who cares about an anecdotal sample of a very specific 1,500 readers? But they are the two most common comorbidities. That’s been established for years. We all benefit from the prodigious amount of research done on ADHD. But, let’s break some new ground? Or maybe I’m just getting old and cranky?

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Overcompensating for our ADHD traits

whether consciously or unconsciously, many of us identify pretty early in our lives some of the ADHD trades that we would like to minimize or eliminate. It might be impulsivity, disorganization, being late, or any number of other things. Of course, there are trades that we can’t control. Otherwise ADHD wouldn’t be a legitimate diagnosis and we could just “try harder.” but there are usually some things about ourselves which, through sheer force of our will or because of overwhelming anxiety, we can work very hard to get better at. But I think we often overcompensate. It can be helpful to recognize that it can be healthy to realize our achievements and our progress and come back to a constructive middle ground. in an effort to be less esoteric, I’ll give you a couple examples. A prime example in the area of impulsivity is spending money. I think many of us have had issues with impulsive spending at some point in our lives. My dad used to tell me that money would burn a hole in my pocket when I was a kid. Not that I couldn’t delay gratification and save up for something if it was really important. But most of the time I’d spend it as soon as I got it. as I got diagnosed in medicated, as I got older and more mature, as I recognized what I wanted to improve about myself, I worked hard to be less impulsive with my spending habits. I worked to delay gratification. I worked differentiate between want and need. But all that’s easier said than done. And to a certain extent, I developed a lot of anxiety about spending money. Of course this was some time ago when I realized it was an issue. I’m not sure we were fully…

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Getting Back on the Horse

So I had covid about 4 weeks ago. I was really really sick for about 36 hours. And then reasonably sick for about a week after that. I was also stuck at home with a disregulated not very sick but covid positive 8 year old. There’s also a lot going on in my household in terms of mental health with both of my kids. And thankfully, business is good. So I’ve been digging out of the covid hole for the 3 weeks since. But I would be lying if I said that that was the only reason that it’s been a month since I posted a blog entry. If I’m completely honest, the further away I get from posting the harder it is to start again. I know this about myself, so I know that it’s not going to be a forever thing. But, there is a psychological barrier to coming back after not posting for a while and not putting in a particularly robust effort. So I make more of it than I need to and it gets a little harder to do. And then the longer I wait the better I feel it needs to be. And then it makes it harder to do. Quite the vicious cycle. Many years ago, this is the kind of thing that would have derailed me for quite some time and could have been the thing that truly broke a habit. This is the kind of thing that plagues many of my clients when it comes to consistency on any number of topics, including writing, working out, self improvement, mindfulness, whatever else you can think of. So I decided that the best way to get back into posting was to post about getting back into posting! Step one is to take the…

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meet yourself where you are.

It’s a principle of management. It’s a principle of parenting. It’s probably a good principle of conflict resolution. It’s a cornerstone of good teaching. You have to meet people where they are. But I find that my clients consistently forget to meet themselves where they are. As ADHD adults, we tend to be harder on ourselves than anybody else’s. Which is funny because the rest of the world often thinks that we don’t care and we’re not trying that hard. But the reality is that every little failure, mistake, misstep, or faux pas, whether real or imagined, it’s just another opportunity for us to beat ourselves up for our shortcomings. I’m not saying we don’t need to work on ourselves. I’ve more or less made a career out of working on myself and then teaching others to do the same. I think working on ourselves is an essential part of being a good human and a happy human. But understanding how to work on yourself in a productive and self-loving way is so important. if you constantly have expectations for yourself that are unrealistic you will consistently set yourself up to fall short, experience failure, and not succeed in the way you want to. But if you set realistic expectations for yourself and focus on succeeding that can be a foundation to be a little bit better and then a little bit better and then a little bit better over time until you’ve reached the place you want to be, even though you’re not there yet. I joke with my clients that my success in life is based on setting a low bar. The reality is, I think my success is based on setting a realistic bar, achieving what I can, and then figuring out how I can raise the…

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