Tuesday, September 7, 2010

Adult ADHD and "Time Blindness": Dr. Russell Barkley's Tactics for Taming That Trickster, Time

Time.  That's one word that always makes the top of the list when I ask adults in our local CHADD discussion group to name their top ADHD-related challenges.
  • Keeping track of time.
  • Estimating the time it will take to complete a project.
  • Planning for future time instead of getting totally wrapped up in present time.
Managing time is a constant challenge for most humans, especially in our speeded-up age. Yet, for people with ADHD, time can be a particularly shape-shifting trickster

No one knows this better than psychologist Russell Barkley, a preeminent researcher, lecturer, expert, and author in the field of ADHD. And no one better explains to the layperson why this is and what to do about it than does Dr. Barkley in his new book, Taking Charge of Adult ADHD

The following excerpt, from Chapter 10, offers tips for taking charge of your time. Earlier chapters build a strong foundation for understanding ADHD neurobiology and guidelines for medical treatment; remaining chapters offer straightforward but in-depth strategies for tackling your particular issues in various areas of life. 

Tuesday, August 3, 2010

The "Invisible Ropes" of Adult ADHD, And How A Special Type of Therapy Can Help Set You Free

Introduction:  When I'm asked about the best kind of therapy for Adult ADHD, I explain that the research thus far points to cognitive-behavioral therapy (CBT), in combination with medication.  Then I emphasize a critical point: not just any CBT but that with a special focus on ADHD
      Standard CBT that does not acknowledge the neurobiological role of ADHD can be counter-productive, at best.  How do I know this?  Because I listen to the top experts who make this study and practice their life's work. 
      I'm pleased to offer a guest essay this month from one of these top experts: J. Russell Ramsay, psychologist and co-director at the Adult ADHD Clinic at the University of Pennsylvania. (Please see bio at the end of this post).  In preparing my talk for the upcoming CHADD 22nd International Conference on ADHD ("Adult ADHD Symptoms or Poor Coping Skills?"), I relied heavily on the book he co-authored with Dr. Anthony Rostain (see below).  
      The conference will be held in Atlanta this year, Nov. 11-13.  I cannot overemphasize the wealth of knowledge, validation, and support to be gained at this conference. If there's a possibility that you can attend, try your hardest to get there!  Sign up by September 15, and receive the early-bird discount!   --Gina Pera

By J. Russell Ramsay, Ph.D.

Circus elephants are trained while secured with ropes until they are subdued. Trainers then teach them to perform tricks for audiences without the use of restraints. No less powerful than when they were in the wild, these elephants are held back by the invisible ropes of their training.
      Growing up with ADHD, particularly when it has gone undiagnosed until adulthood, makes it very likely that adults with ADHD have encountered their own “ropes” in life, such as academic trauma, ongoing troubles handling the demands of daily life, or hurtful criticisms made by others. Although their circumstances may change in their adult lives, these experiences may have trained them to hold negative attitudes about themselves and their future.

Tuesday, July 6, 2010

John and Abby: Solving the "Problem with No Name"

This July 4, my husband and I celebrated our 12th anniversary.  Compared to couples married 30, 40 or even the 50 years of my parents' marriage, 12 years is hardly remarkable unless you figure in unrecognized ADHD.
     As I joked to my friends on Facebook: "We can credit the fact that we're still married—and happily so—to equal parts brutal honesty, teeth-gnashing, affection, shared interests, sense of humor, and inertia."  
     Mostly, though, we can credit keen ADHD awareness. To see our wedding photo and read my interview with a reporter from Health.com, click here. (Notice in the photo that I am clearly in the dripline of the double-umbrella my new husband is holding; let's just say that is rather symbolic of the early days of our marriage, when his ADHD was flying well beneath the radar screen yet still having an impact.)
     In many ways, we are like the couple whose story I share below, John and Abby, excerpted from Is It You, Me, or Adult A.D.D.?:

Thirty years ago, at age 13, John set his sights on becoming a computer scientist. Despite almost flunking out of high school, he went on to earn his doctorate. It required Herculean effort, though, and tanks of ulcer-inducing coffee, not to mention a tunnel-vision focus that eclipsed a social life and other healthy habits. [Note: That's a caffeine IV in the illustration at left.]
      Sure, John noticed that other students, many less intelligent than he, didn’t suffer concentration problems like his. But he thought it was just his nature, something unchangeable. Upon finally leaving academia’s structure for the business environment, John found himself constantly on the outs with managers for missed deadlines, miscommunications, and an uncooperative attitude.   

Monday, May 31, 2010

Adult ADHD is Real: But How to Convince the Unconvinced?

Living with unrecognized ADHD, in a loved one or in oneself, can feel like being lost in the fog—often on a roller coaster.
      “I hope others can be spared from stumbling through the fog like my husband and I did,” Edith says. “For our first 25 years together, I thought Joe was lazy or selfish or both.”
     Edith also wondered if she was failing as a wife because she had so little success in motivating Joe to be more cooperative and thoughtful toward her and the children. At times she chalked it up to she and Joe marching to the beat of different drummers. “For years, I went back and forth in confusion, with no idea that adult ADHD existed,” she says. “Then he was diagnosed at age 55.”
     Adults with ADHD also use the fog metaphor, including this woman, who was diagnosed at age 52:

I don’t quite know how to describe my life to people who haven’t experienced ADHD the way I have. Imagine driving a car in heavy fog. You get tense, because you can’t see the edges of the road or what’s in front of you. In other words, you often can’t see how your actions will result in predictable consequences, which instead seem to come out of nowhere. 
So you inch along, gripping the wheel, anxious that you’re going to crash into something.That’s how my life was for a half century, until I figured out ADHD. Few people other than my family members would have guessed I had ADHD just by looking at me or talking to me. I worked hard to “pass for normal,” had earned some impressive college degrees, and had tons of plausible excuses for my goof-ups.
When I started taking the stimulant medication, though, the fog suddenly lifted and the road ahead was clear. I could relax my hold on the wheel and enjoy the drive. I could even appreciate the scenery without worrying that I’d get distracted and run off the road. The things most people take for granted, most people with ADHD struggle over for years until they figure out they have it.

Until now, perhaps you have been slogging through serious mental fog, not understanding how your life got so confusing. Even if you have learned about ADHD, maybe you harbor concerns or misconceptions about the validity of the diagnosis or the safety of the medication that help treat it. You are not alone. Everything about ADHD seems to cause confusion, including its name, until you get the facts.
      Below are five statements or questions I sometimes hear from skeptical partners of adults with newly diagnosed ADHD (and, phrased slightly differently, from some adults with ADHD themselves). So, let's take some time to debunk each one.

Monday, May 3, 2010

Pt. 2: When a "Good News" Diagnosis Means Bad News for the Relationship

Years ago, when my husband first agreed to be evaluated for ADHD, he did it on one condition: that I be evaluated for it, too.  

Whether he simply disliked being singled out or truly thought me ADHD'ish remains lost in the mists of time and perhaps distorted perception. 

My guess: He simply wasn't connecting the dots between his actions and my reactions. From his perspective, my reactions seemed to come irrationally flying out of nowhere. 

From my perspective, of course, my reactions were entirely justified. But could I be sure? No.  

Beside, something had to be up with me if I continued to "ride the rollercoaster" of miscommunications, conflict, agreements gone kerflooie, and so on.  So, I happily agreed to join him in a professional workup.           

Two lengthy evaluations later, my husband was diagnosed with ADHD and I was not. Instead, the psychiatrist pronounced me "complex" and said, "We usually recommend that our patients with ADHD have partners who are organized and can take care of practical matters."

It took me a minute to comprehend: Wait, you're prescribing ME for my husband? 

(What might this nationally known clinic prescribe if my husband didn't already happen to be married to an organized  person. Divorce? A professional organizer love-match-making service? I was too stunned to ask.)

For the next few years, we endured some head-spinning confusion as we struggled to understand and smooth out the dynamics between 

  1. Our "personalities"
  2. Our respective neurons, and 
  3. Various permutations thereof 

During that tumultuous time, an outside observer might have been tempted to diagnose us with a smorgasbord of conditions. And, at some points, we certainly would have agreed. 

Fast forward several years. My husband still has ADHD, though most of the time it's now more of a "difference" than a big deal. I still don't have ADHD, as my husband will confirm. 

I'm not perfect. Who is? But these days I'm much less confused, anxious, depressed, and reactionary than I used to be—back when the ADHD Roller Coaster ran full tilt and neither of us knew why. We've both made big changes.

Our story will resonate for many couples affected by unrecognized ADHD. That is, once the ADHD was diagnosed and addressed in a cooperative way, the rest of their challenges were more easily targeted and resolved. That truly made ADHD a "good news" diagnosis. 

For other couples, though, reaching the ADHD diagnosis creates more questions about the relationship's dysfunction than it answers.  That brings us to Part II of why the good-news diagnosis of ADHD sometimes means bad news for the relationship.

Recap Pt. I: Good News/Bad News

To recap Part I on this topic from last month (click here to read the entire post):

       Newly diagnosed adults with ADHD begin treatment, often including medication, and soon the "fog" of distractibility, impulsivity, and inattention begins dissipating.  With newfound clarity, many of these adults start re-examining their choices – job and career, friendships, health habits, and sometimes even their mates.
      Frequently for the first time in their lives, adults feel solidly optimistic about their ability to evoke permanent changes; after all, they finally have the right answers and right tools. As they excitedly embrace new competencies and confidence, though, inevitably the "balance of power" in their relationship starts shifting.
Jack provided our case study in Part I. Newly on board with ADHD treatment, he expressed bitter resentment over what he felt was his wife's abject lack of appreciation for his stellar progress. He concluded she had unacknowledged problems of her own,  including a drinking habit that had grown increasingly problematic over the years. Last I heard from him, they were headed to divorce.   

Last month, I offered a few reasons why Jack might not be seeing his wife's side of things and might even be misperceiving his level of progress. 

The post-ADHD-diagnosis phenomenon is a big and complex topic, full of surprising twists and turns.  

For example, sometimes the partners of adults with ADHD go a bit ballistic when the diagnosis finally is made. This typically occurs when they've long struggled to, as I explain in my book:  "Explain the inexplicable" and "manage the unmanageable" around a partner's unrecognized ADHD symptoms. 

When these "partners of" finally learn that not only did their mate's problematic behavior have a name, it also had a solution, their reaction might be akin to a psychological pressure-cooker blowing its lid. 

They think back to all the years of 

  • Frustrating therapy sessions
  • Futile and ever-changing "accommodations" for their partners
  • Being blamed by their partner for being "too controlling" or  "fill in the blank."  

They might finally understand how they developed a drinking habit to compensate, or why they developed an "anger-management" problem.

The resentment might ratchet up by an order of magnitude if the psychiatrist or therapist suddenly expects them to continue being their ADHD partners' executive assistant without ever acknowledging past hurts or their own need for help.  And if they don't immediately get on board, they are labeled "uncooperative." All of these are common scenarios.

Yet There Is Another Scenario

Another equally possible scenario for Jack is that his wife's dysfunctional behaviors had long flown under the radar screen. Those behaviors had in fact been lifetime problems for her. He simply had been too "disconnected" to notice before marriage or after.  With treatment, though, he was noticing and dynamics were shifting.

Last month's post drew a comment from Katy, who writes about Adult ADHD at the 18Channels blog. She explained how her ADHD diagnosis had a similar bad-news effect on the relationship but a good-news effect in the end:

Bad news: It was one catalyst for the end of the relationship I was in when I was diagnosed...but that relationship wasn't a good fit for me or him anyway. 

He was a nice guy with a little toxic caretaking streak that even pre-diagnosis I didn't need imposed upon me. And frankly, some of my ADHD quirks were a little stressful for him to live with...duh :) He was far too rigid in his routines for me to be able to accommodate.

My diagnosis process made him appreciate me as someone who was working hard to take responsibility for their whole selves...but that didn't change the fact that my whole self wasn't a good fit for his whole self. Plus, he was using my eccentricities to hide behind, so he didn't have to deal with his own...!

I think we're both better off having split up. I got tired of being "the person with the problem" and he got tired of stepping over the garbage can to get to the front door. (Hey, what can I say, I need visual cues).

Good news: I met the love of my life (sappy, sappy, sappy...but TRUE!) after breaking up with the other dude. He has ADHD too. We absolutely adore each other, and aren't one bit annoyed with each others' ADHD quirks. Half the time we don't even notice each other's ADHD quirks, the other half of the time we're delighted with them.

I find it highly amusing to watch him wandering around doing some of the exact same funny things that I do to myself all the time, it's so funny to see it from the outside! Ex: today he tore the house apart from top to bottom, looking for his W-2. 

He says "I just know that I put it somewhere allegedly safe, and I have no idea where that might be!" Every year I lose my W-2's, tear apart the house, and say exactly the same thing. We really need to stop putting things in safe places! I just gave him big hug.

As Katy's story illustrates, one person's ADHD diagnosis and treatment can "level the playing field" in the relationship.  In other words, it allows the couple to more clearly assess compatibility beyond the obvious level of, for example,  "I'm disorganized and he's very disorganized." 

Moreover, the diagnosis ups the ante on the other partner "copping" to any dysfunctional behavior of his or her own instead of, as Katy points out, hiding behind a partner's dysfunction.

Katy made those observations several years ago. As time went on, her joy at being with someone who shared her challenges instead of judging her for them—or trying to control her—was tested. She still loves her husband. Yet, while she has expended considerable effort in managing her own ADHD symptoms, her husband came to the diagnosis more slowly, with  more resistance. And, with more household chaos and tension along the way.  

In other words, a dual-ADHD household doesn't get along magically, because the couple understands each other's challenges. Rather, each can intensely feel the impact of the other's ADHD-related challenges, if not actively managed.

When The "Partner Of" Has ADHD, Too

Using the term non-ADHD partners to describe the partners of adults with ADHD  never made sense to me.  For starters, what if they have ADHD, too?  Happens all the time.

[That is one reason I asked my friend Taylor J, who is in a dual-ADHD marriage, to lead the discussion in the "You, Me, and ADHD Online Book Club."]

But what if these folks don't know they have ADHD? 

Given the millions of adults with  undiagnosed ADHD, of course it's possible. Moreover, it figures that the partner with the most obvious or extreme ADHD symptoms will be diagnosed first while the other might come to it only years later. Or never.

Over the years of moderating support groups for partners of adults with ADHD, I've often wondered if certain members themselves have ADHD. They are the ones who, over long periods of time, continue to report no progress on the home front. Of course, they could be dealing with particularly difficult partners.  But they also tend to be the ones who keep repeating the same problems and asking me the same questions, never seeming to internalize the information and take action. Yes, they quite possibly could have ADHD, along with their partners.

[Side note: I also see this phenomenon among some parents of children with ADHD who don't seem to notice they might have ADHD, too. Or, they minimize their challenges.]

Some eventually do figure that not only they, but their partners as well, have ADHD. But, in my observation, it typically happens  months or even years after a partner's treatment starts to stabilize. 

In other words, when the dust finally begins to settle—when they're not constantly being drawn into a partner's ADHD-related crises and dramas—they (or their therapists) can more clearly perceive their own contributions to the problems in the relationship. 

Finally, they can start separating years of poor coping mechanisms (in reacting to a partner's unrecognized ADHD symptoms) from their own lifelong challenges.  

I receive many letters from readers of my book, Is It You, Me, or Adult A.D.D.?  As you would expect, many are written by the partners of adults with ADHD. Surprisingly, though, most letters come from adults with ADHD. 

Peter started out in the former category but over time also found himself in the latter. To read excerpts from his series of notes to me (posted with his permission), click here.

What The Research Tells Us

The anecdotes from Katy and Peter above are just that: anecdotes. They are not statistical probabilities; they are simply possibilities. When it comes to the mental health of partners of adults with ADHD—newly partnered or in longstanding relationships—anything is possible. 

That hasn't stopped the pundits, however, from issuing often-repeated stereotypes about the partners' psychological makeup or personality, including
  • They have ADHD, too
  • They have low self-esteem (because they stay in a troubled relationship or can't seem to improve it)
  • They are "sadistic and controlling" (in the words of a well-known psychiatrist who himself has ADHD)
  • They are boring "muggles" (in the Harry Potter book series, a muggle is a person who lacks any sort of magical ability; the implication being that people with ADHD are magical and people without are boring)
Trouble is, such certainties are based purely on bias and conjecture even when issued by alleged experts, as they regrettably often are.
First, consider these  facts:

  1. ADHD affects an estimated 10 to 30  million adults in the U.S. alone.
  2. ADHD is a syndrome with highly variable traits and myriad co-existing conditions
  3. There's much more to a person's complexity than variable ADHD symptoms.

In short, we cannot make any one-size-fits-all pronouncements about adults with ADHD. How then can we possibly do that for their partners, past or current?
Second:  We cannot assess the partners' psychological characteristics without also considering the end result of living with a mate's undiagnosed or untreated ADHD symptoms—sometimes for decades and sometimes while also raising children with ADHD. 

Sure, we can make anecdotal observations how the partners typically seem now, a few months or a few decades into these often high-stress relationships.  But what were they like before a few spins around the ADHD Roller Coaster? And what about the partners we don't even see in support groups?

Research is extremely limited on this topic, yet there are two small but important published studies from well-known researchers that shed some light. And there is the ADHD Partner Survey, which examined this topic from several angles.  

First, the published research:
  1. The psychosocial functioning of children and spouses of adults with ADHD found that "overall, spouses of ADHD adults show no more lifetime and current psychiatric disorders than spouses of comparison adults, challenging the concept of selective mating. They do, however, report more psychological distress on the SCL-90-R and less marital satisfaction."
  2. The marital and family functioning of adults with ADHD and their spouses – found that the spouses of adults with ADHD did not differ from the control group in terms of psychiatric health.
      The ADHD Partner Survey queried respondents about the state of their mental health both before and during the relationship. The goal for this part of the survey was to differentiate between baseline mental health-conditions (prior to relationship) and the psychological impact of living with a partner's unrecognized ADHD symptoms. 

The picture that emerges (see chart below; for larger image, click here) is of a diverse group who bring to these relationships very different backgrounds and mental states. No surprise there.

It seems the only accurate description we have for the partners of adults with ADHD is this: They live with (or used to live with) a partner who has ADHD. After that, anything is possible and no one-size-fits-all characterizations are useful.

How about you?  Are you in a "mixed" relationship  -- meaning, for example, one of you has ADHD and the other depression or bi-polar disorder? 

Or maybe you both have ADHD but different sub-types? If so, when were you diagnosed -- before the relationship, during, or after? Please share your thoughts and experiences.

—Gina  Pera

Tuesday, April 6, 2010

When a "Good News" Diagnosis Means "Bad News" for the Relationship, Pt. I

We often call ADHD a "good news" diagnosis. Why? Because it offers not only a long-elusive rational explanation for vexing behavior but also effective treatment strategies.  

So, why does a "good news" diagnosis sometimes mean "bad news" for the relationship. That's the topic of this two-part post.

     The reasons run the gamut—and are as complex as the individuals involved and their history together. Let's begin with an e-mail sent to me by a reader.  His situation illustrates a very common example of the ADHD diagnosis and treatment creating new challenges even as it resolves old ones. 

Jack Celebrates His Success: 

Why Can't His Wife? 

Consider Jack, 42, married 12 years and diagnosed nine months ago:

It took about six months for me to get on board with medication, and the doc and I haven't worked out all the kinks yet in that regard. 

But let's put it this way: Before I started taking medication, I was often criticized for being hyper, loud, disorganized and easily distracted. Since the medication, I hear myself as I sound to others and so have much more sensitivity to my own volume. 

I am also now more aware of my tendency to rant. A good argument used to be like food to me.  Now, I don't have to be in the ring with every discussion, and I can focus normally on a discussion that I am engaged in.   
So, between medication and therapy, I feel my approach to life has changed dramatically.  I'm also better organized, more focused, and doing better at work.  But has all this helped my marriage?  That's the big surprise. The situation at home has actually gotten worse in many respects. 

Tuesday, February 2, 2010

When ADHD is All in the Family

What happens when it's not just "you or me" who has ADHD but you, me, and a few of the children? (And maybe the dog, too!)

This month's post is written by Cynthia Hammer, MSW, an advocate who has long and admirably served the ADHD community in various capacities. She is currently an AD/HD coach in the Seattle area as well an avid bicyclist and mother of three. As a longtime fan of her work and her compassionately insightful writing, I'm honored that she agreed to share this essay with you here.   -- Gina Pera

We existed as a family for over 15 years before realizing some of us had AD/HD. How did we do it? Although life post-diagnosis and treatment still isn't always easy, I look back in wonder at what we went through in raising our children and maintaining a family life. Actually, a review of our life has been helpful as I say to myself, "You've come a long way, baby!"

In our family, the mother (that's me), was diagnosed with AD/HD along with my middle son (without hyperactivity) and youngest son (with conduct disorder). Our oldest son does not have AD/HD, while word is still out on the father. I have "diagnosed" him with AD/HD, but he refuses the diagnosis.

Tuesday, January 5, 2010

Out With The Old, In With The....Wait, Do You Really Need New Clutter?

There Janet was, peacefully washing dishes one evening, when suddenly a loud thumping and banging sounded from the front walkway. The clamor continued through the front door and down the hall. Alarmed, she peeked around the corner with some trepidation.

The source of all the ruckus? Her 6-foot-3 husband Ralph, angrily wrestling the giant outdoor garbage-can-on-wheels through the narrow hallway. Directly into his packed-to-the-gills home office.

"After years of my suggesting that he clear the mounting debris, he finally took action," Janet explains. "But instead of taking his time to carefully sort through it all  -- for example, separating aged pizza boxes from working laptops, brand-new wireless routers from ancient modems -- he was furiously tossing it ALL in the garbage!"

What a sight to behold!  Normally a sweet-tempered guy, Ralph was finally fired up and fed up with the mess. Janet took safe cover in the laundry room until the storm blew over.