Diagnosis II: Eeyore gets groceries

I came away from my day of testing last month with mixed messages.  Yesterday’s results session offered absolute clarity.  Any doubts I had about testing went away yesterday when the doctor went over the report with me.  No one has ever described my interior life so accurately.  It is shocking to feel so deeply understood by someone who I’ve only spent a few hours with.

She began the report by saying how insightful the cognitive testing is, and how grateful she was to have such a tool.  She told me when I went in for my first interview, that she had me pegged for ADHD, that I hit all the criteria.  Then, when she began to go over the results of the testing, at first things seemed unclear, until they took a look at the whole picture.

She started with the measures of IQ.  On the verbal measures I tested at 98th percentile (“so, you’re in the right career,” she said).  Reasoning tested at 95th percentile. Damn, not quite Mensa, I thought,  but still, yay for me.

Then she started to go through the scores that measured things like visual and auditory processing and executive function.  It seems on a lot of measures I tested at average or just below average.  For example, on the test where I had to click when the computer said or flashed 1 but not 2, I had good accuracy, but surprisingly slow reaction time.  Below average for the visual, in fact.

They were astonished that I worked so slowly on the connect-the-dots test (called the “Trail Making Test”), and that I even made mistakes, practically unheard of for people in my IQ and advanced degree range.  The report says:

It is quite striking that Mr. Taylor struggled so much on the Trail Making Test.  Not only was his speed significantly slower than expected for his age and intellectual ability, but he actually made errors, which is very atypical for someone of his intellectual level and educational background.

Throughout the meeting the doctor marked where my tests fell on the bell curve of averages for my age and the split was striking.  IQ at the top; everything else middle or below.

They were also confused on my divided memory test: I had to remember three letters while counting backwards by threes.  I did okay on the short duration, lousy on the medium duration, but better on the long duration.  I told her that I had figured out on the long duration just to make a word out of the three letters.  I could remember one word, but not three letters.  She said that’s the intellect at work, constantly compensating for deficiencies in memory and processing.  There was a note on my evaluation that my performance often improved once I “settled in” to a task.

Something else I found really interesting was that my own perception of how I did on many of the tests was way off.  On the “1 and 2” test, I thought I was clicking really fast, especially when responding to the visual cues. But my response time was low, especially on the visuals.   On some of the language stuff, though, I thought I was struggling, but I scored really high.  I thought I did really well on the tower test, but again, only average for my age.  And I had no clue that I did so poorly on the Trail Making Test.

One thing we discussed about these problems in my life was grocery shopping.  My wife’s in charge of the food, so sometimes I go to the store with a list of things to get.  If there’s more than three things, I need a list because I can’t remember four things.  However, if I have a long list, I have to triple check the list.  I get things from the list, check the list frequently to remind myself what I have done and what I have left to get.  At the end of the trip, I have to stand in the store and check the entire list one more time to make sure I got everything.  If I don’t, what happens is that I’ll have thought something like “I’m in frozen foods now, but I should get the ice cream on my way out so it doesn’t melt.”  At the end of the trip, that somehow has translated in my memory to “I got the ice cream.”  I’ll get home and can’t believe I don’t have ice cream.  So I have to check the items one by one right before I check out to make sure I actually got them.  Add to that my slow visual processing, and I have to be extra careful that I don’t get something “diet” or “lite” (’cause we eat real food in our house).

This all adds up to far more mental effort than it should take, and my wife worries about me because I’m gone ninety minutes to pick up ten things and we live two miles from Meijer.

So certain tasks, which should be easy for me end up being mentally taxing.  Because they are simple tasks, they are also frustrating because I keep making mistakes, or my mind moves faster than my perceptions or my execution or there are gaps in my memory.  (In fact, in my technical communication class today I could not for the life of me remember the name of our textbook.  A student said “um, Technical Communication.”)

When I teach an online class, there are a lot of things to keep track of and a lot of settings to manage on the web site.  When I get a new week’s materials ready, there might be twenty or thirty tasks to get the materials ready to go.  I can think of all the tasks rapid fire, but I can’t hold more than a handful in memory.  I try to work fast to keep up with my brain, but I end up making a lot of mistakes unless I am slow and deliberate.  What happens, then, is a lot of mistakes or a lot of procrastination because the task seems overwhelming.

I’ve learned to keep a legal pad next to the computer so I can write down the list of tasks that comes zooming out of my brain as I’m thinking of them and before I forget them.  It’s like I’m writing down my working memory.  The list helps keep me from getting overwhelmed.  When I am in a bad way, the tasks keep circling noisily in my head like a flock of birds, and I resist even getting started, because choosing a task makes some of the others fly away.  So I read the news or watch funny videos on the computer instead.

The final diagnosis: ADHD with dysthymia (or “mild” depression, but with “severe symptoms”).  She suspected based on my case history that both have been there for a long time.  So long that I’ve treated them just as part of my personality rather than a problem.  The biggest problem is the drain of energy that the combination makes.  The ADHD makes a lot of tasks mentally taxing, frustrating, and discouraging.  Depression saps even more energy, and will make it difficult to sustain any effort that depends mostly on my own motivation (such as grading papers alone vs. at a conference with a student).  It makes it difficult to sustain the effort to make any long-term project work, or any time management or money management system.  I totally agreed.  I don’t know if when I fail at something like that if it’s a bad system for me, a bad system in general, or just my motivation working against me.  I didn’t finish my Ph.D., for example, because I could never make good progress on the dissertation.  I had a great topic, I found lots of research and read most of it, but spent hours and hours trying to decide on a note-taking system and stalling out and deciding on another system and stalling out again until I just gave up.

The best thing she said was that it is difficult to retain any optimism in this state: “It’s like you have to crank yourself up just to get to Eeyore level.”

*  *  *

The doctor made a bunch of recommendations, but its up to me to carry them out.  I just hired her, essentially, to do the evaluation.  The recommendations include seeing my doctor ASAP to get started on some meds, and a referral to a counselor and a computer-based training system called “Cogmed.”  All things I have trouble getting started on: making phone calls, seeing the doctor, checking with the insurance company to see what’s paid for.

Since the diagnosis, I’ve been through the gamut of emotions.  I felt greatly relieved and understood during the session.  In fact, I didn’t want it to end.  I wanted to stay and talk to the psychologist for hours.  On the way home I got tired and started to feel overwhelmed by the number of things I had to do that week and at the prospect of having to make phone calls to begin my treatment.  My wife had to go to a rehearsal out of town, so as I got the kids ready for bed, I had a good rumination session.  I would feel positive about the possibilities one minute (maybe I will be a novelist after all) and the next I was grieving for all the lost years spent doing half-assed and directionless work, or no work at all.

At one point I realized I shared something with my autistic son.  The school psychologist used the term “splinter skills” to describe his enigmatic abilities: advanced on some things, way behind on others.  The term has always stuck with me; the poet in me likes the alliterative esses and the two hard stops of the t and the k.  I’ve used the title for a collection of poems about about my son.  Turns out the apple doesn’t fall far from the Eeyore.

Used white paper behind apple and above apple ...

Image via Wikipedia

Eeyore being sad.

Image via Wikipedia

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16 thoughts on “Diagnosis II: Eeyore gets groceries

    • Kat:

      For me there are a couple issues. First is sensory. When I put a receiver to one ear, the opposite eardrum quivers along with the sound. I am much more comfortable using Skype to make phone calls where I can hear the conversation in both ears.

      Second (and I guess this is sensory too) there’s no body language involved, so I can judge visually how the other person is responding to me. If I’m at all uncertain about the phone call (how I’m going to say what I need to say, if I’m calling the right person) I don’t like not being able to see the expression and body language. It causes me to blank out sometimes, and I can’t remember my own phone number or address.

      I worked as a telemarketer in college for awhile too. That’ll put you off phone calls.

      When I have students call me to talk about our online classes, though, I don’t have as much trouble, because I kind of know what to expect (and I use Skype). Also, in that situation, there is no initiation involved on my end; the call just comes in. AD(H)D people have trouble with initiation.

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  2. Your description of a trip to the grocery store sounds eerily familiar. I hope you’re able to start your journey to mental health health wellness soon. I know it’s daunting, but I promise it will be worth the effort.

    • Thanks. The biggest hurdle is having to make the phone calls to get started . . . it’s on one of my to do lists somewhere. . .

  3. I will be having a test like that soon. I wonder if my ADD will also include Depression. I know I have Depression and am already being treated for that with Zoloft. Wouldn’t it be interesting to get the same diagnosis yet for you to be on Genius Level and me to be possibly the other end of the scale? I do not find myself very smart. I wonder if that is possible.

  4. The way I see it Jonathan, is that you DO have the motivation and intention, otherwise you wouldn’t be blogging away! I am very impressed with your courage to share blow by blow with the world – it makes me nervous for you just to read it, I’m sure because I can relate so closely.

    I just admitted to a friend, who I’d been not sharing the full story of my struggles with attention…that it is getting VERY old to need my husband to list things out in such a detailed fashion, just like you describe with the shopping list. Don’t know about you, but it’s not funny any more. Well, the Perry thing is funny…but my frustration isn’t on *my* stuff : ) .

    Misery loves company…keep writing, it’s helping me anyway. (passes some thistle)

    • Thank you for the comment, Kate!

      I have trouble sustaining efforts on writing projects, unless I get regular feedback. I love getting comments on my work on the blog. That makes me kind of a comment whore, but still, it works. I’ve fallen in love with blogging. I keep writing, I look forward to it, I feel satisfied with what I write, and it often doesn’t feel like work. I spend a day or two on a long post, and then it’s done, not wasting away on a shelf somewhere, and there’s no story arc to consider or anything. And then people actually read them and tell me what they think. The last poem I published in a journal I got not a peep from anyone.

      My own struggles were not funny any more either; I got angry when I figured out that I had ADD because when I read the criteria it seemed so obvious to me and I had spent years working with a psychologist, a psychiatrist, and an M.D., and not once did the possibility come up. Not even in all the books I read about generalized anxiety disorder either; I went back through my library to look for it.

      To me, the funny part is more tragic comedy: I have this gift of creativity and verbal fluency and couldn’t find a way to use it successfully because my executive function skills were so poor. I couldn’t figure out why I generally felt like a smart person but kept doing stupid things. Why would an otherwise high functioning person not be able to pick up five things at the grocery store? Pay a bill at the same time each month? Remember to do something five minutes after I promised it? Find a jar of mustard in the refrigerator? What kind of joke is the universe playing on me by giving me this odd mix of skills and putting me in a time and place in history where executive function is highly necessary (otherwise you are [shudder] “irresponsible”)?

      I have been writing on and off for years, mostly as a poet, so laying myself bare on the page is nothing new, but I am very secure in my job and don’t have to worry about public persona so much or backlash from revealing what’s going on. I’m pretty sure half my colleagues are on some sort of meds (or they should be . . . ). Having a disorder sort of gives one some street cred as a poet anyway. I’ve been admitting it to all my friends. Probably too many!

      It’s good that you’ve realized the list helps you. Detailed lists help my wife and I get along as well. The overarching theme in my adult life has been frustration indeed, mostly directed at myself, so I can relate.

      Thanks again for your comment; I really appreciate it! I say with all seriousness that blog comments are what I am most thankful for this year.l

      • You’re welcome! Looking forward to the next posts, and hoping to have time to visit your teaching blog and learning a thing or two…and on my to do has been to pass on your poems to friends who work with/live with autism on a regular basis.

        Guess where I’m going now – the grocery store! On an empty stomach.

      • Thanks for the forwards! Empty stomach shopping is a recipe for compulsion, especially if you go somewhere like Sam’s Club (“No, we really do need fifty bags of M&M’s!”)

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