ADHD: Smarter isn’t Better

Been there, done that.

Why Being Smart Doesn’t Help People With ADHD

For bright kids with ADHD, parents and teachers tend to assume the problem is their motivation or will power. These presumptions can follow patients throughout their childhoods and seriously impact their education.

http://www.healthline.com/health/adhd/iq-adhd#2

Hat tip to Overexcitable.

My Books

By the way, this is my 200th post, so yay me.

 

Deathbed Confessions

Here’s a fun argument.  ADHD denialists point to the meme that Dr. Leon Eisenberg, the “father” of ADHD, supposedly said that ADHD is a fictitious disease on his deathbed.

I hope when you are 87 and on your deathbed that you are able to give lucid, accurate statements that sum up your entire life (and that if they are reported by the media, that they are accurately reported in context).

Arguing about the credibility of the source has limited sway, though, so the easiest rebuttal to the argument is so what?

Even if that’s what he said and he meant, what does that actually change?  Do all the decades of scientific research since Eisenberg’s work suddenly disappear from the universe? Do my symptoms go away?

A pictorial description of the United States; ...

You can read Snopes.com analysis of the rumor here (http://www.snopes.com/politics/quotes/adhd.asp).  Basic story: Eisenberg was expressing concern about ADHD drugs being too casually used for children, and some of the quotes have been mistranslated from German.  Also, it was several months before his death, not a dramatic deathbed confession.

Fake ADHD Isn’t Real (Part 4 of 7)

Many people have an old-fashioned notion of willpower, leftover, I think, from a Victorian notion of morality.  Technology, science, and medicine change rapidly, but culture and social structure, in many ways, change at a glacial pace.  Slavery ended in 1863, yet we arguably still feel effects of this scourge today.

Charlotte Perkins Gillman’s short story “The Yellow Wallpaper,” published in the 1890’s is about post-partum depression/psychosis and the popular “rest cure” for well-off women of that era which consisted of nothing less than solitary confinement.  In the story, the narrator complains to her husband that although she may be getting better in body, she’s not making any progress in her mind and may be getting worse.  His reply:

I beg of you, for my sake and for our child’s sake, as well as for your own, that you will never for one instant let that idea enter your mind! There is nothing so dangerous, so fascinating, to a temperament like yours.

This dialogue belies a belief that many people have today.  If one is depressed, the advice is “just don’t let it bother you,” that one can just shut it out.  Likewise, the common advice for those suffering from ADHD is to “try harder.”  (The better advice is “try differently,” but that’s for another post.)

Part of intellectual maturity is to recognize that people are different in mind and see the world and function in different ways. This lesson comes to me all the time when I grade papers with students.  I’ve had students thank me for a D and storm out of my office for a B+.  I’ve always thought that personal essays are more fun and easier to write than research papers, but I’ve had students tell me the opposite is true for them.  Having autistic children helps me understand different minds too.

(Next: Everyone is a little ADHD. Especially professors.)

All my posts on ADHD Fakeness.

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Photo by flood llama

Fake ADHD Isn’t Real (Part 3 of 7)

Another source of ADHD denial is the way we’ve defined freedom and discrimination in the United States.  In a class I taught, I once posed a question about discrimination.  Way back in the olden days I sold cell phones, the kind that only made phone calls and had roughly 18 minutes of battery time.  If you wanted to listen to music on your phone you had to duct tape a cd player to it.  The store where I worked required a two-year contract and a $250 deposit if a customer did not have a credit card.  One customer who did not have a credit card complained to me that the policy was “discrimination.”  I asked my students if they agreed. They said no.

We had a long discussion and came to the conclusion that in broad terms “discrimination” applies to being judged negatively based only on things which one has no control, such as race or gender or height or whatever, whereas other kinds of decisions are based more on things people can control. There are lots of exceptions, but that seemed, for everyone in the room at least, a good starting point. A customer with poor credit did not merit a credit line. You can argue about to what degree people have actual control over their finances, and there may be systemic discrimination in play, but the popular conception is that one has some control, or at least should.

I think for less serious forms of mental illness, that many people believe the symptoms would be controllable if the sufferer just tried harder.  According to this line of thinking, for someone who is not obviously mentally ill, not ranting and writing manifestoes and wearing unwashed clothes, what’s the big deal?  Just buck up like everyone else.  And that person better not get any special help! It’s okay to discriminate against people with mental-illness-lite because those people are suffering the consequences of their own actions.  No one says to me You wear glasses?  You should just try harder to see more clearly But I was told a thousand times you could do your homework on time if you really wanted to.

Everyone experiences sadness, grief, loss,  and hopelessness at times and for some people such emotions turn into clinical depression and others they do not.  Everyone at some time has trouble settling down to focus, but people who have more trouble may look like they’re just not trying.  Hyperfocus confuses the issue because ADHDers have tons of attention for things they like.  It’s true for me. I can spend hours reading a book when I really need to spend ten minutes opening my mail.  Turning off that hyperfocus kind of attention is just as hard as turning on other kinds.  And it has nothing to do with intelligence.

In the United States, these discussions of deficit and agency and accommodation take place in a context where traditional values include self-reliance, rugged individualism, and the meritocracy.  As an example, see the “you didn’t build that” dustup from the 2012 presidential election, where a vague pronoun turned into a tussle about American values.

(Next: Victorians mess up everything.)

All my posts on ADHD Fakeness.

A Motorola DynaTAC 8000X from 1984. This phone...

No cell for you! Next!

ADHD Awareness Month

Well, I’m late as usual on this because it is ADHD Awareness Month and I was only aware of it as of today, said month being nearly over.  But here is an important means of battling the ADHD myths:

7 Facts You Need to Know about ADHD:

  1. ADHD is real
  2. ADHD is a common, non-discriminatory disorder
  3. Diagnosing ADHD is a complex process
  4. Other mental health conditions often occur along with ADHD
  5. ADHD is not benign
  6. ADHD is nobody’s fault
  7. ADHD treatment is multi-faceted

Full discussion, handout, poster, and references here:

http://www.adhdawarenessmonth.org/adhd-facts/

Anno Domini High Definition

I don’t know what this has to do with ADHD, but it’s pretty.

ADHD and BS

A good post on Reddit about ADHD and public perception, etc.

It’s amazing how much high quality scientific research is out there on the disorder. Put simply, we know a lot about the disorder; its causes, treatments and long-term outcomes of those affected. ADHD has been constantly studied, and we have a wealth of peer-reviewed studies pertaining to the disorder.

Often, journalists and other various people who claim to be ADHD “experts” constantly trivialize ADHD with their latest “theories” and “causes,” most of which have no understanding of the scientific findings of ADHD. Many of these people are just grabbing for attention at some media outlet. The problem I have with this stuff is that it does a disservice to those of us with the disorder, making it hard for us to get through all the bullshit and see what ADHD really is.

Full post and discussion here:

http://www.reddit.com/r/ADHD/comments/1ol3ue/there_is_a_lot_of_bullshit_about_adhd_i_wrote_up/

Image representing Reddit as depicted in Crunc...

 

Fake ADHD Isn’t Real (Part 2 of 7)

I used to think ADHD is fake. Or at least poorly defined.  One of my first memories of ADHD was a student research project in a class I taught as a new teacher.  This student’s assertion was that symptoms of ADHD in children were also the symptoms of being a child in the first place: not sitting still, having difficulty focusing on things that aren’t exciting, and so on. I tended to agree.  When I got my first letter about having to provide an accommodation to a student with a learning disability, I thought oh, great.  I was young and struggling anyway to keep up with my work as a teacher (with undiagnosed ADHD), and now I was having to provide this accommodation, to take class time and my personal time to recruit a note taker to a student who didn’t seem all that different from anyone else.  I’m not proud of that response, but I understand where it came from.

Back then, I did not consider that I could have ADHD for two reasons.  I thought it was a children’s disorder (with sketchy symptoms) and I thought having ADHD meant that you could not concentrate, and I had always read compulsively.  I just thought I was a brat because I didn’t like to do boring things or deal with thorny problems.

Working in an educational institution, I know that one reason people deny ADHD exists is that limited resources will be directed toward some people and away from others.  As a parent with two autistic kids in special education, I am keenly aware of the resources spent on my children while schools are being closed and programs cut. As a professor at a teaching institution (as opposed to a research institution), the overall focus is on trying to help all of our students learn and succeed, but there is backlash and resentment from some professors.  Someone put a quote on a wall once that said good students learn no matter what the teaching method. I’m not sure if that was an indictment of poor students, or a justification for laziness on the part of professors.

My kids get special, individualized attention, but my son’s entering kindergarten class had thirty kids to a room.  I am grateful for the resources, and, though I’ve never really experienced it, I would understand other parents’ frustration and jealousy. I’ve even heard some of the special ed staff gripe about the money spent on vocational ed. We’re lucky that the state of Michigan has stringent requirements for special ed (because it can’t be cut), but on the other hand, the staffing and facilities shift around more than a hyperactive toddler in an airport.

When resources are scarce, the claws come out.  Just witness the United States federal government when it works on budgets (if you don’t give in, why I’m just going to shut the whole thing down!).  Why do kids with ADHD deserve a break for their behavior and extra help and others don’t?

(Next: ADHD is un-American)

All my posts on ADHD “fakeness.”

senate

Kind sir, I beseech thee, take your Obamacare and shove it up your Teapot Dome.

Fake ADHD Isn’t Real (Part 1 of 7)

ADHD is a story we tell ourselves about a pattern of behavior.  As such, it isn’t real.  It’s not real in the sense that all the stories we tell ourselves aren’t real; they are mere interpretations/representations/translations of reality.  In the strictest sense, nothing is real other than reality itself. In this sense, ADHD is not any more real than democracy, love, God, and fantasy football.  To quote a cheesy movie, “There’s no such thing as an ass.”

The philosophical sense of “real” is not what people use when they question whether ADHD is a real thing or not.  I hope you’ll forgive my rhetorical trick in the title and keep reading.  The best search engine hits on my blog come from “fake” and “ADHD.”

Aristotle, a 4th-century-BCE philosopher, port...

Aristotle is the father of rhetoric.  His name is Latin for funky hat.

I get a little flash of anger when someone says that ADHD, anxiety, or depression isn’t real because these things affect me, the same way I get defensive when people assert that online classes aren’t real classes because I teach a lot of online classes, and people who make those assertions don’t know what the fuck they’re talking about.

Putting anger aside, though, I ask why would a person need to make such a denial?  People who use the term “real,” aren’t usually interested in metaphysics.

Consider Andrea Yates.  She’s the woman who drowned her five children, one a time, whose lawyer used postpartum depression as a defense.  She was found not guilty by reason of insanity.

I teach a class called “Justice in Literature,” which is a general education class for criminal justice majors.  I’ve used an essay about this case in class to talk about culpability and mental illness.

Most of my students are young enough not to have heard of this case, but knowing only a few basic details of the case, more than a few students have responses that condemn Yates.  They say things which seem cruel, like “she didn’t want to be a mother any more and used depression to get away with murder,” or “everyone is depressed sometimes, but only lazy people use it as an excuse.”

I don’t condemn such points of view in class, but explore them further, trying to use a factual approach as much as possible.  One detail I provide is the fact that by “winning” the case, a now-treated Andrea Yates spends her time in an institution with perhaps a fuller consciousness of her loss.  At the time of the murders, she was denied treatment despite warnings from her doctor and kept confined to the home by her strongly religious husband, and was convinced that by drowning her children she was saving them from eternal damnation.  People take many things from the Andrea Yates story; I’ve heard people blame religion, patriarchy, a too-weak medical system, a too-strong medial establishment. As a teacher I think it is more important to explore the reasons for one’s honest responses to texts rather than pretend to adopt the “correct” reading.  The former instance is called “learning” and the latter is called “coercion.”

(Next: Who said ADHD is fake?  Uh . . . I did.)

All my posts on ADHD “fakeness.”

What’s ADHD Like?

I’ve been following the ADHD subreddit lately:  http://www.reddit.com/r/ADHD/.  If you have ADHD, you should join it. (Because you need something else to follow.)  Anyway, one discussion I particularly like today is here:

http://www.reddit.com/r/ADHD/comments/1na6lz/i_need_help_explaining_adhd_to_someone/

Brainscan of brains with and without ADHD

Purple fire shoots out of my brain.

Taking the A-Train, Part II (I Think)

This is a follow up post to Part I.  But I repeat some of that post here.  So maybe forget Part I.  But there is new stuff here so this is really Part 1.5. (Shut up and tell the story already!) If I “shut up,” though, I can’t technically tell the— (Really? This is how you talk to people?)

Okay then.

Aong the myriad changes to my life this summer, I began taking a new drug: Adderall.

After visiting a new ADHD specialist, I started on Adderall XR 20 once a day.  After a few days, the plan was to taper in Wellbutrin as well, after I described my depression as “severe” (with accompanying documentation)  The first day I took the Adderall, I felt relaxed and clear.  I took it in the morning and did my usual mental check.  How do I feel about finances?  Job? Mortality?  All topics returned positive thoughts.  It was a Saturday, and my wife and I had a good long talk about difficult topics: the finances, aging parents, our kids’ autism, our younger son’s cancer, etc.  I felt unburdened; I could send my thoughts anywhere without the automatic anxious responses. I could see my way to fixing many problems that have been ongoing, even those that I have always had trouble with since leaving home for college about a bazillion years ago (okay, it was 1989).  Those things being finances and getting things done in general.

But I cautioned myself.  Being on Adderall was a new project.  It was fun and untainted and full of possibility and lacking any failure suitcases.  After a second day of feeling good and getting some things done, I took a risk and had an antihistamine.  I have seasonal allergies, but I find that taking any kind of medicine for them gives me bad mood side effects (in that I seem to hate everyone and want to crawl under the bed) so I endure the allergies rather than experience those side effects.

English: Adderall

I slept well that night and started the Wellbutrin the next day. I felt confident about the anti-depressant because I had taken it years before and it had worked adequately. The idea of the new stimulant together with the antidepressant seemed like a potent combination to battle my sitting-around-ness.

However, something in that mix did not sit well with my brain.  My wife and I ended up in a big fight about nothing and I ended up taking a long walk around town to cool off. My wife called a friend over to stay with the kids and went looking for me in the car because I seemed too unpredictable.  I was sure it was the antihistamine and took another Wellbutrin the next day.

I didn’t have another tantrum, but I ended up with the same problem when I started Wellbutrin years ago: insomnia.  I wasn’t willing to wait it out this time, though, and felt like the depression had lifted with the Adderall anyway, so I chucked the Wellbutrin idea.

For the first two weeks, it felt like the positive change I was hoping for was just around the corner.  I saw clearly how to fix broken things in my life, and the steps were attainable.  There were so many of them, though, that I had made little actual progress.  That, and there is always the backdrop of my son’s cancer to consider.

I started to notice the first side effect of the Adderall: jaw tension. Adderall cuts me off from certain body signals. I can have a bad night’s sleep and still function okay and not have the crushing sense of fatigue that I’ve always felt. I am also less hungry.  Instead of stress affecting my whole being, stress seems only to affect my mouth.  My lips get tight and I have the urge to clamp my front teeth together.  From doing yoga and practicing mindfulness, I know I typically carry anxious tension in my body, but my normal jaw clenching is my back teeth.

tiny mouth

tiny mouth

On Adderall, when I start getting “tiny mouth,” I have to think to figure out what’s going on with my body.  Oh yeah, haven’t eaten in six hours. Or only got four hours of sleep last night.  The jaw tension also happens when the slope turns and the stimulant starts to wane. Normally hunger and fatigue would be right there without my having to think about them.

The Adderall effect feels different from the Ritalin.  On Ritalin, I’d upswing (which I hesitate to call a “high,” because that suggests a hopped-up feeling) for an hour or two.  I’d feel energized and calm and, on good days, have a sense of well being.  Then it would drop off and I’d feel like my baseline anxious mess of a self.  And then take the next pill.  I’d take as many as five a day and be up and down that roller coaster.

If you’re a coffee drinker, my Ritalin experience was like having that first good cup of coffee after you wake up and then within two hours going right back to just having got out of bed and everything sucks feeling. And doing that several times a day.

At the end of the day I’d feel exhausted from all the yo-yo feelings, and my depression would creep in there and make me feel hopeless.  God forbid I’d wake up in the middle of the night.  I would be so far away from Ritalin at that point that I would feel like I was dying. Some nights I was sure that I had completely stopped breathing in my sleep and only through some miracle had woken myself up and started breathing again.  Try going back to sleep with that thought in your head.

I had tried to remedy the roller coaster feeling with Concerta.  The timed release is supposed to give you a more steady feeling.  On straight Ritalin, I took 40 to 50 mg a day.  On Concerta I was up to 54 mg a day without the positive effect.  Also, with the Concerta, I had no options after it wore off. It was impossible to work in the evening.

English: Kirnu, a steel roller coaster in Linn...

The next option was to boost the Concerta, but I couldn’t understand why 54 mg of Ritalin inside the mechanism of Concerta did not work as well as 40 or even 30 mg of plain Ritalin.  My doctor was also concerned about my blood pressure which was testing at borderline high.  More Concerta could increase my blood pressure.

I now know that my family doctor was the wrong person to manage my ADHD meds.  The new doctor, the ADHD specialist, said several things about why my treatment wasn’t working.

  • First, some people respond more to the slope of the medicine rather than the level.  Concerta has a more gentle slope, so it’s not uncommon to need more of that than straight Ritalin to get the same effect. And plain Ritalin has a vicious down slope.
  • Second, if I was taking time release pills, I needed to have a “booster dose” of non-time-release stimulant on hand if I needed to work late.
  • Third, the way my family doctor measured my blood pressure was all wrong. I’d barely get into the office and after the nurse would ask me a stream of stress-inducing questions (when was your last physical [25 years ago] did you have your flu shot [no] why not [um . . .]). Then he or she would take my blood pressure while I sat uncomfortably on the edge of an exam table.

My new specialist waits until we’ve been talking awhile and lets me sit in a comfortable chair the whole time.  If I test high, he moves my arm to a more relaxed position, lets me breathe a couple times and then remeasures.

He said the other method virtually guarantees a wrong reading.  I bought a home blood pressure kit and thought it didn’t work because the readings were so different from in the family doctor’s office. (My other doctor was aware of this “lab coat syndrome,” but his solution was to get it monitored somewhere else on my own. To quote Bugs Bunny “He don’t know me very well, do he?”)

The upshot of all this was that I had plenty of room to go upwards on the Ritalin/Concerta route if I wanted to.  I was ready to be done with Ritalin, though, and he thought the slope of Adderall would work better for me anyway.

Adderall XR felt very good, but left me without much benefit after 4:00 p.m.  He told me to call if I needed a booster dose, so I did and left a message.

If you don’t know, ADHD stimulants are controlled substances because people abuse them.  My personal and unscientific opinion is that if Ritalin and Adderall were naturally occurring in coffee beans, they would be a regular part of our society, and if caffeine were only synthetic, it would be a controlled substance. I had plenty of friends who abused caffeine in school; No-Doz and Jolt were the study aids in my day.  Plenty of people are addicted to caffeine and use it daily as a “crutch.” Also I can’t make out why alcohol and tobacco are legal and marijuana is not. (Climbs down off soap box.)

Because stimulants are controlled, they are less convenient.  They can’t be called in, no refills are allowed, and there’s a limit to how many you can get at one time.  I have to physically take a paper prescription to the pharmacy and often have to show a driver’s license. I worried about how this might be a problem with my new specialist being an hour’s drive away.

I called and left a message and didn’t hear back and was feeling worried that maybe this was not the best place for me to be going after all.  I was thrilled to be proven wrong when a new prescription sheet arrived by mail within three days.  And it had a neon green sticky note attached with a reminder of my next appointment!  The significance of this cannot be overstated: not only are sticky notes important to my life, but neon colors are essential; pale yellow ones just don’t cut it.  This practice knows how to work with ADHD people.

Overall, the feeling of Adderall is more steady.  It is indeed a long slope and does not have that horrible drop off.  I do have the occasional what are you doing anxious thought at night, but without all that inconvenient existential dread.  I feel almost like a normal person sometimes.

On the downside, I am more blunt in my speech and say things that I intend to be funny that come out as mean.  I forget to eat sometimes and I eat less overall, but I can afford to miss a meal or two. (Dear Taco Bell: Fourthmeal?  I scoff at your paltry little number!)  I have to be careful not to take a booster dose too late or have too much caffeine or I have trouble sleeping. There is a slight decline in sexual response.  And the weird mouth tension thing.

But overall I felt much more positive and focused and less anxious and avoidant.  Until the end of my summer got messy.  But that’s for Part III.  Or maybe Part 2.25.  Can you do decimals in Roman numerals?