Thursday, August 18, 2011
Driving a Ferrari with Bicycle Brakes
Attention Deficit Hyperactivity Disorder may be the most poorly named condition in the DSM-IV - it's neither a deficit of attention nor always accompanied by hyperactivity. It also may be one of the most vilified and least understood learning disabilities in our culture causing just as many people to go undiagnosed as those hyper kids who get drugged up to get off their parents nerves. My goal with this blog entry would be to briefly go through what ADHD is and is not, help people better understand it and in the process better understand me. I have ADHD - Inattentive form, have had it my entire life and will always have it yet didn't manage to figure this out until this last year. How is it that I could make it to 33, be a counselor who can diagnose and treat ADHD, wrote a thirty page paper on ADHD in grad school, and have never figured this out - because even I had a host of misperceptions about the disorder and myself. There are two types and those kids, more common in boys, who have the hyperactive variation they are usually spotted and singled out for being a disturbance, while the inattentive variation is largely undiagnosed, or more accurately misdiagnosed as lazy.
ADHD is a neurological disorder affecting the executive functioning area of the prefrontal cortex responsible for regulating attention and impulsivity. In brain scans the rest of the brain is lit up with activity while one small spot shows gray and dead when completing regular tasks - but it isn't dead, it's just sleeping because when the subject engages in an activity that is exciting, taps into a passion, offers an interesting challenge, or if the fight-or-flight response is engaged it lights up bright. What this results in is a kid who can play Call of Duty for 12 hours straight without blinking but can't stay focused long enough to complete their homework or an adult like me who has a ridiculous ability to photographically recall enough information to fill up libraries but will take two hours to do fifteen minutes of paperwork. This is where our society and especially the Christian subculture will often just say this is a heart problem, we are just lazy and irresponsible. Problem is that when you look at us in an area that is of passion and interest to us we are more responsible and hard working than anyone on the planet. The frustrating part not just for you guys putting up with us but for us as well is that it isn't that we have no focus, we just have a hyperfocus, but only on the things that wake up our brain. If your normal brain is like a shotgun, we have lasers - you can spread your attention between several things at once and can decide which activity deserves your best attention, we are like Cyclops from the X-men without his fancy glasses. So if we are doing monotonous tasks, busy work, or anything that doesn't wake up our brain then anything out there in the background that could be more interesting will forcibly grab our attention - email, a bird flying by, a conversation across the office. If we are engaged in a task that ignites our passion then nothing else exists, our hyperfocus gives us the brain raw horsepower of a Ferrari engine without power steering and bicycle brakes - full throttle intensity with very poor handling.
The other hallmark of ADHD is little to no impulsivity control, if it pops in our head we just run with it. Therefore we are horrible with time management, financial restraint, and we are far more likely to develop addictions. We are prisoners of the now, able to immediately get over being hurt and very unlikely to plan ahead. If something is not directly within our field of vision then it doesn't exist, and even if it is right in front of our eyes but isn't our focus then it doesn't exist. We're the person who says the wacky thing that pops into our head which half the time makes everyone crack up laughing and the other half of the time gets nothing but blank stares and uncomfortable silence. Impulsivity is fantastic when it results in creativity as a brain without caps can create art or music that a normal brain would never come up with. It isn't so great when our emotions don't have the normal cap that other people's have - we feel the same emotions as others but with more intensity. When we are sad or hurt we feel it stronger than others often looking like depression, when we are anxious our mind can race faster than someone with real anxiety, when we are irritated and angry we can snap at people before we even register what happened. A low frustration tolerance, moodiness, and a hard time forcing ourselves to just snap out of how we are feeling are almost always there, even if we have developed a personality that wants to make people happy and so would never express these things on the outside.
In addition to the attention and impulsivity problems that are biological we usually end up developing secondary problems as a result. We feel weird and different so often become loners or even embrace weirdness as our identity. We don't always track with people because our attention wanders so we feel like we are socially awkward when usually others don't even notice. We become procrastinators because if mundane tasks don't wake our brain up then we come to rely on last minute anxiety to give us a shot of adrenaline to get the task done. We often become very driven and self-critical because we end up believing that we really are just lazy and need to try harder, but even when we try our potential never matches our productivity. When we can finally accept that our brain works differently, not better or worse we can do what it takes to succeed - medication can keep that part of your brain woke up increasing attentiveness and impulse-control - counseling or psychoeducation can help us develop skills in things like time management, responsibility follow through, and budgeting - and just becoming more informed means we don't just see it as a curse, but actually quite a gift.
So why did it take so long for me to get diagnosed? Well I believed a lot of the myths floating around that lazy hyperactive kids must just have bad parents, that if this was ADHD then everyone must have it - they don't, and I had figured out all sorts of ways around it. My hyperfocus growing up was always school which really doesn't often get you in trouble, and being naturally intelligent meant I could still get good grades even when I forgot my homework, spaced out for half the lecture, or forgot there was going to be a test. My personality has always been one that wouldn't allow me to have a temper problem, and so my low frustration tolerance never became much of a problem until I had kids. I assumed the meds were just to tranquilize unruly kids into zombies rather than tools that can wake up the brain so that I can better direct my own attention and resist impulsive drives. There is no miracle pill but it definitely helps better than my previous medication - caffeine. I really believe the key to success, however, is mostly within accepting that if you have ADHD then you will be really bad at some things and really good at other things and that whether you like it or not that is OK.
At some point I'd like to throw in some of my adult ways of compensating that may help others as well as how best to parent a child with ADHD, maybe something on how ADHD affects marriages, or how to succeed in your career with it, but those are for another blog.