Something Shiny: ADHD! - All About ADHD - Part VI

All About ADHD - Part VI

Explicit content warning

03/02/22 • 31 min

Something Shiny: ADHD!

Isabelle & David welcome Isabelle’s husband, Bobby, and their friends, Christina, AJ, and Gabe, to continue to listen and learn from David’s tried and tested presentation on ADHD, which he normally gives to fellow clinicians (for the 1st-5th parts of this talk, please see episode 4, All About ADHD Part I; episode 6, All About ADHD Part II; episode 9, All About ADHD Part III; episode 12, All About ADHD Part IV; episode 15, All About ADHD Part V). The audience checks in about the things they’ve remembered from previous lectures—the need for structure, wins, energy bar (making sure you use your energy during the day)—inability to integrate past memories into future experience means you have to develop metacognition, thinking about your thinking. What are we going to do about ADHD? ADHD is most often scapegoated for the world’s crap. For example, people dealing with all kinds of things, but the one diagnosis a parent will share on the playground after their kids shows all kinds of behaviors is ADHD, not the OCD, Bipolar II Disorder, etc. that their child is also experiencing. We also only attribute things to ADHD when they’re negative or could be viewed as negative—for example, after a meltdown—“It’s my ADHD” when no one ever completes a task brilliantly and says “it’s my ADHD!” Are people born having ADHD? Yes, you are born with it, you are genetically predisposed to it, if you have it someone in your family likely has it, and in places where ADHD is not present in the entire family, there is a family traumatic experience that can prime you, and even specific gene setups that can link to being more or less vulnerable to environmental factors (See Orchid Children article below). David talks about ADHD as a gift, referencing his incredible friend, Bill, who’s excited and about to make anything exciting when he talks about it. He travels the world giving speeches, writing articles, or improving his investment portfolios, the man does not relax—this is also about ADHD. It’s genetic, not a choice. What we do have a choice in is how we develop frustration tolerance, developing a sense of who you are, developing your self-esteem: that’s the variable. You have to believe you can do “it,” no matter how realistic, the belief needs to be fostered. The second most important thing is advocating for accommodations: knowing what you need and asking for it. The third most important thing is metacognition (thinking about thinking): knowing why the accommodation works, knowing you can do it because you’ve done it before—understanding why it works—for example, knowing you’re frustrated because you didn’t use your energy bar. Some people are born like an orchid, some are born like a dandelion: a dandelion can grow through a concrete slab, you can mow over them, they grow right back. David describes the orchid he is purchasing for his love and partner, Robin, and got this orchid and then he says he’s going to take care of it, and he killed it in a week. You can also put one ice cube on the orchid a week (or sprays)—and let it run with water. Students in schools are all treated like dandelions; but if you water an orchid like you water a dandelion, it’s dead. But orchids are beautiful, they last so long, they grow on some of the most inhospitable things, they add color and beauty to anything. What are the environmental watering instructions for someone with ADHD—it’s constantly having a menu and having to do things differently. Knowing why you struggle with something—a school would never take someone in a wheelchair and asks them to walk—they would create accommodations. So why take someone with ADHD and ask them to do something that they need to do differently and ask them to do it the same? ADHD is not a learning disability, it’s a sitting still, a pacing disability (when things move slowly, David turns into an insane person—like a slow-walking person...but put him in the trenches and he’s ready)—so he crosses the street, he goes out of the way to mitigate his frustration. Using a relief pitcher metaphor from baseball, a relief pitcher doesn’t pitch the whole game, or run, or hit the ball—it’s hard to define them as a baseball player...but they’re highly coveted for what they do. Now imagine a relief pitcher saying to their school: “I want to be a baseball player” so the school focuses on the running, hitting the ball, etc. but...it misses the thing that person does and does well. So part of the accommodation is knowing where you a relief pitcher, what you do well, and staying in your lane. For example, David and his partner set it up so that he has an allowance and passes money to her—not because he’s in shame about how he manages money, but because it helps him stay in his lane and not spend all his money on jujubes...

Previous Episode

ADHD Origin Stories: How Isabelle & David Each Learned They Had ADHD

Joined by Isabelle’s husband, Bobby, who also has ADHD, Isabelle and David explore their origin stories in the first recording of Something Shiny ever (from over 3 and a half years ago). Isabelle describes how she first became more familiar with ADHD through working with David and working with clients who had the diagnosis, turning to David for help. She would then come home and tell Bobby the tips and kept telling him he had ADHD, not like it was some bad thing, but like it would only help him to know. She started noticing how sessions with her clients with ADHD had a different feel to them, and she really enjoyed them (as well as sessions with her neurotypical clients, it just had a different speed). One day, after about a year of this more focused work, she was talking to a fellow clinician who was sharing her ADHD origin story with Isabelle. She described what it was like to go into a room to get a cup of coffee, only to clean the kitchen, only to pick up three things and forget what she was doing. Isabelle started shaking and realized it was just like her. She had a flash and thought “somebody else does that?” She came to David the next day and said, “I think I have it” and he said “I know. Welcome to the tribe!” And she cried and felt so welcome and love it. She wonders how she went so long without getting diagnosed. Her mom was called into a parent teacher conference when Isabelle was in preschool, thinking she would need ESL support (English is Isabelle’s second language, her parents are Polish immigrants), and the teacher’s feedback was that Isabelle would not stop talking. She would get this feedback throughout her schooling and recognized that she was always talking and distracting other kids, but she was really lucky to have teachers who would redirect her, give her extra work, let her read and hyper focus on what she wanted to do. She then wonders how she got through Harvard, and realized retrospectively that she was prescribed Wellbutrin, which is a medication that also helps with ADHD. After weaning herself off of it, she was running around to her friends describing that she thought she had ADHD, who dismissed it as withdrawal symptoms; she accepted this explanation at the time, though she could not longer focus and magically do her work, and then went all over the place the next couple of years. After landing a corporate gig, she was able to focus on pretty boring stuff, but she had undiagnosed hypothyroidism, and any time her meds would increase to bring her thyroid to a normal level, she would again notice ADHD symptoms increase dramatically. David and Isabelle clarify how the hypothyroidism, which would normally produce lethargy, was taking away Isabelle’s impulsivity and ADHD symptoms, working like a lead vest. When Isabelle started to suspect she had it, she came home and cried and Bobby thought she had cyberchondriac’d (see definition below) herself into a diagnosis, because he saw her as focused. He had just come to terms with his ADHD and couldn’t believe his wife had it, too, because she seemed so different to him. Then she suddenly appeared to have it, very obviously, seeming much more scattered and he wonders if its because she didn’t have to fake it anymore (see Masking definition below). Isabelle notes that her and Bobby are a very small sample size, so she only has to be more focused than him to appear focused. She resonated with David describing how you can self medicate with anxiety, she noticed that she did it all the time to leave the house and make transitions. This connected to how when she realized she had it, she unmasked and suddenly didn’t want to use anxiety to help her transition anymore, making it harder for her to do things like leave the house. David then shares how he has symbol recognition disorder in 5th grade, and it was never validated that he had ADHD and was labeled as lazy or like he wasn’t trying. The struggles in school got significantly worse as he got closer to high school, and the group all agrees that no one ever says that middle school was the BEST. David wasn’t testing well, he went to a really prestigious school with all the resources, and he was never diagnosed because he was deemed ‘too smart.’ However, freshman year, he got the label of having behavior disorder, which meant school got worse, really fast. He ditched school, got a ‘screw you’ attitude, playing Mortal Kombat with all the delinquents and got kicked out of high school. He was kicked out of school because of behavior problems and sent to an alternative school, still without an ADHD diagnosis, but he had a much better time in school. He got his homework done because all homework was done in class. In his previous school, he would go home, not do his homework, and then be too ashamed to go to ...

Next Episode

A Conversation About ADHD Medications - Part I

Big Ol’ Disclaimer: We are not doctors or prescribers, but two therapists who have a lot of experience working with folx on/off, loving/hating, trying/not trying all types of medications and accommodations for ADHD. Please seek medical advice for all your medication questions! Continuation of disclaimers galore: we are not giving medical advice, just our opinions. There are a lot of doctors in the world who know what medical terms actually mean and what they mean long term, we very much are aware that psychopharmacology is not our specialty, but we have a lot of experience with people trying medication. Nobody really talks about medication without being hyperbolic: it’s talked about as something that saved your life or that is awful. Most people who find something really effective medication or accommodation don’t talk about it everywhere. They just take the win and talk about it with their therapist. People often get the pop-psych version of what antidepressants, antipsychotics, anticonvulsants, stimulant, etc. meds are, v. How often we talk about something like insulin or blood pressure medications: they carry more shame, stigma, myths and misperceptions. ADHD is a medical condition that can have psychiatric consequences. This is something that is medically warranted but not psychiatrically warranted at all times. People think you can’t go to a regular doctor and get ADHD medication, but you can: it is a neurological difference and a medical condition. Not every person with ADHD needs medication AND it’s not a deficit if you have to take medication. A dilemma David experiences as a therapist is that he is hired by his clients to help wean them off of a medication; we have these thoughts around dependency and what it means to be on meds. What’s strange is how differently we view medication as opposed to other accommodations; for example, no one suggests you work a program to improve your vision to remove your need for eyeglasses (if such a thing exists, barring LASIK), but it’s something we do with medications. David just accepts he’s wearing glasses because they’re super effective. We don’t talk about how effective ADHD medication is for those who want to take it. Isabelle pauses to do a real-time look up of the numbers on efficacy, it is so much more effective than it is for other psychiatric conditions because it is a medical condition (70% of adults and 70-80% of children shortly after starting treatment, per the Cleveland Clinic—see the link below; this is contrasted to a 50% efficacy for antidepressants per the National Health Service—also see link below.). Also a way to think about how quickly you find a med that works for you, versus an antidepressant. It’s important that an ADHD med can help you and not be the right medication for you. Individuals with ADHD require more stimulation to do boring, nonstimulating, low-novelty tasks, so they’ll self-medicate with their own emotions, using anger, excitement, anxiety or fear—all of those make your heart beat faster, arouse your nervous system. Those emotional states are stimulants. David describes gamifying pairing his socks to make his self-stimulant through excitement rather than anger. For people who find anger or anxiety shutting them down in life, when those things get in your way, you might want to think about ADHD medication—it’s not just about impacting focus, it’s about the emotional consequences that come with ADHD. David reviews how non-stimulant medication (eg. Like Strattera) works like small chemical restraints, slows you down. More effective for anxiety-heavy ADHD. Stimulant medications (eg. Like Adderall and Ritalin) are more a way to stimulate your nervous system so you don’t need to self-stimulate to reach that condition. David describes that he didn’t get medication until he was in undergrad or college, the before moment was: “someday I’ll read a book.” And the after was “I could read a book,” this is why he’s such an advocate for people finding what works for them, medication nor not, medication for David was the difference between being a C/D student to becoming an A student. The closest he ever got to as focused as he was on meds was when David convinced himself he would be homeless if he didn’t finish a book in 8th grade, aside from that he didn’t read. To name the abuse of stimulant meds: people can abuse any substance: you can abuse food, for example. It’s important that these drugs are prescribed with therapy, so that a person starts to learn what a medication works for and what it doesn’t work for. The medication doesn’t change your life, you take the medication so you can change your behavior, to fix your life. It’s not speed and doesn’t make everyone do a lot of work...