Deconstruct Your ADHD Coaster

Deconstruct Your ADHD Roller Coaster

What does it mean to “deconstruct your ADHD roller coaster?”  It’s my way of explaining that ADHD manifests differently in the individuals who have it.

Moreover, most adults diagnosed today carry years of negative misinterpretations of their challenges—and of the world. To begin forming more clear interpretations, we break it down into symptoms and the counterproductive coping responses developed over a lifetime.  Taylor J. explains what this means to her and her husband, both only recently diagnosed.

—Gina Pera

By  Taylor J.

Welcome to Chapter 3 of the “You, Me, and ADHD Online Book Club,” based on Gina’s first book: Is It You, Me, or Adult A.D.D.?

We all need that friend that we can trust, the one who can tell us that we have a piece of spinach stuck between our teeth, or no, those pants look really uncomfortable on us. We need to know that someone has our best interests at heart, and when we get wound up, can help us take a step or two back, and see the big picture.

At just the right time, Gina was that friend for me.

One night, I became so frustrated and angry with my husband. I told the support group, “Don’t give me the ADHD excuse! I have exactly the same diagnosis he does! Yet, I would never, in a million years treat him the way he treats me [on XYZ issue].”

Gina—in her perpetually calm, rational manner—said that everything he was doing was textbook ADHD. She pointed out that his behavior was completely contrary to his character. She asked if he was medicated at the time. (“Well, no, he said it had worn off.”) She then said characterizing my ADHD and his ADHD as “exactly the same” was “myopic” at best.

[Note from Gina: Being 100 percent Italian, I am laughing at the “perpetually calm” part.]

Deconstruct Your ADHD Roller Coaster

What Does Myopic Mean?

I confess, in my post-baby, sleep-deprived state, I had to look that one up:

my·op·ic
ˌmīˈäpik/
adjective
adjective: myopic
1.    nearsighted.
synonyms:    nearsighted;
shortsighted
“a myopic patient”
antonyms:    farsighted

I chose to believe that my long-time friend had my best interests at heart. I listened to Gina’s advice, and when she turned out to be right, Dr. Math and I worked through that episode in our marriage with tender care.

As I read through chapter three, however, now I can see the full extent of what Gina meant:

Trying to understand ADHD can feel like trying to nail Jell-O to a wall. Even within one person, the traits can appear slippery and shape-shifting over time or in different circumstances.

Chapter 3 helps us understand why ADHD can look so different in different late-diagnosis adults. Not only are they individuals experiencing various aspects of a highly variable syndrome, but they are also carrying around decades of poor coping strategies, developed in order to survive challenges that didn’t have a name.

ADHD self-regulationA Key ADHD Challenge: Self-Regulation

We begin with a primary challenge for people with ADHD: self-regulation.

Adults with ADHD typically have trouble achieving balanced behavior and instead, zigzag between one extreme and the other.

Please, as you’re reading the book, underline that. Put stars beside it. Highlight it. Write that phrase on sticky notes and put it on your bathroom mirror.

How many things in our daily lives require self-regulation? Without even looking in the book, we can reel a few off—eating, arriving on time, staying in school, doing chores, playing video games, managing your temper, finding your stuff, and being consistent in, well, anything!

Also, since ADHD affects individuals—that is, people who have their own distinct upbringing, faith, political views, socioeconomic status, and personality—how many different ways can “self-regulation” problems affect these individuals?

 

Deconstruct Your ADHD Roller Coaster
M&Ms or Skittles?
ADHD Symptoms or Poor Coping Strategies?

ADHD Symptoms—or Poor Coping Strategies?

It’s mind-blowing to realize that ADHD can look so different, just between Dr. Math and me. But now let’s add another layer of confusion: which of our behaviors are ADHD-related and which behaviors are poor coping skills, developed after years of living without knowing we had ADHD?

Chapter 3 helps us distinguish between symptoms and poor coping strategies. It also provides strategies for staying positive while we sort out all those behaviors—and it can feel like we’re sorting them one M&M or Skittle at a time!

Next, I focus on two highlights that helped me understand ADHD more in my life, and in our marriage: Executive Functions and working memory.

Viewing ADHD Through the Executive Functions Model

One way to think of ADHD-related challenges is in terms of Executive Functions. (EF for short). Those functions are responsible for

  • Formulating goals
  • Planning for their execution
  • Carrying those plans out effectively
  • Changing course
  • Improvising in the face of obstacles or failure, and
  • Doing it all successfully, in the absence of external direction or structure

That’s a lot.

Think of your Executive Functions as the conductor of a very large orchestra. Our brain has lots of instruments, such as intelligence, creativity, emotional regulation, physical energy regulation, and sensory information (smell, touch, sound, etc.). The job of any conductor is to direct and cue the musicians at just the right time, to create beautiful music. If the conductor is sloppy or misses a cue, the music sounds awful, no matter how skilled the musicians are.

ADHD executive functions

Sht. Sht. Sht.

I experienced this first-hand in college when I sang in the university choir and orchestra performance of Mahler’s Second. The conductor had so much energy and was so emotionally moved by the piece during the performance, that he forgot to cue us to begin with the first word of that passage: Schtein.

Instead, we all came in at different times. I cringed. The sound “sht…sht…sht…sht” repeated at different beats all across the choir—the entire piece marred by that one mishap.

We were fantastic singers! We all knew what we were doing! This had nothing to do with our skill level, our perception of music, or how much we’d practiced.

In the same way, Executive Function disorders have nothing to do with a person’s intelligence or creativity. You can be a brilliant PhD (like my husband) or a fantastic athlete (like Michael Phelps) or have any other gifts or challenges. However, those pesky Executive Functions are hard-wired, and not something we learn.

Great.

Looking Back On My Own “Roller Coaster Track”

Now, looking back on my life, it’s a bit more easy to understand why I became defensive and hard-to-please in some areas of my life and, in other areas, developed a propensity to bend over backward and aim for perfection.

Using Gina’s metaphor, ADHD “laid the track” for my personal roller coaster, but the feedback I received from people around me gave me a much more rickety-than-necessary ride.

  • “You have so much potential!”
  • “You’re brilliant—if you’d just apply yourself.”
  • “You really need to grow up and get organized.”
  • “Why don’t you slow down? You should lay off the caffeine!”

“Not surprisingly,” Gina writes, “many children with ADHD grow discouraged, depressed, resentful, and irritable.”

My husband had it even worse. His parents were extremely organized, providing everything the anti-medication wingnuts say “good parents” should provide to “keep their kids off medication.” Lots of farm work. Reminders. Tight schedules. Following up for him.

They did a great job! He was a Valedictorian, and got a full scholarship to college! That ADHD is gone, right?   Wrong.

Yet, when he grew up, married, and had children, there was no one around to be his external mental structure. He (understandably) didn’t know why I couldn’t provide the same amount of structure that his mom gave him.

Common coping mechanisms among many late-diagnosis adults include:

  • Rationalizing and blaming
  • Controlling
  • Being aggressive
  • Rushing through tasks and activities.

I’m surprised that list doesn’t include: “Throwing our hands in the air and saying, ‘Screw it all!’”

ADHD hoarding

Working Memory

Here is another amazing takeaway from this chapter:  The “five mental modules” that are affected by Executive Function Disorders. I’m only going to focus on the one that blew my mind:

Poor (or “leaky”) working memory

Now, the concept of “working memory” is different from “I can’t remember things.” Instead, working memory is “our ability to hold information in our minds and use it to guide our actions.”

With strong working memory, our actions stay anchored in the past (where goals are set) and connected to the future (where goals are met.)

Now for the particular part that blew my mind…

Poor working memory disconnects cause from effect, impairing the ability to predict and prepare for outcomes.

What? Excuse me while I walk around the room for a minute and digest that.

Have any of you ever watched the TV show “Hoarders?” In one episode, lady lived upon tremendous piles of dolls in her house.  But she didn’t see the problem. She held one doll up to the psychologist on the show and yelled, “How is this doll a problem? This is a cute little doll with stringy hair and china hands and feet….”

The psychologist kept trying to re-direct her attention back to the pile of dolls that were buckling the foundation of her house and draining her bank account. She couldn’t see that this doll was only one of thousands.

Making Connections—Pre-Diagnosis

This is why I couldn’t understand how my husband with a PhD couldn’t understand certain things. I struggled for years simply to be heard—to make him understand how several of his behaviors were affecting me.

Once, and only once, I succeeded in spelling this out before treatment.

We were sitting at Panera, drinking their hazelnut coffee, and I was trying to explain why I needed to buy some storage containers for the kids’ clothes.

I asked, “Do you see the big picture of why I’m asking for this $100?”

“Of course!” he said. “So the system will sort everything out, and it’ll be a lot easier to find what you need.”

“Well, yes. But if we sort everything out, and it’s easier to find what I need, then I can cut down the amount of time I spend doing housework, which means I’ll have more time to work on my novel.”

Then he looked at me like I’d sprayed him with a water gun. “Did you just connect storage tubs to your calling as a writer?”

It never occurred to him that time spent doing one activity meant that time could not be spent elsewhere.

Discussion Points:

Now to hear from you, dear readers, with some points to launch the discussion:
•    How does the primary challenge of “self-regulation” show up in you or your partner?
•    Which of the “five mental modules” have you seen affected?
•    In what activities do you or your partner tend to “zig-zag” from one extreme to the other?

Next Up: Chapter 4: It’s Only Money, Honey!

 

32 thoughts on “Deconstruct Your ADHD Coaster”

  1. Finally finished chapter 3! Felt like I could underline the entire chapter. Found myself nodding my head and saying yes to everything. It’s not the time to get my husband to read this book but some day I hope he can read this and see himself in it and maybe get some hope from it.

    Taylor, I LOVE Panera’s hazelnut coffee.

    The cause & effect thing–if you spend less time on X, then you’ll have more time for Y. My husband does not get this AT ALL. He does not put it together that if he helps clean up dinner, then I’ll have more time to hang out with him after the kids are in bed (instead of having to do the dishes because he didn’t).

    The discussion questions:
    • How does the primary challenge of “self-regulation” show up in you or your partner?
    I related to Frank’s story on page 46. My husband will argue with me about the sky bring blue, but he will back down from any confrontation or negotiation in the real world. There was an instance with my van at the service department at the car dealership once and he ended up calling me while I was out of town at a work conference because he wouldn’t/couldn’t handle it.

    • Which of the “five mental modules” have you seen affected?
    Leaky working memory!! He often goes on Boy Scout campouts with our son and the last minute packing (and angry outbursts) that go along with it are so frustrating.
    Also, the three loose planks were so eye opening. Insatiability describes him to a T! He tries to pin his unhappiness on me All. The. Time. And the rigidity/inflexibility leading to an authoritarian parenting style. WHOA. So true. He is so hard on our kids.

    • In what activities do you or your partner tend to “zig-zag” from one-extreme to the other?
    He is a total workaholic right now. And he’s taking Adderall. 😛 he doesn’t talk to me about it at all, so I don’t know how well that’s being managed.

    My challenge right now is trying to determine which behaviors of his are due to ADHD and which are due to his poor coping strategies or him being a jerk. Funny that this point comes up in this chapter as my personal therapist posed this very same question to me this week

    1. Hi Deb,

      I’m so glad that you realize this “book club” is ongoing. And I really appreciate your participation.

      Good luck with that “symptoms or coping strategies” challenge. That’s the presentation I most enjoy giving. 🙂

      best,
      g

  2. Gina and Taylor,
    I thank god there are people around like you. I need many more.

    I’m getting slowly smarter about how ADHD affects me, and dealing with it, may not “fix” me.

    I went on a late unplanned journey, on the last week of the summer, The decision to go was bred more from desperation before the closing window of one of the least productive and most disappointing summers of my life was shut. I couldn’t think things through,

    I just knew I needed to do something before job responsibilities, that a year or so ago “Fell in my lap” based on past activities, and which I happily accepted, will break up my large block of unhappily unoccupied days, of continued “wanting” what others seem to have.
    I am thinking this up as I type, but it has been going on in my head forever. Book titles such as “what Does Everyone Know That I Don’t”, which I haven’t read, do describe my ADHD well.

    What “I don’t know”, isn’t general knowledge, in the sense of facts, or awareness of what is actually physically happening, or tasks (physically or socially ) that are needed to be accomplished.
    It is the context , sequence, DEGREE, and FORMAT in which they are expected by others to be achieved.
    It is also my lack of confidence in achieving them in ways that others are looking for.
    An explanation TO ME, regarding my ADHD , the Executive Functions, the sometimes inconsistent hyper and low focus, and a loss of a consistent sense of “self” in terms of time and “place” (what is the immediate best step forward “for me” from where I am “right now”).

    I get easily excited, though through the years I have learned that that excitement, which is still there, is to be tempered as an adult. The same goes for disappointment, which is often just as strong.
    What comes out are internal and sometimes external short blasts of one or the other, mixed in with unexpected indecision and divisiveness, as to what feelings are actually acceptable to be displayed. My external self rarely gets to match my internal self.
    If you want cognitive dissonance come into my brain, or more specifically come to the doorway where my brain and the outside human world interacts.
    The, in some respects, limited, short term “working memory” or, to me, the somewhat autonomous transcriber and frustrating, door keeper of the two way narrow passageway of input/output, that seems like the only door of a crowded room where everyone is trying to get in and out at the same time. At other times, they are content to just socialize inside among themselves, impervious to the weather outside, unless of course there is an exceptional storm, rainbow or sunset.

    For me it’s a two way street. The Exceptional, and obvious things get in pretty well. The new, and unexceptional (often normal) struggle in input. And even then, once through the gate, are juggled, for what seems like an eternity until they fall into there appropriate place.
    Output is sometimes limited by the same juggling which causes thoughts and sentences to merge, creating verbal cramming, into limited time and space, or a real crash, as input and intended output clash, frustrating myself and the people I am trying to communicate with.
    To limit conflicts I need to be extremely short and direct to get my meaning across, which can seem oft putting, or I can over explain which can seem condescending. It’s always the extreme.

    Nobody is “the” normal person. But having ADHD in our Society , when it is not understood, treated, or supported, is like preventing someone who is different and who is forced into your culture from ever adapting to your language, values and traditions.

    On my end of summer trip, I can list, and became more aware of so many ADD moments, as they were happening, from the hotels I ended up staying in, to the meals I ate, to the amount of money I spent, that, looking back I could and should have avoided. That’s the norm for me. The exception is when I actually do the things in the ways I wish I always could.

    Without finding the right treatment, every trip would be as haphazard as this last one was.

    And, yes there are good things about anything, just like you can learn from bad teachers. But wouldn’t you rather have good ones?
    Some would still say spontaneity is good, but if it’s always spontaneous it isn’t.

    1. Hi PB,

      As usual, you articulate these internal/external struggles so well. I’m just sorry that you know them well enough to describe them so accurately.
      g

  3. Hi ,

    I took to heart the Strattera idea. In the recent couple of days I wanted to find a person,locally, familiar with ADHD, and it’s medications. It’s an idea of mine to have a “friend who is also a professional” I don’t want to be a patient, or do another assessment.
    I struck out, not surprisingly, with the usual and justifiable statements of “not professional”, not “by the book”, liability issues, and not wanting to step on Doctor-patient relationship without Doctors request.
    I understand all of it.
    Even so, I get upset, that I really just want someone, who doesn’t necessarily know or understand me. One that I could talk to, pay if necessary, quiz, and have a back and forth discussion about the Medications, side effects I notice, things I might want to know, before, I go to the Doctor of my choice. Is there a rent a Gina service? I want your site “in person.” Thank you for this.
    I want to feel that I am not at the bottom of the pile when it comes to my health care.

    Sorry, I just ran through my feelings.

    It was a lousy 2 months at 18mg. Concerta from 20 mg Generic MPH.

    However today, at just one day, at 27mg I feel hope again. It may be the cooler weather, it may be just the thought of change, who knows? But today, I felt like my normal, and comfortable self. Something I haven’t felt in a long time.

    I am looking forward to your next couple of Chapters.
    Please, emphasize as you often do, that there is “no cookie cutter”.

    Whether it’s hyper focus or no focus, working immediate memory, working long term memory, coping, compensations, or even driving.

    The big picture of the commonalities of known and unknown causes of ADHD, and its wide and varied range of consequences, is so important for everyone, including myself to understand.

    We are all individuals and, it is very important (at least to me) that the interpersonal , often difficult, relationships of “difference” on an individual with ADHD, as with any difference, needs to be looked at for what it is, not put into generic, “disabilities” or “gifts”.
    I say this, because it is so hard for me to explain that, often, some of what other people consider to be the easiest tasks are the most difficult for me, while some of the hardest tasks for others are fairly easy for me. In a wide and varied range specific to me and circumstances. “Like everyone else, only different”, is a term I often find myself thinking or saying.

    The Strattera is being considered, after a time, on this change. So far so good. Thank you again, Gina and Taylor.

    1. Hi PB,

      I absolutely wish I could go with you —and all my friends with ADHD—to the doctor’s office!

      Many (not all) need an advocate, someone in their corner who is paying attention.

      It’s a LOT to ask of a person who already has trouble paying attention, remembering, organizing thoughts, etc. to sit in a doctor’s office and ask the right questions, remember the answers, notice if the doc seems sharp or squirrely, etc.

      I do offer private phone consultations. Sometimes validation and “backbone strengthening” is all people need.

      re: your Concerta dosage. Talk with your MD (I have to say that..lol!) about increasing the dosage. The idea of “titration” is to increase the dose until side effects outweigh symptoms. You won’t know what is the best dose for you until you do that. It might be that 27mg is the best for you, but it is lower than average, for what that’s worth.

      best,
      g

      Also, I ask clients to fill out forms as a way of emphasizing data-collection. Getting things on paper and out of the swirling mass in the brain. From there, it’s much easier to find solutions.

  4. I haven’t tried Strattera with the MPH yet. I’ll motivate myself to read through the Chapters again. How is it for others who have to force themselves to do what they want to do?
    Anyway, the amtriptyline was prescribed for what I was told was depression. I started it shortly before I was away from I home in a very large group setting. I would be in bed sleeping and would “instantly” wake up and be wide awake, I would also be prone to feel like crying, for who knows what reason, in seemingly short (a minute or so periods). I called the doctor, and he said, from 200 miles away, “we can play with the dosage”. It was way too overwhelming for me to deal with my normal self, much less be in a large group setting, which in many contrary ways I loved, and to deal with a brain in a remodeling mode. I decided to stay with what I knew, and at least have some of the fun I knew I could have, rather than risk messing up a whole summer, with a breakdown not in my control.

    I will read and write back by Monday. Thanks for the “push” as I see it.
    As for the anxiety. Probably, by itself, or because of. It’s like living with allergies your whole life and being told that puffy dry scratchy eyes, headaches, especially in the fall, aren’t normal. Only after your in your 40 s. I thought it was because of the running, or being dehydrated.

    1. Hey PB,

      As someone who had lifelong allergies and only figured out why a few years ago, I get it.

      I actually don’t mention Strattera in the book; it was still suffering at that time the blowback from MDs climbing on the bandwagon of prescribing it as monotherapy — at too high a dose. I steered clear.

      But since then, I’ve learned how it works very well for many people, in combination with MPH (not sure about AMP). But at a LOW dose — 25-60 but more like 40 mg. Too many times docs prescribe it too high, and intolerable side effects ensue.

      You might be the exception. But it might be worth talking to your MD about (or TELLING your MD). 🙂

      g

  5. Yes
    I’ve written before regarding those. I am currently taking too low a dose of Concerta. I tried doubling, and it was too much. It’s been a rough 2 months playing with the change from generic 20 mg methylphenidate to 18 mg Concerta.
    I will try the next level of Concerta (27mg? ) in the next week. Do Professionals ever consider what it’s like to self evaluate when you are not in a regular contact relationship with others?
    The Methylphenidate 20 was definitely better than the 18 Concerta . But having gone through the ups and downs from amptriptiline in my 20s pre diagnosis to Adderall in my 50’s following my ADHD diagnosis, the drug roller coaster is an even scarier ride. I got off it totally for about 15 years. Running 6-10 miles a day and/or working physically for the rest of the time didn’t fix the ADHD, but it made it slightly tolerable. I can’t do that any more. Even so, I tend to move forward very slow with medication changes. My physical activity now is down to about 6 miles hiking, often 2000 ft up and down 5-6 times a week with my dog.

    Did I mention the stress of paying for the pills and fighting with Blue Cross Blue Shield?

    1. I thought I remembered that, PB. Sorry to make you repeat it.

      Yes, the physician should be working with you to come up with treatment goals/targets. Goals that you can measure objectively (e.g. read three chapters in a boring book I had to read for work).

      It might be that you have some anxiety, too, and that should also be addressed. Did you ever try a low dose of Stratter with the MPH?

      Amitriptyline used to be a first-line Rx for ADHD. It still works well for some people, but there are some side effects (e.g. dry mouth, constipation, etc.)

  6. Taylor and Gina,
    Thanks for your comments.
    There is a side story to the “see it do it “. For me, it does not apply to things that I perceive as only involving me.
    For whatever reason, I will struggle, often with myself, to get obvious things done, due to seemingly minor “blocks”. Mostly fear of missing something or fear of making a mistake. Even so, I seem to keep a “self benefit” “PROJECT” hovering in my background.

    The underlying reason, right now, is no one else is around to set the “boundaries” , including time and possibilities.
    The worst fear is not having something to do, making my life open to others to take over. A side effect of my ADHD, due, I think, to the working memory issues.
    Extremes are the rule. Everything seems turned all on or all off. Totally free-“nothing left to lose” , totally occupied-“a slave” with little input, but lots of output.

    I’m not implying that I have no self control, or wants, it’s just that due to past ADHD history, and ADHD itself, it’s a continuous all consuming struggle. Emphasis on all consuming. My roller coaster doesn’t have a seatbelt, just whatever shells I can muster, which often seem inadequate.

    1. Hi PB,

      You have a great facility with articulating these challenges.

      I just have to ask….have you tried medication?

      g

  7. While still undiagnosed when we first got to know each other, my husband described himself as having ADHD. His history of academic mishaps and wacky career tales came out first as amusing if somewhat embarrassing anecdotes, then later with more candor about how deeply painful and confusing it had all been.

    Unlike many other accounts, he wasn’t in denial about having ADHD…he was afraid of being told yet again that he did NOT have it. He’d been evaluated several times growing up, the last being after he was kicked out of college at the end of his first semester for almost complete lack of completion on any assignment (no more parent-imposed structure) and was always given a different non-answer: maybe depression or this or that learning disability, but definitely not ADHD. The last time was the biggest blow, because not only was he told it was depression, but that the depression stemmed from his dysfunctional behavior. So, he wasn’t trying because he was depressed, and he was depressed because he wasn’t trying. He never returned to college.

    This was the mid-90’s, and as adult ADHD got more and more media attention, he scoffed at those past evaluations and concluded he did have it. He WANTED to have it. Because that meant he wasn’t a lazy person with bad character. But he’d been hurt enough he was too afraid to get another evaluation even in 2009, in case he “failed” again. He confided in me his worst fear was finding out definitively that he didn’t have it.

    He’d become a computer programmer anyway, but tended towards companies with deeply dysfunctional cultures where not only was his behavior tolerated but he worked in a sea of same, smaller companies where nearly everyone had ADHD or aspergers or other similarly impairing conditions and it was all highly romanticized. Sloppy hygiene, junk food, coffee and energy drinks, insane hours, coworkers derailing each other with long arguments about the ethics of quinoa, arbitrary deadlines that seem solely about adrenaline-chasing all nighters….it was a lifestyle. (Don’t want to derail here, but ever hear of the Reciprocality Project? Now there is some crazy stuff that touches on the ADHD-as-gift cultures he sought)

    So what did this mean for me? It was no trouble for our first three years together. It wasn’t until 2012, after we got married, that the roller coaster stopped being fun for me. What we thought about ADHD was plain wrong. We began to fight about what control he actually had over what. I was really hung up on this idea that if I pointed out he was “being ADHD” at that moment he ought to be able to stop for at least that moment. I thought of it as simply not noticing when it happens, but if I’m there to prod him then there was no excuse. Sadly, he often agreed. He’d bounce from intense defensiveness to complete shame that maybe he really was just using ADHD as an excuse.

    By the time I’d found this book, it was 2014, and we’d already been through two therapists who got just enough right to feed us the poison pill of misinformation in other ways. His CBT therapist pointed us at Russell Barkley’s work, but also thought he had an anxiety disorder and not ADHD (as if both is somehow impossible). Our couples therapist agreed he had ADHD, but that he probably didn’t have it that bad because “you’re paying attention to me right now just fine”. She spent a lot of time carefully explaining that while, yes, she did see signs that he wasn’t trying, there are other explanations besides ADHD, and that still didn’t mean it was his fault. She suspected low self-esteem was the real culprit. Both therapists steered us away from seeking ADHD medication. Because it’s a dangerous slippery slope. And psychiatrists often get it really really wrong. Neither therapist had much trust in psychiatry, though both had a recommendation or two they presented as the only good ones they knew of but who they still doubted.

    We both felt like things improved between us and terminated the expensive therapy, but also felt more confused about what to expect and where to go from there. I picked up this book simply to further my education and test fresh techniques, not expecting to find out that we and our therapists had gotten more things wrong than right about what ADHD is and how it presents. And what we believed about medication was all horribly wrong. By chapter 3 in my first reading about a year ago, I was already dumbfounded to be faced with “lack of brakes” as a clearly common feature. This was the very thing myself and 2 therapists saw as a “not ADHD” thing but some other issue.

    If ADHD is a roller coaster, misinformation is another even bigger roller coaster the first is seated in. I tearfully approach my husband clutching the book and tell him everything we thought might be wrong and he just started laughing cynically, but with compassion too. He was far more prepared for that to be the case than I was. He’d been rediscovering ADHD all his life.

    He was diagnosed and began the medication journey about two months later. Still looking for the right fit at 10 months in! The current med regime seem to be making the hyperfocus worse, and therefore “braking” is worse, but he can do what he points himself at now (even if it’s boring!) and even finish in good time. The trouble comes when the task can’t be completed in a day…it’s really tough for him to find a stopping point to pick up tomorrow. But we have an appointment to see what to try next! And a little more hope. And a sense of humor. And a lot of anger still as well, at how flipping hard it is to find and evaluate the professionals to help us, but we keep chugging along anyway.

    1. Oh wow, Chloe. You made my day. Thank you.

      Please re-read that chapter on medication selection/titration. Most docs just cannot be trusted to be methodical (or sometimes even rational).

      And yes, he very well could have ADHD + anxiety. And that can involve tweaking Rx to balance dopamine, serotonin, etc.

      (But…is he taking Adderall? Please try other options. You cannot know what’s best until you try a few different classes and formulations.)

      Beyond that, though…yes, there are strategies to learn. Organizational. Cognitive. etc.

      I am working right now on webinars for therapists, to teach them how to guide their ADHD-challenged couple-clients on these issues. Helping with practical strategies forms the CENTER of ADHD-focused therapy.

      If you can’t find a therapist who understands this, look for an efficiency expert. Such as my friend Holly Graff. http://www.cluttercontrolangels.com/

    2. OH MY GOSH!!! 🙁 Chloe, I’m so sorry. 🙁 I’m so glad you found the book, and this site. Dear Lord, what a nasty ride. 🙁 And yes, ADHD + Anxiety exist in many of us. It’s a “special hell, normally reserved for people who talk in movie theaters.” There are many treatment options, but *you* may have some hyper-vigilance/PTSD symptoms after dealing w/ that for so long. <3

    3. Thank you, Gina and Taylor.

      Gina, on his medication thus far:

      He was started on Adderall, 2.5 mg every 4 hours (8am, noon, 4pm) with instructions to increase weekly based on benefits/side effects. (The pills were 10 mg we cut ourselves into fourths with a splitter). He didn’t notice much of anything at first except for a reduction in anxiety, but otherwise no real benefit or side effect.

      By the end of the month, he was taking a full 10mg at 8am & noon, and a 5mg half pill at 4pm. Obvious benefits by then, and still no negative side effects. Anxiety was gone, he was working straight through the day without his usual detours, his driving improved, he was far better in conversation. It seemed like a perfect fit.

      After another month, however he began to notice an emotional crash around 8pm. He’d come home feeling good, but would feel depressed and irritable when the last dose wore off. Doc advised to increase the 4pm dose (so from 25 to 30mg daily now).

      This worked for another month, then he began to feel this crash at the end of every dose, about an hour before he was to take the next pill. A small snack at that time was suggested. This seemed to help but then he had one story after another about snapping at someone at work (or at me on weekends) during what we began to refer to as the Danger Zones.

      So then, Vyvanse was next. 30mg extended release each morning. This eliminated the crash issue but he wasn’t focusing as well, so it was bumped to 60mg. This did perfect for a few months, but then he was feeling like it wore off by 3pm and he felt he was lost in a scattered fog the second part of the day.

      So then, while 60mg Vyvanse has remained, 10mg Zenzedi was added for this new afternoon slump. And that is where we remain. His productivity is amazing, but he is all hyperfocus now when medicated. He struggles to leave work on time. He’s also saying he feels depressed, not at particular times, just in general. He’s trying to talk me out of mentioning it to the Doc on our upcoming appointment. (Too bad, I say kindly).

      Idk, even though it seems clear to me additional tweaking is called for, he weirdly attached to the current med plan. He says the depression is more the changes in his life. That in the old days he defined himself by his erratic forays into random projects (working on short films, creative writing competitions, Burning Man projects, web comics, creative coding endeavors, etc) but now he just lives the simple life. Work, home, social outings, sleep. He says he used to be driven to do lots of projects, but now he can choose what he does. He’s grieving the way it felt to get swept up in stimulation-seeking. He likes the meds and doesn’t want anything changed about them based on what he sees as a grieving process, adjusting to the new normal.

      I hear what he’s saying, but I don’t understand why he doesn’t want the doc to know all this. I suspect he’s fine with finding better stimulant fits, but doesn’t want antidepressants to get thrown in. And he’s tired of all the changes, maybe he just wants things to be consistent for a while.

      I’m frustrated. On one hand, I want to let him be. We are both tired of my pushing & prodding. But on the other hand, when he’s hyperfocused at work he ignores my phone calls, has stopped acknowledging emails, and is too busy to discuss daily logistical things anymore. In the evenings he gets sucked into various chores or errands. I feel like I have less of his attention than ever. Except when we are on a date, then he’s the best lover ever. When I do have his attention, I really fully have it. It’s just rough getting on the roster now.

      I’m going to explain this to the doc, but in addition to that I’m trying to get my husband more educated. I’m the only one reading up; he’s been pretty resistant to educate himself (because it’s all gonna change in 5 years anyway, he says. Poor guy has been jerked around so much). I was firm with him this last weekend, and got him to agree to read this book. He can’t face it on his own, so we set up a weekly date for him to read it out loud to me, then we can talk about it after. We’ve also got Barkley’s Taking Charge of Adult ADHD in the house too, but that didn’t go over well because I gave it as a gift after a fight. So, this book it is.

      I’m so exhausted myself, whew! Thanks for this book club series! It’s come at a good time for me to have a second read through, though I’ve used various bits for reference all year. The additional discussion here is great.

    4. Hi Chloe,

      I could have guess that this is how his treatment went. Adderall. Amped up. Okay for a month or two. Then crash.

      If you can find a more knowledgeable prescribing doc, I encourage you to do so. Immediately.

      And, please read the chapter on medication in my book. It’s important.

      I would also encourage you not to make your husband read the book now. It might be too hard to bear.

      Instead, go right to the chapters on medication. Read those. Photocopy them. Take notes.

      best,
      g

    5. Will do. Thank you!

      Ugh, this is going to be hard. He loves the Doc.

      I’ll get him through the med chapters first ASAP, then try to present the idea of a new physician.

    6. Ugh is right. Nothing worse than a “charming” doc, who can’t prescribe.

      Good luck!
      g

    7. I wanted to share an update on this situation: he’s now read the medication chapters and is willing to find another prescribing physician, and until we do, ask his current doctor to try a lower dose of his current regimen (morning Vyvanse 60mg and late afternoon Zenzedi 10mg) to see if it reduces the hyperfocus until we can figure out something else.

      However, a new obstacle: he revealed that he was only expecting to stay on medication for one year. This is the first I’ve heard this! His prescribing doctor did not put this in his head, his former therapist did. She had told him he can be on medication for one year or maybe two (after finding the right fit) in order to organize himself and build new habits, then go back off with systems in place.

      Weirdly, he likes being on meds, so I don’t understand why he thinks he needs to go that route. He is willing to consider other information, but I haven’t been able to find anything to debunk this idea. Can you point me at any info that discusses this “one year round” business?

      I told him that sounded to me like something that is tried to pull someone out of clinical depression, but that for ADHD that only makes sense if perhaps there was a heart condition or some other solid reason medication would be too risky for a particular individual for some specific reason…but not any “rule of thumb” for treatment, but I don’t have any resource to back this up. He agrees he’d like to stay on meds forever (even if he is on too high a dose right now, he is loving his new “superpowers”), but seems to see it as overindulgent because of cost (our insurance only partially covers it, we have to pay about $200 out of pocket per month to pay the difference). *I* certainly think it’s worth it and told him so…

      Anything you can point me at that discusses this “one year” idea that I can show him? Thank you.

    8. Hi Chloe,

      That idea — going on meds to “get organized” and then getting off — has been mentioned by a few “online ADHD personalities” but no legitimate experts.

      I do despair sometimes of the slew of “experts” online claiming expertise (and not having it) while most of the true experts are actually working, in the officer, in research, etc. It’s like alternate realities!

      Sometimes, that idea might be used as a way to counter the person’s ADHD-tendency to view things in black/white terms…”I’ll have to be on medication FOREVER.” By staying, “just try it for a while and see,” it takes the pressure off.

      if your husband is not on some kind of anti-depressant (something to target norepinephrine/serotonin,) that’s the addition I’d be talking to the MD about.

      good luck,
      g

      good luck

  8. “It never occurred to him that time spent doing one activity meant that time could not be spent elsewhere.”

    Taylor J zapped a jolt in my head with that statement. I see me in both her and Dr Math.
    My ADHD coping strategy… Is it a strategy, if you just did it because you didn’t know what else to do?…I say that in serious and in laugh at self mode….

    My survival mode was “hyperactive see it do it so you don’t have to do it later or forget to do it.” This evolved into “the strategy” because it worked. Over time, I could see that little steps taken over a period of time saved me from having to make much larger efforts later…Or getyelled at, at least some of the time.

    It kept me functional and made me somewhat of a workaholic and coworker oddity, and has convinced me that I really really like to work. I do, really, I do. And as a side benefit. I got to see and do a lot of different tasks, whether they had to be done or not.

    But even with the occasional praise, and self reward benefits, in my mind, of the accomplishments I made, I didn’t fit in, in several ways. I never understood why the majority of people didn’t operate the same way, leading to frustration for me. They never understood that I was looking forward for me, even when I didn’t know it. Odd stares, glances, comments., also frustrating to me, knowing that, apparently, I was somewhat off putting to them.

    Even now, I still have trouble seeing another way.

    What is it like to take a break, relax, converse with others, find a proper balance of work and “what?”. Some might think “sanity”. To that I’d say “sanity for whom?”. I still find myself saying, “why can’t I see the other side?
    Taylor and Gina, in this chapter and above, you have highlighted the possible reasons. And like learning anything, it’s hard for me. I’ve read them and have heard them, from various sources over and over in the last couple of years, but it’s only been recently, that they are truly sinking in.
    I still struggle with, “when does it make sense, as an explanation, and when might I be using it as an excuse? And when does that matter? I know that answer, in the end, may or may not be important, and either way will come from within, with understanding.

    1. Hi PB,

      You are so right: calling these “coping strategies” makes them sound so….strategic. And planned. When really, most of the time, they are survival responses.

      Just reading your comment makes me feel exhausted. Not your writing; you’re very clear. But because it really imparts the feeling of what it’s like to go through a day in your life.

      You close with:

      I still struggle with, “when does it make sense, as an explanation, and when might I be using it as an excuse? And when does that matter? I know that answer, in the end, may or may not be important, and either way will come from within, with understanding.

      And that is another essential challenge with ADHD: picking out wheat from chaff, prioritizing, finding context.

      To me, it doesn’t seem like you’re looking for excuses so much as answers.

      best,
      g

    2. Dear PB, when you said…

      “My survival mode was “hyperactive see it do it so you don’t have to do it later or forget to do it.” This evolved into “the strategy” because it worked.”

      … you just described how I wrote the first posts in this series. I wrote like a house on fire, because I knew that w/ 4 ADHD family members under one roof, plus an upcoming move, and three kids with major health issues, SOME sort of insanity would happen to derail the whole thing. It’s so hard, because even though you are just trying to “survive,” you (or we!) are constantly trying to head off the next disaster! It’s so exhausting at times. I’m so glad you’re here, and I’m glad these posts helped you put some things in perspective.

      Taylor J.

  9. So good Gina. You and your writer do a wonderful job. The writing is great, and so are the visuals (a little fun). You are the pioneer that others will produce their own work from your seminal thinking. You should be very proud of your work work, as I am.

    Love to Gina,
    your big sister

  10. I’m understanding my ADHD better with everything I read from your posts and emails. Thank you for explaining to me the rollercoaster effect or as I call it back and forth moods and thoughts. Making up my mind is the worst for me.

    1. Hi Kim!

      Dr. Math also has trouble making decisions. He can take half an hour just to pick a dish from a menu. I developed a habit early on of chasing off servers and making light of it by saying things like, “He takes a while with decisions, but he picked me, so I’m okay with that.” 😉

      However, when we’re *driving*, that decision-making trouble is an entirely different story. 🙁

  11. Have mercy, this is my husband all over. Even medicated, his ability to hold things in his short term memory is almost non-existent. He can remember things he did when he was 4 years old in great detail, but what I said a minute ago? Nothing.

    He makes perpetual lists of chores, which can include things like brush teeth, but it will take him days, weeks, years to work through some of them. He has horrible mouth problems, but seems unable to put taking care of his mouth daily on the radar. Or he’ll start an ambitious program and do it for weeks and then one day, he just can’t do it any more and can’t seem to get back on the wagon. Even me telling him how much it costs us (me – I’m the main breadwinner here), doesn’t motivate him.

    His mind flits from one thing to another or hyper focus’s on something to the elimination of all awareness of time (reading on-line comics, looking at other people’s pictures on some website or watching some inane comedy show where he laughs but doesn’t always get the joke).

    His inability to control the time in his life stifles so much of what he could get done. And my prompting with ideas like doing a chore and then getting on the computer a bit, trading off until all the chores are done, doesn’t work for him like it does for me.

    I honestly don’t know what to do about this stuff besides learning to live with it and sharing my brain with his to do the best we can. And unmedicated he was so much worse! Sigh.

    1. Hi Penny,

      All that you describe was a major motivation in my spending the last 3 years creating the new book for couple therapists.

      There are cooperative strategies that can help, but couples need guidance in implementing them.

      And of course, the range of physical strategies might need re-assessment — good nutrition, better sleep, exercise.

      And I know…that will require more effort from you. It can be exhausting.

      g

    2. Penny, I’m the same way sometimes, and it’s only gotten worse recently—my short-term memory seems completely shot. The Firecracker (my oldest daughter) has been teasing me about it recently: “Mom, you just gave me my medicine, then you asked me if you gave me my medicine! What’s wrong with you?” I’m hoping it’s just the stress of moving, plus recovery from *years* of sleep-deprivation. 😛 And yes, if I’m unmedicated, it’s a lot worse.

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