March 30, 2010

Up To Now: The Day Before The Adult ADHD Assessment

So today is the day before my official Adult Attention Deficit Hyperactivity Disorder assessment.

In November of 2009 (5 months ago) my therapist suggested that I consider Adult Attention Deficit Hyperactivity Disorder (ADHD or ADD) as a possible root cause for the depression, anxiety, work, school and relationship difficulties I've experienced over my life.

She suggested I buy a book on adult ADD - "10 Simple Solutions to Adult ADD".

I read it, nay, devoured it. It was as though a team of white coat clad researchers had been watching my life very carefully and had been taking notes, and decided to write a book about me (in a non-paranoid-sort-of-way!).

Then I bought "Driven to Distraction" and noticed that several chapters were obviously written with me in mind - the authors were thoughtful enough to change the pertinent details so as not to point me out to the readers.

I jest of course. But boy oh boy I was touched and wide-eyed reading the stories and cases of all these adults who had spent decades feeling the shame, embarassment, hopelessness and the toxic mix of underachievement and distracted hyper and inconsistent attention that I have experienced.

Early report cards admonished me for spending time distracting classmates and too little time on class assignments. Middle school and high school report cards showed me having 30%, 40% and 54% and other miserable marks in classes, with puzzled remarks by teachers wondering why I was able to achieve 80s and 90s in my final exams, but be dragged down from having not completing assignments on time. I have a fun and terribly destructive habit of wanting to write tests as quickly as possible. Entering university with a dream of becoming a white-coat clad biologist, I learned that psychology suited me well because I attended 2 classes in my first semester of first year psychology, skimmed through my text book the night before and scored around 90% in my final exam, giving me a 90% for the class credit. And I left the auditorium of over 500 people - to my delight - before anyone else left. It was always a contest for me. But obviously there were times that this contest didn't do well for me.

I took statistics 4 times in university, and failed each time miserably, but was able to tutor other students in this course. I scored very highly in my Psychology Graduate Record Examination (GRE) test which I took down in Buffalo, USA one heady and sleepless weekend at the end of my university degree which took me 6 years to obtain - with 1 year put on academic suspension after second year because of low grades. Yet when my results were mailed to me, I found that I had scored in the top 2 percentile of those taking the GRE around the globe at that time (the time is synchronized across time zones, to prevent students phoning international friends to give them advance notice of questions and answers), meaning I got a higher score than 98% of folks writing the exam to gain admission to a Graduate School. I never ended up going to graduate school, writing the admission forms and documents just seemed too onerous, too burdensome, too hard. Story of my life. All my report cards said I "have such high potential". I hated hearing that. Fuck that I would say. Fuck it.
I hid in libraries and read books. I read all sorts of books. I read them a lot. It was my escape - my power.
Ah... the ruthless stories of ADHD. Theories abound as to what the causes and etiology of ADHD are.

Like any diagnosis, symptoms of ADHD (or ADD as it is also known) belong in all individuals along a normal continuum. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM) Text Revision (DSM–IV TR) (American Psychological Association 2000) diagnostic criterion, the symptoms must have started prior to age 7, be age inappropriate, cause impairment in multiple domains and not be caused by other conditions. The DSM-IV TR ADHD diagnosis is broken down into three subgroups: ADHD predominately inattentive; ADHD predominately hyperactive-impulsive; and ADHD combined type. In order for an adult to receive a diagnosis, the adult must have 6 of the 9 listed DSM-IV symptoms in at least one subtype and these symptoms must have caused consistent clinically significant impairment for 6 months or more (American Psychiatric Association 2000).

I suspect, based on reading and symptoms I've reviewed, that I belong more in the ADHD predominately inattentive type - I recall being screamed at by a teacher who claimed I was daydreaming his class away - he obviously took it personally. I found that quite humiliating. He apologised to me the next day, but he remains in my black book (!), whatever his name was. Lazy. Bored. Insolent. All of this. And I couldn't see what was going on.

I recall a paper I read in a class in school about psychological public policy where one can define a mental illness as one that causes a significant degree of discomfort such that it also significantly affects a person's interpersonal relationships (check), work life (check), homelife (check), etc... (check, check and check). Now, some authors - and I don't think this is merely a semantic position - suggest that ADHD should be viewed as a personality type which runs counter to the normal experience of others. There is a hunter-farmer theory of ADHD whereby hunters need to always be moving on to the next and brightest opportunity, without need to rely on working memory so much, and encounter high stress and high distractability in their day to day lives (running from hippos, sabre-toothed tigers and such). There is the arousal theory which suggests that ADHDers are attracted to and distract themselves with highly stimulating environments in order to feel some sort of sense of engagement and indeed participation with their environment. I'm not sure of that last one though.

All that I know (and I'm quite certain at age 39 that the more I know, the more there is for me to learn) is that I have had a pissy time at this all. I have seen therapists. I have eaten SSRI antidepressants for depression and benzodiazepines for anxiety. I freak out in malls when I can't run to an exit.

I have self-medicated with beer, and in my late teens and early twenties, tinkered about with hashish and pot and a few other soft drugs. As I grew up, I continued to drink at pubs, and then in the last decade, only beer at home on weekends. I realized when I stopped drinking any alcohol 6 months ago how much I was medicating myself to quieten the multiple channels always playing in my head. It is as though I had a dozen of those screen-in-screen TV boxes.

How depressing. Relationships failed because of my tendencies. I lost jobs. I quit jobs. I was fired. My contracts weren't extended. And I was so frustrated, and it almost became a morbid joke with my wife in the early years... she picked me up once from where I'd just been let go (I never really understood why) and I was on the verge of crying in frustration. My wife took one look at me, and said "Another one? Don't worry! You'll get another job... they weren't any good anyway." That raised my spirits. She had - and despite all of my failings - continues to have faith in me.

The theory that sits best for me is that ADHD is the result of a biological and neuro-developmental disorder that is based in the poor regulation of various neurotransmitters (catecholamines - like dopamine and epinephrine) throughout various functional elements of the brain - resulting in an overflow or excess of attention to the environment. The problem is that the governing mechanisms don't work well in an ADHD brain - and so the threshold of distractability in my hairy coconut is so low that I jump from book to book, web site to web site, and very often away from the stuff that is most critical.

Shiny things.

It is as though my executive thinking processes do not get the single-mindedness that they deserve. I'm a guy who is reading 8 books at once. I have 40 or more tabs open in my Firefox web browser. And they're not stored pages for another day, they are pages I devour in that session. I read voraciously. My basement office is a mess of clutter and crap. I makes lists and forget about them. I put some toast on, and make some tea. I go downstairs to quickly check my e-mail and find an interesting link and 30 minutes later go upstairs to check the mail and realize that my toast is cold and that the tea is completely opaque and cold, with a film of tannins clinging onto my spoon.
Woe to those who bore me with business jargon, who are dumb (I'm quite a snob really), and who have no interest in my arcane and catholic range of interests. I'm an athiest too. It helps if you are interested at least intellectually in my interest of religion versus athiesm. Oh, and in psychoanalytic theory, and in bushcraft, and in photography and in nature and in the study of mushrooms and in biology and in biochemistry and in game theory and in international affairs and counter terrorism theory.
I have an odd sense of humour - and use it inappropriately, in all sorts of occassions and situations where it is not fitting. I look at people who don't understand either my humour or indeed that I am being ironic or humorous as being particularly despicably stupid (language gaps notwithstanding). I am quite judgemental that way. I guess that's easier than coming to the conclusion that I'm being an idiot at that moment for making jokes. Imagine being married to me, me who cracks jokes in moments of intimacy or sadness or fear. It is the comedian's disorder, I heard a comedian/ ADHD sufferer once proclaim.

A prominent myth of ADHD is that it is a problem of attention, in that ADHDers can't pay attention. It is more a case of inconsistent attention. ADHDers will hyperfocus, which is how I taught myself ASP classic programming, and learned SQL when I was younger and developing websites as a side business. I have read countless books on psychoanalytic theory, from Jungian to Existential Humanist to neoFreudian, to interpersonal and self psychology (Kohut et al.). I have read countless sources on bushcraft (my other blog focuses on this stuff), and I have probably another 4 or 5 hobbies which take my attention. I am fascinated with military, intelligence and international affairs, and opened a blog for that some time ago. I posted prodigiously.

I am not alone. ADHD is estimated to affect 5%–10% of the child population (Faraone et al 2003) and from 1%–6% of the adult population (Kessler et al 2005). In a recent large epidemiological study in the United States, 4.4% of the adult population was determined to have clinically significant ADHD symptoms (Kessler et al 2006). ADHD is, therefore, a very prevalent disorder across the developmental spectrum.

God, I could write for hours on this - I have learned so much over the last few months reading books, and watching online videos and reading forums and papers on ADHD. But I'll stop now. I'm likely engaging in 'productive procrastination' - I know that I have some papers to organise and present tomorrow during my 3 1/2 hour assessment for ADHD.

I've touched on some long term reasons that I've arrived at today - but the short term is easier to explain.

Through my company's confidential Employee Assistance Program, I saw a therapist to address some personal issues. She suggested I consider ADHD as a possibility laying behind some of my struggles, and suggested some more books on ADHD (she is a big proponent of bibliotherapy, as am I) for me to read. I then went to my family physician who - after listening to me - provided a referral to a psychiatrist in Toronto who specializes in ADHD in adults. So tomorrow I wil attend a 3 1/2 hour assessment, overseen by a psychiatrist, a clinical psychologist and a psychometrist (one who is specialized in the delivery and analysis of psychometrically-based tests).

I am really nervous, really excited, scared, confident and feeling sad all at once about this. I expect good things though, overall.

I will let all 2 people who I expect will read this blog to learn the outcome.



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