May 27, 2010

Hiking & Photography - One of my Antidotes to Adult ADHD Stimulus Junky Conduct

In a slight departure from posts exclusively about Adult Attention Deficit Hyperactivity Disorder, I thought I would write a little bit about what I believe calms my mind and restores order to help me cope with my ADHD symptoms. I am currently reading an AMAZING book entitled "You Mean I'm Not Lazy, Stupid, or Crazy?". Now I've read the series of books by Dr. Hallowell, and they are very good. I've read a few others that all have their own emphasis - but this book is wonderful. It speaks specifically to how symptoms manifest themselves in our lives, provides some theoretical structure as to how the disorder's many facets contribute/cause these symptoms, and finally discusses in wonderful, clear language how to cope with them.

I can't say enough good things about the book, and I highly recommend you go out to your local bookstore and buy a copy now. You can leave your coffee where it is, you can microwave it later or just make a fresh cup later. It's only coffee. You can also buy it online here, or visit my bookstore at to purchase it online.

That said, they have a chapter devoted to meditation and body focus relaxation methods. Sounds a little hippie, I suppose. But keep in mind that ADHDers are 'stimulus junkies' and engage in high-stimulus activities just to keep that ol' epinephrine flowing through our executive-function fulfilling frontal lobes. That's all very well and good, but the downside to that is that the brain has a series of looped connections which ensure homeostasis - i.e. balance. And if one part of the brain is full-on stimulated, then the looped in portions join in. And our limbic system, the seat of our primitive motivations, like sex, hunger, anger, fight or flight, etc... are connected and affected in ADHDers.

Our limbic system when turned on high causes stress hormones to be released, resulting in sympathetic nervous system stimulation. Our immune system (macrophages, white blood cells, and all the T-cells and bits and pieces that comprise our bodily defense system against both external threats like infection, and internal threats like heart disease, abnormal cell growth, gastrointestinal disorders, auto-immune problems like lupus, some arthritis, and perhaps chronic fatigue syndrome) becomes suppressed. We get sick. We get worn out. And the the vicious spiral continues until we fall over with a loud thunk, or find a way to relax.

Anyway, I work in an IT department, and often have some very high pressures affecting me - emergency system outages, and not to mention nearly a couple of dozen people reporting to me who all have their own personalities. I need to be part project manager, crisis manager, counselor, application and system manager, and this can be kinda tiring.

One of my ways to calm myself down is to get into nature. And so last Sunday I went for a hike.

I went for a nice hike up at Whitchurch Conservation Area north of Toronto, just off of the 404 highway near Stouffville on the weekend.

View Larger Map
Above is a map - if you can't see it, you may need to install a Google Earth plugin, or simply use the normal view of Google Maps.

I brought along my military surplus knapsack that I picked up at a thrift shop for a few dollars. It is made of canvas and is a terrific piece of kit - big enough for a day trip, with lots of connection points on the outside for attaching extra gear.

I reached a grassy verge at the edge of a pond, and laid out my wool blanket, my stove, and cooking kit, pulled out my book and sat for a while relaxing and reading.

I brought my Trangia kit - a great compact size, everything fits into the pot. I brought my Mora 510 carbon steel blade knife, and a stainless steel camping cup for eating lunch. It was still early, so I read and watched the birds, and listened to the sounds of nature for a while.

At one end of the pond, last year's growth of cattails are fluffing up and breaking down amongst this year's growth. Had I been especially hungry, I would have pulled up the roots and made a little stew or roasted them over a flame. I wasn't especially hungry.

The grass was full of edible and medicinal plants. Narrow leafed plantain above.

Broad leafed plantain or common plantain. You can cook up the leaves like spinach - and roast the roots for flour.

I was on a grassy spot but most of the area is thick woods, a mix of deciduous and coniferous woods.

The other end of the pond was narrower, and at one point a Great Blue Heron flew in. It got spooked and flew away the second it saw me bumbling with my camera (shaky and blurry shots below).

Fat bumbling tadpoles soaked in the sun in the shallows.

They might make good bait if I were in a fishing mood.

I had the place to myself. Wonderful. And on a Victoria Day long weekend (a Canadian holiday) where traditionally most folks go to cottages or go camping or to wilderness areas to escape the city and to locate the beers.

I'm not sure what this little yellow flower is - anyone?

Ahhh.... Wild Strawberries! The paths through the woods were littered with them. As I crawled along the ground looking for plants (a sight to see), I noticed beneath the strawberry leaves there were little strawberries. I ate a few and they were tart and delicious. Each of them, a tenth of the size of a domesticated strawberry had as much flavour as the latter and a much fresher taste too.

I ate a small handful worth of them.

After nibbling on strawberries, yellow wood sorrel, plantain, and other bits and pieces I found about, I read for a while longer.

Then I figured it was time for curried chicken with rice. I opened my can of curried chicken with my knife, and plopped in some rice. Nothing tastes so good when you are hungry and when you are outdoors in nature.

A rude honking squawking sound emerged from the sky, and I had to scramble to turn on my camera and try to capture pictures of a Great Blue Heron (Ardea herodias). It looked like a gigantic pterodactyl.

It landed but despite my stealthy stumbling, it saw me and flew off as quickly as it could.

Next time I will wear a Ghillie suit and hide in a tree for the day, waiting for the bird to land again.

The bigger and the more unusual the bird, the ruder the sounds they make. That's my theory. The loud, coarse rattle of this irritating bird was a Belted Kingfisher (Ceryle alcyon). Well, it was nice for a while, then it got irritating.

After a few hours, I decided to be on my way. I packed up, ensured the place was cleaner than when I first got there, and started through the woods on the path back to where I had parked my car near the road. As I walked slowly, looking carefully at the various plants scattered along the pathway, I recognized ferns, and wood sorrel, and a couple of Jack in the Pulpits.

And then suddenly, as though I had recognized an old friend, I saw a mushroom standing amongst the leaf litter. I knew instantly that it was a Morel, although I've never seen one in real life before. It is such a recognizable mushroom, much like a giant puffball is unmistakable.

These were highly prized, rare, and exceedingly edible Morchella esculenta. I picked the two that I was able to find, for a dinner treat later that evening.

This is an Ink Cap - I believe. There is a self-digesting enzyme within the cap, that upon maturity emerges to cause deliquescence... Deliquescing is what happens when the cap liquifies, through autolytic action. It is named an Ink Cap, because the black fluid that the cap breaks down into was once used as a writing ink.

Here is a bunch of immature Ink Caps still in their button or egg form. They are edible (always cook mushrooms before eating them), but if you drink alcohol within 72 hours, you will suffer from mild gastric distress, due to an interaction of the metabolites of alcohol and the Ink Cap.

I've always been drawn to the soft, velvety leaves of the first-year growth of Mullein. My mum told me they were known as fairy blankets when she was a child in Ireland. If you pick one up, you'll understand why.

Baby blue coloured Forget Me Nots were scattered at the wood's edge.

They look so nice. By the time I was in the car, carrying two Morel mushrooms in my jacket pocket, lots of pictures in my camera, rice, curry and chicken in my tummy, I was rested and relaxed. I had read a terrific book and was feeling really positive.

There is nothing like nature to restore and to calm the ADHD mind.



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May 20, 2010

Goal: Remember So As To Do

The last couple of weeks have been tough, but easier than the hundreds of weeks that went before in my life. I am amazed at how I am becoming aware of how impaired my working memory is. I forget shit all the time. I don't just forget stuff, but I forget shit.

All. The. Time.

Everyone gets distracted. Everyone's attention is diverted by compelling stimuli. If we weren't distracted, we would risk being hit by a car, or be seen as socially inept when someone tried to get our attention, etc.. etc...

And it is our working memory, the theoretical construct within cognitive psychology that refers to the structures and processes used for temporarily storing and manipulating information that allows us to recall that which we were initially doing, and return to it. What differentiates ADHDers and non-ADHDers is the poor quality or deficit of working memory. After a distraction has redirected their attention, ADHDers do NOT return to task, whereas non-ADHDers do return to task - e.g. the document they were writing, or the clothes they were folding, or the food they were cooking.

For example, I go downstairs with the express intent to get a pair of pliers from the tool chest. I notice some batteries on my desk. I remember that my Motorola camping walkie-talkies need new batteries. I insert them and feel good. Then I see a book on camping near where I had stored the walkie-talkies and pick it up, because I intend to read it later on. I come upstairs again with the book, excited at the thought of sitting down later outside in the sunshine and reading through it. But then I recognize a lingering suspicion within me that I've forgotten something. It takes me a minute or so to mentally retrace my steps, and actually talk to myself quietly to figure out what I'm missing: the pliers.

My wife asked me the other day to pop downstairs to grab a print-out from the printer we've networked across the house. She prints a document upstairs and the print-out appears downstairs. I went downstairs. On my way to the printer, I changed my socks quickly, as I had a hole in one of them. I then noticed my garbage can needed emptying so I quickly emptied it into a garbage bag. Then I went to the washroom. Then I thought it would be a good time to trim my goatee with my new fancy trimmer. Then I saw a T-shirt that I wanted to wear. So I returned upstairs with my nice T-shirt, feeling good, and got back to making the tea I'd started on when she'd initially asked me for the print-out.

Now that she is realizing (I believe) that my ADHD plays havoc with my working memory, she sort of smiled, and asked me gently where the print-out was. I told her (thinking quickly on my feet) that I needed my special T-shirt first so that I could go get the print-out. I'm clever that way. I skulked back downstairs and fetched the print-out.
"[...]most patients with ADHD continue to struggle with a substantial number of symptoms and a high level of impairment.

For example, adults with ADHD are thought to have deficits of working memory as exemplified by less ability to attend to, encode, and manipulate information. Such deficits in working memory may decrease the ability to filter out distractions, which contribute to further symptoms of inattention in adults with ADHD. Although less defined within ADHD, organizational difficulties and procrastination also appear common.*"
My new motto and new mantra is something that Dr. Russell Barkley said in a presentation - that a very important goal for ADHDers is to "remember so as to do".

So now when I forget to grab that print-out or grab my T-shirt, or close the garage door, or forget to close the kitchen cupboard, or forget my security pass for work, I am kinder to myself than I've ever been. Normally I have chastised myself and told myself that I'm 'such an idiot', and when appropriate apologize and apologize to whomever is blaming me for leaving something undone.

I now remind myself that I am working hard at developing new habits and coping skills, and learning more and more of the ADHD limitations that I can work to overcome - including with the help of medication. And I remind myself that my new goal is to more effectively "remember so as to do".



*Seidman LJ, Biederman J, Faraone SV, Weber W, Ouellette C. Toward defining a neuropsychology of attention deficit-hyperactivity disorder: performance of children and adolescents from a large clinically referred sample. J Consult Clin Psychol. 1997;65(1):150-160.

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May 14, 2010

Video: Dr. Russell A. Barkley - Management of ADHD

Dr. Russell Barkley is a great educator and researcher. If you have an hour and 20 minutes, watch this. Or just watch it in chunks. But watch at least the first 10 minutes... You will learn a lot about ADHD.
"Russell Barkley, Ph.D., discusses the recent advancements in understanding the nature and subtyping of ADHD as well as recent discoveries in what might cause the disorder and medications that might help treat ADHD. Series: M.I.N.D. Institute Lecture Series on Neurodevelopmental Disorders"



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Managing My Physical & Mental Health

If I am to find a way to manage my mental health - i.e. find a way to cope with and treat ADHD, I think it is important to have a positive attitude. Having a positive attitude comes with good self-esteem. Years of failures and struggles and frustration in part due to ADHD will lead to low self-esteem.

For many years now - probably since I ditched my bicycle and learned to drive a 4-cylinder internal combustion engine powered automobile (A.K.A. a car), my weight has slowly crept up. I used to be a skinny kid. Then in high school I was a wiry kid. And in the first couple of years of university I was a slightly muscled, thin guy. Then I worked as a butcher for a couple of years in summers and in the year I was put on probation and told to take a year off university. I worked out at a gym and ate meat each day. I remember getting to 200 pounds and was happy - bulk and great strength was required when hoisting sides of beef about a very slippery floor in the shop.

Then that weight became more tipped to the side of fat, as opposed to Herculean man-strength and Sean Conneryesque Mr. Universe tone (the fun thing about a blog is that you don't have to have it peer reviewed or authenticated by any authority).

In 2003, when I was married, I weighed about 220 lbs. My suit was ill-fitting, or at least I was ill-fitted to my suit. I had more chins than an Argentinian, United Kingdom, French, French Canadian or Portuguese toast (Chin Chin).

My Body Mass Index calculation suggested that I would no longer be overweight once I reduced my weight to 184 lbs. Yeah right. That seemed a little outlandish. In November I decided to stop drinking for good. Not that I was reeling drunk all the time, but I was certainly having a few too many drinks on the weekends, and this helped me forget (a) what had happened previously and (b) what was to happen to me - and thus was a nice temporary relief. So I stopped. No twitching, or spasms or shrieks of agony. Just stopped. And I think for all the lack of those calories I began to shrink.

Around the same time I decided to stop drinking the 6 to 10 cans of full calorie Coke that I was drinking to (in retrospect) self-medicate my ADHD and help me focus. I switched to Diet Pepsi. Diet Coke tastes like barely-fizzy diluted cat piss. Diet Pepsi is nicer. And so I shrank more. Then I decided to replace each breakfast with 2% milk with Slim-Fast powder mix - which is really just milk powder, sugar and some Aspartame - and vitamins. Then I stopped snacking during the day.

The longer I've been on this calorie-reduced diet, the less I get urges to binge on food.

So here is my progress since then (graph below) - I want to go down to 180 lbs and stop there. I think I would like my upper range to be 185 lbs.

My point of this rambling post? Well, I feel proud of having done this. I'm not doing this for beauty reasons (despite my Sean Conneryesque appearance), but because I'm nearly 40 and I don't want to be putting extra weight on my heart and joints. I want to be a positive example to my little boy. And I want to be around for a long time.

And doing something I take pride in, makes me feel proud. And feeling proud increases my self-esteem.



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Another Step: Blood & Cardiac Function Testing Needed Prior to Medication

I'm writing this and other recent posts in order to give you a sense of what is involved in getting a diagnosis of ADHD, and what is involved in getting treatment, and the steps in between. That is, what has and will be involved for me. Not everyone has to go through so much, and some may have a more tedious and lengthy experience. And of course, I am not just talking about pharmaceutical treatments, but changes involving and that result from the very fact of receiving a diagnosis, and everything that follows from that (including medication, but also self-help, counseling, lifestyle changes, implemented tips and techniques etc...).

So this morning I left early so that I could make it to a local hospital where a clinic is located so I could get blood-work and an ECG (electrocardiogram). These were needed prior to being put on Strattera. The results will be shipped to my family physician, and I have an appointment booked with him in a couple of weeks to followup. Hopefully (and I expect) everything will turn out well - that my blood will be found to be the purest and most balanced in every respect that the clinic has ever seen and that it will be written about in medical journals and texts for decades hence, and they will need to ask for a release form (with mentions of plush royalties payable to this author) to feature my ECG printout in a world standard cardiac textbook on what a 'perfect' ECG should resemble.

These tests are necessary because Strattera should be prescribed 'with caution' to people with a preexisting condition of tachycardia, and to people with preexisting impaired hepatic function. Since stopping any alcohol intake since November of last year (seemed a wise thing to do, given that it probably didn't help me focus all that well), and since I don't smoke (never have) or inhale solvents from a plastic bag (honestly, never have) in the alley behind my house, I'm assuming I have a lovely, ripe, healthy, delicious and chortling liver. I believe that my heart beats with the regularity and the robustness of a fine - and extremely expensive - Swiss Chronograph.

Since I could go to any clinic to get this testing done, I did a quick web search yesterday, and called a clinic that appeared (on Google Maps) to be along my route to work. They answered, and said that no appointment was necessary - just to come in with my Provincial Health Card (I live in Ontario, Canada) and with the requisition form that my doctor gave to me.

I arrived at the hospital 10 minutes before the clinic opened. I was the first in line, and the policy there was first in, first out. 15 minutes after entering the clinic, I was pressing the elevator button to return to the parking lot. I made it to work a half hour early, missing only a few milliliters of the red stuff, sporting a cute band-aid on my left arm, and with a hearty (no pun intended) kick in my step.

Feelin' good.



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May 13, 2010

Another Step: Appointment with Family Physician, then Blood Tests, etc...

Well I went to my doctor's office this morning and it turns out that prior to getting the Strattera prescription, I must have a battery of blood tests, and an ECG or cardiac test. Apparently normal routine stuff. He took my blood pressure and said that it was 120 over 80. Which is good.

My weight is down 25 pounds or thereabouts since November because I deliberately decided to lose my beer gut etc... by stopping drinking beer, and sugared (actually high-fructose corn syrup sweetened) cans of Coke. He was pleased with that too.

Anyway, to expedite this whole matter, I've made an appointment tomorrow morning at 8:00 to go to a clinic on the way to my work to quickly get my tests done.

The sooner the better, because then the sooner I can get on the medication and hopefully regain some focus. I have another appointment with my family physician in 3 weeks, and the ECG tests etc... take about 2 weeks to come back, so I'm working within a time line here. If I were rich, I'd have a personal physician named Horace and he'd get this done faster.

Hope everyone is having a fine evening!



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May 12, 2010

About Atomoxetine - ATX Strattera®

The Canadian ADHD Resource Alliance has a huge amount of resources on their website. I highly recommend you browse on by...

Here is a section in their Medications for ADHD about Strattera, the medication I will be put on this week (hopefully).

I have read about all sorts of less-than-positive experiences on Strattera, and had some very helpful e-mails and comments to urge me to research it. I'm going to see how it goes - but will definitely be my own advocate in the event that I am badly affected by side effects, or if it simply doesn't do anything for me. Thank you everyone for your interest and input - I really appreciate it!
"Atomoxetine - ATX

Atomoxetine is a specific noradrenaline (a.k.a. norepinephrine) reuptake inhibitor and comes in seven doses (10, 18, 25, 40, 60, 80 and 100 mg). ATX is not classified amongst the psychostimulants and it is not a controlled substance.

The major strengths of ATX are that: a) it provides continuous coverage including the late evening and early morning periods; b) it is indicated by Health Canada in all ADHD patients across the lifespan; c) it may be particularly useful for ADHD patients who have tic spectrum disorders or comorbid anxiety, resistance and/or side effects to stimulant medications, and there is little problems with worsening of sleep; d) at this time, there appears to be no substance abuse or diversion potential; e) samples may be available to establish efficacy before a commitment is made though it is covered by the majority of private insurance carriers; f) it may be covered by some provincial special access programs, and g) a new indication may be emerging for its use in enuresis.

The onset of action is slower than stimulants as they act on different neurotransmitters and the maximum treatment effect may not be reached for two months. The clinical changes are gradual. It would not be suitable in cases where there is an urgency to obtain a rapid onset of action. The dose is calibrated to the weight of the patient (see relevant tables for initiation, titration and maximum doses). There appears to be no increased benefit past 1.4 mg/kg/day though there may be some improvement of ODD after 1.8 mg/kg/day.

The American Academy of Child and Adolescent Psychiatry has stated that the doses could go as high as 2.2 mg/kg/day but this is much higher than the Canadian standard. If higher doses are contemplated, a referral to an ADHD specialist should be made. If the doses should exceed one pill a day, the cost of the medication is doubled. The capsules should never be opened as it may cause irritation of the gastric lining. The medication's safety profile has been established including the same risk factors related to cardiovascular conduction irregularity similar to those of stimulant drugs. Two cases of reversible alteration in hepatic enzyme are noted. No special monitoring protocol is required (i.e., blood tests) but patients should be advised of the clinical symptoms of hepatic dysfunction. Poor metabolizers (i.e., 7% Caucasians and 2% African-Americans) are unlikely to have toxic effects given the slow titration schedule.

Measurements of blood levels are not required. There have been rare reports of increase in suicidal ideation; one suicide attempt (overdose) was identified; no completed suicides occurred. Clinicians need to carefully monitor suicidal ideation, especially in the early phases of treatment not unlike many antidepressant medications. The clinical efficacy was the same as stimulants in patients who were treatment naive. ATX can be combined with stimulants to augment the effect in the case that the clinician feels the patient has not achieved an adequate response, but in these circumstances, a referral to an ADHD specialist maybe indicated."



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May 11, 2010

Thank You All for Visiting my ADHD Blog!

Since I started this blog less than a month and a half ago 2,620 readers have dropped by to read what I've written about my Adult ADHD assessment, diagnosis and treatment experiences. 485 of you have returned to read my entries week after week. Amazing.

I've had visitors from the following countries (in descending order of visits):
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Because of the number of international visitors, I've decided to include a translation tool - have a look on the right side of this blog. Now you can translate this blog into most major world languages.

Welcome everybody, hope you are learning as much as I have been learning, and are enjoying my posts about Adult Attention Deficit Hyperactivity Disorder.



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Adult ADHD Books & Making a Medical Appointment

I have been reading several books over the last week to learn more about ADHD. One suggestion that the psychiatrist made was for me to learn about mindfulness. Though I'm not suffering from depression, the principles in "The Mindful Way through Depression" can easily relate to anxiety disorders and specifically to Attention Deficit Hyperactivity Disorder. I am finding it to be a very interesting and intelligent read. I highly recommend it.

Being as I am tending towards distraction, I am also jumping back and forth between that book, and "Driven to Distraction: Recognizing and Coping with Attention Deficit Disorder from Childhood Through Adulthood", "Driven from Distraction: Getting the Most out of Life with Attention Deficit Disorder", and "The Disorganized Mind: Coaching Your ADHD Brain to Take Control of Your Time, Tasks, and Talents" - all of which I highly recommend.

Yesterday afternoon I did a bit of juggling.

The ADHD clinic was to have transcribed my treatment plan and faxed it through to my family physician. I found out on the weekend from a family member that my family physician was soon to embark on a vacation... so I wanted to get the prescription for Strattera before he flew off.

But when I called his office, they said they had not yet received anything from the clinic. So I made an appointment for later this week in the morning, and then phoned the clinic back, explained my predicament. They said they'd get it all faxed through by the time of my appointment. I will follow up later this afternoon to be sure.

I felt good after doing that. I felt like I was taking control of my treatment plan. Doesn't sound like the biggest deal on earth what I did, but when juggling a busy day at work - along with the rest of life - sometimes mundane administrative tasks like this can seem almost unachievable, especially before even embarking on it. Ah, ADHD.

On another bright note, I am finding that chunking my daily schedule out into discrete patterns of time for more mundane items like - take shower - leave for work - create resourcing document - prepare for management meeting - review daily task list - evaluate daily task list before leaving work - leave work - take baby bottle from fridge to warm up etc... has been very useful to me. It is helping me work on developing a time sense. This is a topic I will be covering shortly - something ADHDers with their poor working memory have to work on.



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May 5, 2010

It's Official: Adult ADHD Combined Subtype

Yesterday I had the final session of my Adult ADHD assessment at a specialized ADHD clinic. I met with a new psychiatrist and the psychometrist who had administered and analyzed a series of psychometric measures, and who had interviewed me in the first session.

We all sat down, and they said they had reviewed the notes from the original doctor, the psychometric results and the historical and interview information. I was watching carefully, waiting to hear the 'verdict', almost afraid to hear that they didn't think I had ADHD, but in fact was simply a nervous hypochondriac (!). But the psychiatrist nodded affirmatively as he finished his statement, and then leaned his notes towards me where it was written "ADHD-C". He said that the diagnosis was ADHD, and that the subtype was the combined type. He said the subtype was more of interest for the diagnostic process and less important to me, but suffice it to say, I have ADHD. The psychometrist commended me on the volume of historical records I had brought to bear, and then said that all the test results indicated that I had 'all the hallmarks' of the diagnosis.

So I asked a few questions about the diagnosis. They asked me if I was intending to pursue counseling beyond their office, and I said yes. They asked me if I had self-harm or suicidal thoughts. I said no (I guess they need to ask that as it relates to medication). Then the psychiatrist presented his conclusion that medication would be appropriate. He said given my age, my history, and my comorbidity of anxiety, the best course of medication would not be one of the stimulants (Concerta, Ritalin XR, etc...) but rather a norepinephrine reuptake inhibitor (NRI) called Strattera. I didn't know much about NRIs so I asked a lot of questions. I think he was getting a little irritated with me at one point for trying to understand the benefits of NRIs over stimulants, but I steeled myself thinking that I was owed at least a good explanation (noting of course my tendency to perseverate!). In the end I was convinced it was a better choice.

Adults are better candidates for NRIs because while the results may take up to 3 or 4 weeks to kick in, they have better self-control and don't need an immediate fix - they've developed sophisticated coping mechanisms for the disruptive and painful symptoms of ADHD. Instead of two or more doses a day of stimulants - which may end up causing insomnia, NRIs build up and provide 24 hr relief that does not affect sleep. Children on the other hand often need to demonstrate a quick response to medication because they have a lot less self-control over their symptoms, for all of the obvious reasons, and so stimulants are a better candidate for them. Also, because of my anxiety (which stimulants can increase), NRIs (which do not increase anxiety) are a better choice.

A quick note about anxiety etc... You should imagine a Venn diagram with circles for anxiety, depression and ADHD symptoms. Adults generally (something like >85% of adults) suffer from comorbidities that have arisen due to or in concert with ADHD symptoms. Being able to tease out which is which can be important in some cases, but in my case, it is enough to help me be more functional, and less affected by ADHD and anxiety symptoms at the same time - which NRIs can address. I was told that it would be a good idea to lay off the 6 or more caffeinated drinks I have daily, as that would increase my anxiety. I figured that it would help focus me, but I have decided only decaffeinated cola for me now, and I will try to limit my caffeine intake to maybe a single cup of tea or coffee in the morning. I am to take the NRI in the morning along with my SSRI antidepressant (Celexa). It may be that in short order I will be able to come off the SSRI, as I am not exhibiting signs of depression currently - both shown by their examination, but also by my self-report.

They are going to pass the consultation notes on to my family physician who will then prescribe me the Strattera. This could take up to 2 weeks.

I am relieved. I was thinking that there was my life before yesterday and then there is my life from today onwards - ADHD never goes away. One cannot be cured of ADHD. But many report incredible changes to their lives post diagnosis and upon the start of a medication regime - and this gives me a great deal of hope. I am weary, and I am tired, but I know that I have headed down the right path. I wish I had known about this years, or even decades ago, but so it goes. I'm here today, and have only the future to fulfill. I am doing this for me. I am doing this for my wife. I am doing this for my lovely 16 month old baby boy. I am doing this for the person I was, who I am in a way reaching back into time and taking care of.

Onwards and upwards,


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May 4, 2010

One... Two... Three! (of a Series of Sessions of my Adult ADHD Assessment)

Today I have an appointment at the ADHD clinic - my third session of my Adult ADHD assessment. It will be a meeting with a psychiatrist and I believe with a psychometrist. I don't have details of the agenda, but I expect they will be drilling down a bit more on a possible diagnosis (to sort out comorbidities, and to clarify diagnostic subtypes), all towards a goal of presenting a treatment plan.

Or they may simply pronounce me irretrievably mad, and suggest I be locked away in a nice room with soft walls. Irretrievably mad - although not an official DSM-IV diagnosis - is sometimes an appropriate label for how I think of myself, at least in darker times.

But I am certain they will be kinder with me than I have been with me. They have all been nice up until now, anyhow.

I figure if the treatment plan includes medication, there will need to be a few meetings to follow to review the dosage, type and regime.

Hope everyone is having a fine day. I'm guessing I will be worn out by the end of the day, so will follow up shortly with details.



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May 2, 2010

My Recent Visit to the Clinical Psychologist - 45 Minutes of Hmm...

Last Wednesday afternoon, I met with the clinical psychologist who is part of the team of specialists tasked to conducting my Adult ADHD assessment.

I immediately liked him, he seemed very experienced and very curious about me. He stated that he had not yet reviewed my file. Bruno Bettelheim said that is was always best for a clinician to go into a first meeting without ever having read the case notes of someone else prior to a first meeting, in order to avoid unconscious expressed opinions (found even in the most fact-driven notes). Perhaps that's the reason he didn't read mine.

We spoke as though we had met at a friend's house during a party. He asked a lot of questions, and I felt more and more comfortable with each question. He focused on my current life, on the last year or two, and asked about my symptoms. He asked a lot about the significant people in my life - my immediate family, but focused more on my family in which I grew up.

He said that it sounds like after all of my reading, I had diagnosed myself. I hesitated, because I didn't know how to answer that. I squirmed a bit. After all, a lay person can't diagnose themselves or anyone for that matter, in the same way that they can't conduct an official arrest or absolve someone of their sins, or certify a bridge is sound and can take road traffic. They don't have the role authority, nor have they got the relevant experience. I cannot therefore utter the performative phrase "You are diagnosed with this psychiatric condition".

I replied that having read book X, Y, and Z, after a previous therapist with experience in ADHD had suggested I pursue an assessment and after having thought about many of my behaviours (I gave many that were criteria-based to the DSM-IV diagnosis), that pursuing a diagnosis through the clinic seemed the best thing to do.

He was explicitly complimentary, and that made me feel really good. He said I was obviously very psychologically minded and very sophisticated in my thought processes. It was nice to hear what sounded like an authentic compliment of certain qualities I believe I hold. In fact by the end of the 45 minute long meeting, in which I think I spoke about 80% of the time, I was feeling really good. And calm. And sane. And confident. And OK. Which ironically made me wonder if the doctor was really getting the guy who worries so much, who forgets so much, who can't perform like he thinks he should, who is clueless and desperate for some answers. The guy who procrastinates and can't focus in meetings with more than one other person, who hops about thought processes like a lumberjack hops about on rotating logs in the strong currents of the Athabasca river.

He asked what I would like to get out of this process. I answered that I wanted to develop strong, consistent and controllable qualities of focus, follow-through, insight of chronology, and would like to overcome the behaviours and indeed self-opinions that hamper me at my work and those that hamper me in my personal life. Didn't know what else to say. "A cure" would have been disingenuous, but in the same way we all want to win the lottery and never have to worry again, I was tempted to answer "I want this crap to be cured". And I suspect he would have understood.

I was a little uncertain, as though I wasn't sure if a person with whom I had shared such secrets, would be interested in ever learning more about me. I asked him if he had any sort of feedback or a sense of me as it related to a possible diagnosis. He hedged and said that he would be speaking with the psychiatrist (who I would be meeting with next week) and reviewing my file with him and with the psychometrist I had previously engaged with.

That seemed reasonable, I thought. He gave me his business card, and told me to call him at any time if I had any questions prior to my next meeting. That was a nice expression of trust and caring, and I put the business card in my pocket.

I will be attending my next session this Tuesday, with a psychiatrist, and possibly with the psychometrist, to answer the same sort of questions I'd been posed in my first interview, but this time with the benefit of the first psychiatrist's notes on meeting with me.

Like most things that hold great interest for me, I am utterly fascinated with this process. I want it to be done already though so I can move on to the next steps. But I guess if patience is what the universe is suggesting for me, who am I to argue with the universe? After all, the universe made spitting cobras, and black holes, and arguing with the universe would seem hazardous. You never know what the universe will throw at you, you know.

Hope everyone is having a nice Sunday night, and for those ADHDers out there, I hope your journeys are progressing strongly.



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