ADHD Part 3 – Managing

ADHD (Attention Deficit Hyperactivity Disorder) is a complex condition that affects how you focus, behave, feel and interact with people. Realising that you have the condition allows you to begin making intelligent adjustments to your variant.

Part 1 – Defining ADHD [Link]

Part 2 – Experiencing ADHD [Link]

Managing ADHD

There are two primary methods to manage ADHD, and it recommended to use both where relevant and possible.

Therapy

CBT and DBT are the better methods to manage ADHD from a therapy and egocentric perspective. That is, with some suitable help, the person who meets the criteria for ADHD can learn to manage the symptoms that earn the label.

CBT

CBT (or Cognitive Behavioural Therapy) is a method for identifying specific problems and countering them with specific solutions. This looks at identifying the problematic behaviour and or thought process and developing a specific skill to address this which changes the behaviour or thought process. The advantage of this method is that it address unique presentations and develops unique solutions to meet the variance of the client. That is, it doesn’t give you a one solutions fits all, but it may take advantage of known useful tools.

DBT

DBT (Dialectical Behaviour Therapy) was initially developed to treat BPD (Borderline Personality Disorder) in a specific course like way. The course happens to also be very useful for learning to regulate mood dysregulation (a common experience for people diagnosed with ADHD) and social interpersonal skills (another common experience). While specific parts of the DBT modules can be used in isolation
(DBT informed therapy/therapist), most people gain the most use by doing the entire course in a group (may not be compatible for all people).

Advantage and Disadvantage of Therapy

Therapy is useful for addressing expected or identifiable skill deficits, giving power of control back to the individual who is often experiencing a chaotic life due to a lack of, or poor use of, life and self management skills. The problem often comes in with a basic aspect of the disorder itself – difficulties concentrating, difficulties sticking to a task and frequently learning disabilities. It is hard to learn any skill with this interference.

Medication

Medication is often used to help manage a major component of ADHD – task prioritisation. Given the hyperactive nature of ADHD, it seems odd to prescribe a stimulant. The brain is a wonderful and complex organism. While the specific parts that affect all people with ADHD are likely to be different, some common differences are found in the insula and the anterior cingulate cortex. The insula is often attributed to mood regulation and the anterior cingulate cortex is often attributed to attention. Both of these are frequently found to be smaller in people diagnosed with ADHD (more research required). It has been found that certain stimulants boost the abilities of these parts of the brain, compensating for their underperformance. That is, the underperformance of these two parts of the brain means the patient is likely to find their mood and attention span poorly self controlled; stimulating these parts increases the patient’s ability to self regulate, decreasing the most problematic symptoms.

(Reduced insular volume in attention deficit hyperactivity disorder [Link] and Anterior insula hyperactivation in ADHD when faced with distracting negative stimuli [Link])

If all brain scans had shown an equal problem with all people fitting the diagnostic criteria, this would be known as a neurological condition and the question would only be “how much of this one medication to prescribe?” Each brain scanned is a bit different, and not all people that fit the diagnostic criteria that were scanned have the same regions undersized. This means that medication is not going to work for all people who fit the diagnostic criteria, nor will the one type of stimulant match all peoples needs.

As such, a range of different medications have been found to be differently effective depending on the specifics of the individual person.

A very common co-occurrence of ADHD is drug addiction. Stimulants such as caffeine (coffee/tea/energy drinks), amphetamines (dexies, speed, meth amphetamines, ice) and nicotine are often used to help increase focus, while sedatives such as alcohol and diazepine are used to calm down from being hyper, and psychoactive drugs such as THC and LSD are often used to create an alternative state of mind that is easier to manage. Each of these are often used in conjunction to just self manage an undiagnosed condition.

Someone with undiagnosed adult ADHD who has a co-occuring Substance Use Disorder (SUD) will frequently struggle to be given a prescription for ADHD medication as it is either easy to dismiss the person as drug seeking (which ignores how easy it is to get illicit drugs compared to prescription), or difficult to manage due to the patient often continuing to take illicit substances. In Australia, psychiatrists are the health professionals who must diagnose and prescribe ADHD and ADHD medication. It is not uncommon for the patient to have to “go clean” prior to receiving necessary medication to manage their symptoms, which is incredibly hard; or to get frequent drug tests to ensure compliance with medication in the absence of illicit drugs.

(Treatment Strategies for Co-Occurring ADHD and Substance Use Disorders [Link])

Advantage and Disadvantage of Medication

Medication doesn’t work for all people diagnosed with ADHD, and when it does, it doesn’t always work equally. Going through various medication trials can seem daunting and frustrating as your body adjusts and adapts to the medication. Some people find medication as a gateway to illicit substances, however most people with undiagnosed ADHD have already attempted to moderate their experience via illicit substances, so this is a bit of a chicken and the egg fable – for those who are compliant with their prescription, this doesn’t seem to be an issue. Using medication to feel better and function better can have an existential query of “Who am I really? The person on medication, or the person off it?” or stigma questions such as “why does society only treat me alright when I am on the medication, but then blame me for taking medication to be ok?”

An advantage of medication is that when it works, even partially, it makes a profound different to your experience. It can be the launching pad for effective therapy, it can quiet the more destructive impulsiveness and it can allow you to focus enough to earn a degree, get a job and have good relationships with people.

BOTH Medication and Therapy

The best results often come when a person uses both approaches – medication and therapy. A person experiencing ADHD is likely to struggled to be able to focus and retain the information and drive to take in the therapy that upskills ADHD management without medication, while someone who takes medication now has that capacity to upskill, but doesn’t have a good mentor and guide to learn what skills are actually useful.

A good combination of both medication and therapy addresses these issues and gets the best results.

ADHD Part 2 – Real life experience

Understanding ADHD

ADHD (Attention Deficit Hyperactivity Disorder) is a condition that many people experience, even if it is undiagnosed. It can often be mistaken for anxiety and depression, behavioural problems, autism or cognitive impairment. Most write ups fail to describe what the condition is actually like, only citing medical criteria.

Below are some views from people who have been given the diagnosis of ADHD.

Part 1 – Defining ADHD [Link]

Part 3 – Managing ADHD [Link]

From the Inside

— S

Sometimes I would hyperfocus – do a thing obsessively until it was done. That hyperfocus is the reason I never thought I was [ADHD]. It helps to drown out the “noise” when there’s too much to think about or it’s too overwhelming. Prioritising can be challenging too. This is why I end up with mount foldmore [laundry].

I described it as my brain is like a pinball machine. I cannot type or speak as fast as my brain and that is frustrating for me. I’m constantly flitting from one thing to another, when I walk into one room to do xyz I see something else and get distracted by that. This results in many unfinished chores/projects. I particularly find it difficult to finish tasks I find boring, though I can obsess over tasks I find interesting. This makes life balance difficult.

It can waste a lot of time being so easily distracted. I used to wonder wtf was wrong with me. Everyone else can do it, why can’t I? I’m educated, intelligent, capable. The tasks are not difficult tasks. It can be incredibly frustrating.

Quite often I cannot get from one end of the sentence to the other. I will go off on tangents, at some point realise I’m rambling, then ask what the original point/question was. I am sometimes perceived as being rude because when someone says something I want to react, and can butt in before they are finished speaking. I’m not trying to be rude or not listen, I am just enthusiastic and if I don’t spit it out then and there I will get distracted and forget it. I forget things nearly every time I go to the shops. If it’s not put in my diary immediately I will forget it. It feels like most people live slower than me. They have a relaxed demeanour and an ability to finish tasks that I don’t understand. I don’t and can’t sit down and relax. That makes me anxious. I need to do SOMETHING, anything. I prefer written text over spoken word because I am able to review what I have said first.

Hammy from over the hedge on red bull is a very good representation of how I mostly feel. Meds help, a lot. They also illustrate my differences as I notice when they wear off. I’ve asked others for outside perspective and they said that’s just how I always was. It was only once I started my meds that I realised just how much different I am. That took some processing and support from very good friends.

Scattered, or as my friends and I call it, “squirrel”, is not an occasional thing – it’s every moment of every day. Have you ever walked into a room and wondered why you came in there? I do that ALL the time. Whereas others may remember after a moment, I have to backtrack to where I was to remember. Or more often than not I see something else and get distracted doing that. Until I walk back into the other room, see what it was that prompted me to go looking for something and go back to get/do it.

I have strategies in place to help. Like my keys go here, my phone goes there. I don’t have to remember where I put them because they have a specific place. I write lists. Appointments go in my diary. If they aren’t in there with reminders then I will forget. 

On meds I slow down. It’s not that I do things slower, though I do talk slower. It’s that I’m able to stay on task and stay focused. I can finish a sentence without getting distracted. For those that know me it’s very obvious when I have skipped, or when they wear off. Mine wear off about 6pm. If you are here with me from before that I’ll be talking normally, then over about half an hour I go to 1 million miles an hour. When I realise (usually when someone says something) sure enough I check the time and it’s between 6-6:30pm.

Hammy from the film Over the Hedge, just after drinking the energy drink, the world seems to freeze as tiem for Hammy

— M

As someone without medication, 3-5 thoughts a second, can’t focus on a single thing, forgetting where you put something 5 seconds ago walking into a room, “what am i doing in here”

— T
About a decade ago I was “diagnosed” by a GP with anxiety +/- depression. Recently I was re-diagnosed with ADHD and I am using medication for it. My psychiatrist thinks that the anxiety is mainly a result of coping with unmedicated ADHD. I’m inclined to agree with her as I’m now fairly stable on long acting dex and have been able to come off SSRIs [anxiety/depression medication].

I’m a good example of how inattentive type can easily be missed, especially in girls. I’ve never been overly physically hyperactive (but I am mentally and sometimes verbally). I’m still unpicking how much camouflaging I’ve had to learn in order to function and realising the emotional costs of that.

Some interesting things for me have been:

  • learning about hyperfocus and how it relates to inattention. It’s really the adhd superpower and most people don’t know about it. It helps to account for my awesome research skills but has drawbacks for interpersonal relationships.
  • the flip side of that is the intense antipathy I feel to things that don’t interest me. Housework is almost physically painful at times. I never realised how abnormal this degree of dislike of tedious tasks is.
  • rejection sensitive dysphoria is really really horrible. I’ve mostly learned to make friends (this took an active effort to change myself in my early teens) but still sometimes put people off and can’t always pinpoint why. I can very easily tell when I’m annoying people however and it spikes my anxiety something terrible. It’s very very hard for me to not care about what people think

Medication has been helpful, but with some challenging side effects. I’ve always had trouble getting to sleep at night, my brain runs at a million miles an hour. If I imagine a swing swinging, I often can’t get my brain to stop the motion. The first day I took dex, I felt physically energised but that night my brain felt calm. It was amazing!

Medication helps me focus more consistently and work on tasks that I need to, not just ones I’m interested in. The short acting dex had some pretty nasty physical crashes later in the day as it wore off. Long acting is better for me in that respect. It’s also helped me moderate my eating, not just by suppressing my appetite (which it does and can be annoying), but by reducing my use of food as an emotional crutch. Interestingly still, the less sleep I get, the more my diet goes to shit. Having kids certainly exacerbated my symptoms.

Ultimately I see the diagnosis as helpful. ADHD is poorly named and badly understood but has some positives. The hyperfocus for one. Also likely a tendency towards and enjoyment of creativity. I love brainstorming and coming up with creative solutions to problems and that seems to be more common in folks with ADHD. The emotional sensitivity can be painful, but can also be helpful in various situations (interestingly a lot of people I know with ADHD are heavily involved with charities, not for profits, goodwill projects and similar).

Another thing that may interest you. I first learned I may have ADHD by reading an article a friend linked to on FB. I was reading it to be a good ally, but then it sounded awfully familiar. Like they had cameras in my house! Both my GP and my counsellor were very dubious (my counsellor sees other people with ADHD, I gather they mostly have more challenges with it). But my GP wrote me a referral and my psychiatrist (who specialises in ADHD) had no hesitation diagnosing me after a thorough assessment.

Ultimately I do want to go public with the diagnosis, but I still have some unpacking to do first and I want to make sure as much as possible that it can’t be weaponised against me.


The difference between a regular conversation and an ADHD conversation, according to Dani Donovan [Link], who writes a great deal about their ADHD experience.

Public Perception

Public perception is often about blaming people diagnosed with or who fit the criteria of ADHD for their behaviours. People are accused of not trying hard enough when they don’t stick to a task, for being impatient when things go wrong. They are blamed for not taking things seriously when they don’t recall, or prioritise what J Average thinks is important. People are blamed for misbehaving when they haven’t managed to develop some level of impulse control.

People who take medication to help their ADHD symptoms are often seen as weak or drug addicts. This is odd as we don’t blame people who take diabetic medication to manage their blood sugar as addicts, nor blame them for having hyperglycemic or hypoglycemic incidents without their medication. Yet we want people who experience ADHD to manage without because of some judgement about their medical condition.

This creates a damned if you do take medication and damned if you don’t if you act out. People often feel justified for defining people diagnosed with ADHD or experiencing ADHD symptoms as naughty, misbehaving and annoying. A moral judgement is passed, as if this were a choice.

No all public perception is like this, there are many allies out there who comprehend that ADHD negative behaviours are not the fault of the individual, but rather are a side effect of insufficient support, understanding, and or treatment. Allies understand that changing the way a thing is done, or explained, or presented facilitate the quality of life and experience of someone with ADHD, but are also quite willing to call a person on bad behaviour, or point out boundaries that should be considered.

Carer Perception

— K

So what’s it like being a carer for an ADD child. Before he gets his meds in the morning and when they wear off in the evening he will not focus, it is hard to get him to do as requested as he is often in the midst of something he finds very important. This thing may be trivial to me but to him it is the world.

There are times when he will be willfully defiant too. Even if I get his attention, it will still take multiple repeated times of asking him to do as requested
such as getting reading for school.

Before he started on meds, his school work was lagging seriously. It was a chore to get him to write (mostly as I think it was hard for him and he couldn’t focus on the task at hand). Now, on the meds, homework and school work is much better. He still struggles to finish work given to him, but will readily attempt to write and read now. He once told me, the pill helps me to hear what people are telling me.

His massive temper tantrums have lessened while he is on the meds, he is more compliant with requests, less easily distracted (still is a bit but what 7 yr old doesn’t get distracted).