File 0082: ADHD, Not Just for Boys
Dr Russel A Barkley - 30 Essential Ideas Every Parent Needs to Understand and Raise a Child with ADHD - I highly recommend this playlist for anyone who thinks they have ADHD, already knows they do or has a loved one with ADHD, regardless of whether or not you have kids. Note that this talk occurred ~2009 so some of the information presented herein has since been updated
For the most up to date research on ADHD we recommend checking out ADDitude Magazine, CHAD: Children and Adults with Attention-Deficit/Hyperactivity Disorder, CADDRA: Canadian ADHD Resource Alliance and Barkley's site RussellBarkley.org
Also Jessica McCabe's channel, How to ADHD is an amazing and insightful resource! (see right)
Attention Deficit Hyperactive Disorder
The year was 2015, I was 24 and working at a callcenter for a major Canadian telecom, I had been there for four years.
My career up until this point had primarily been a bunch of entry level jobs
You see I had done well in school. Some times. I either excelled in classes or did miserably, but I usually managed to stay on the honor roll with minimal studying. I had planned to be an artist anyway, big dreams of becoming a Mangaka in Japan like every other 14 year old I knew. After high school the thought was tossed around to attend art school, but I ultimately decided to take a few years off, which resulted in me never pursuing a post secondary education and just running off to a town much closer to Vancouver
My first real job was a callcenter supporting Hewlett Packard computers and I would end up there for a couple years hopping between contracts and departments. Ever since I was young, I always excelled at technical and logic puzzles, which still baffles people as I am a major contradiction, an artist that likes excel.
My whole career philosophy was to do something I didn't hate, that could pay the bills and afford me the time and money to work on what I really wanted to, which was art. I watched as artists I admired spat out massive projects, art books, a webcomic spanning decades and wondered why I could never stick to something long enough to finish it. I had dozens of projects I have been working on since high school. I had never wanted to work for someone else as an artist, which was what the bulk of paying art jobs are: making someone else's vision come to life. But for me I had my own stories I wanted to tell.
Around 2010 I would end up moving to Vancouver and not long after entering a new relationship, with someone we'll call Alex. I hopped from jobs until I wound up at that major telecom. I started out doing phone support for internet cable and landlines, and quickly moved up the ladder, until we get to where we started at the end of 2015, where I was working as part of the operational support team
Ops had a plethora of responsibilities we had a massive inbox that was constantly receiving mail from all departments, we were essentially the point of contact for every team when they didn't know where to go next. Then I got word that there would be a brand new team of business analysts and project coordinators put together, and I could apply for it
I had no experience as a business analyst, but I had plenty in pulling reports, analyzing data and problem solving. I read about the role and I was ecstatic, this was something I really wanted to do and maybe it would finally be the job that would keep me engaged with its everchanging work
There was one problem though. About a year or so prior I really started to notice my memory was failing. It had progressively gotten worse, by this point, I would look at an email on one screen and switch to the other to do the task and forget what it was I was doing.
I had tried all sorts of things, cutting out alcohol, trying cannabis, cutting out cannabis, gingko biloba, and every other home remedy to help with memory issues you can imagine
And I would do those memory game apps that were supposed to improve your memory and I would excel at them and they'd tell me I had an excellent memory, but yet couldn't remember what I had eaten for breakfast.
I had been kind of coasting, I was able to do my current job, though some days were harder than others. But I really REALLY wanted this job and as I started reading about the role and researching business analysis I knew I needed to step up my game as my brain just couldn't absorb the information and I knew the competition was going to be fierce
I was told in my teens that my mom's side of the family had depression, I had always been fascinated in psychology and when I learned there was often a hereditary link with depression, I chalked up my mental struggles to that
I was terrified of going on medication, all I had ever heard were the horror stories of people becoming complete zombies or other horrible side effects
I had seen an art therapist as a kid and in my teens and I was always looking for new techniques or skills I could learn that might help, things like CBT and other mindfulness techniques. All with the intent to avoid going on medication. But I had never talked to my GP about it, so that was the only logical next step
When I did, I explained my struggle with depression and explained what I was experiencing with my memory, assuming that I was just going to have to finally cave and get on some antidepressants, knowing that memory issues were a common symptom of depression
She gave me a series of assessments to fill out, the kind used to help diagnose mental illnesses. She analyzed the results and said with complete confidence "You have ADHD"
I was dumfounded. I had never once considered it, I thought it was something only boys would get.
I wasn't hyperactive, and I didn't have issues with focus, I could focus on things for hours! I had been a hardcore world of warcraft player for years by that point. I used to stay up all night reading books. I could sit and draw for days. I could focus, so how was she getting ADHD out of this?
She gave me a prescription for concerta and said to give it a shot, I figured why not since nothing else had worked up until that point and I went home. Naturally I neurotically began to research ADHD as I do with anything that catches my interest or is relevant to my life (huh, maybe I should make a podcast...)
And the more I learned the more I realized this was it. My entire life suddenly made sense.
First going on the medication was a bit of a rollercoaster, but within a week I already was noticing a difference, my mental clarity and memory sharpening dramatically.
I got the job
6 months later, I would be in a mad dash packing up everything I owned and loading it on to a truck while Alex was at work. And moving in to a coworker's house who I had only asked a couple days prior if she needed a roommate
There is a sentiment in ADHD communities where for so many other disorders getting your diagnosis can be a sobering or even negative experience, but for us ADHDers it can be the best thing to happen to us
And for me it was. It completely changed my life. Kickstarted a new career, started a webcomic, started several podcasts and probably most importantly leaving a 5 and a half year long abusive relationship
What is ADHD?
So in case you haven't guessed this yet, today we will be talking about ADHD. This is a topic very near and dear to my heart and it's October, which is ADHD awareness month!
Anyone that has known me for 5 minutes knows that if you want me to start talking and not shut up, ADHD is the topic.What is ADHD
Oh man this is a complex question, but boy do I have answers for you. Most of the information I am going to talk about today comes from talks and research done by Dr Russel A Barkley, a psychiatrist and professor who spent the last forty years focused on the study of ADHD and is considered one of the foremost experts on the topic. And the guy is a great talker. There's an awesome talk he hosted in 2009 "The 30 Essential Ideas Every Parent Needs to Know" [about ADHD]
The whole thing can be found on a youtube playlist that I will link on the site. The talk is targeted at parents, but I strongly recommend it for anyone that thinks they might have ADHD, if they know they have ADHD or have a loved one that does. It explains so well how the ADHD mind functions and dispels the many common myths we hear repeatedly. Also he's funny, so there are lots of laughs to be had
First thing's first, ADHD, stands for Attention-Deficit Hyperactivity Disorder, it's a developmental disorder that most often begins in the womb. All cases post birth are caused by injuries or toxins that effect certain parts of the brain. So no, too much candy or too much tv is not what causes ADHD. You can not turn a neurotypical child into an ADHD child, unless you brain damage them, and then we have bigger issues. So eliminate that idea from your mind.
Many mental disorders like depression and anxiety are defined by the abnormal expression of traits on top of regular development. So for example with depression, you live relatively normal when the depression is not acting up, but when it does it induces abnormal symptoms. Everyone can be depressed some times, but with clinical depression, when it's acting up, your depression is more severe and lengthier than normal depression and can often occur with no triggers or reasoning, or be triggered by minor things that would not normally bother a person. A disorder disorders your life, prevents or hampers you from doing what you need to do, like go to work, feed yourself, care for yourself and others etc.
For ADHD, it is defined not by the abnormal behavior but the underdevelopment of traits. With ADHD, you will always have an underdeveloped brain, it doesn't come in waves or bouts, but a plethora of medication, therapies and techniques are available to help cope and close that gap and function on a closer to neurotypical level
A neurotypical child and an ADHD child will appear to develop similarly in their first couple months. But the ADHD child will eventually begin to lag behind as some parts of their brain develops slower
This gap, widens with age, the neurotypical child developing at a normal rate, while the ADHD child falls further and further behind. And this isn't an education or knowledge thing, it's not like you can just work extra hard to catch the child up, you can't change the rate at which the human brain develops. You can't out-train ADHD
For humans our brains continue to develop until our 30s. For Neurotypicals this levels off and they have completed race.
For ADHDers, when brain development falls off, we're still behind, for some of us, way behind and we will never catch up. This is why it's so common for people in their late 20s and early 30s end up getting diagnosed, especially women as the gap is at its widest and it's not getting better, it's only going to get worse. Unassisted we simply don't have the equipment to perform at the same level as a neurotypical individual, and whether we like it our not, this is a world designed for neurotypical people, we're racing in a golfcart vs a mustang. We aren't worse drivers by any means, we just don't have the same equipment
Every person with ADHD I have ever spoken says the same thing: they dismissed all their symptoms because they were told and believed that they were just lazy. It's something we hear our entire lives: not just from other people, but ourselves, that if we just tried harder, if we just dedicated ourselves, we could do what everyone else does. And it's the most frustrating thing ever as you can't figure out why it's so easy for everyone else to get to work on time, remember to make and pack their lunches, go to the gym or really anything regularly.
This is a very serious disorder that's poorly understood by the general public and thus dismissed even among people that have it. Some people who were diagnosed as kids thought they grew out of it, or thought maybe they were just part of the "overdiagnosis" that was happening in the 90s and they never actually had it and if they were on medication they stop after high school.
But only a third of children diagnosed with ADHD, will progress to a level where they do not need treatment in adulthood
So what is it that makes us act this way? Why can't we just be normal, why are the most basic things such a massive struggle for us?
Three Kinds of ADHD
The DSM says there are three kinds of ADHD: combined, inattentive or hyperactive. According to Barkley the DSM classification is useless, the alleged hyperactive type of ADHD never existed and really these classifications are more akin to the life cycle of the disorder than 3 distinct variations
- Hyperactive: children will most likely be diagnosed with hyperactive
- Combined: within 2-3 years of their diagnosis they will usually end up becoming combined, or subthreshold combined, meaning they are missing one or two symptoms
- Inattentive: what most adults will be diagnosed as
There is a lot of issues with how the DSM classifies mental disorders and because of this there are two disorders listed entirely separate from ADHD that are in fact closely linked to the disorder
- ODD: oppositional defiant disorder: the primary characteristic of children with ODD is that they're defiant, uncooperative and sometimes hostile. They also have difficulty managing their emotions. ADHD children are 11x more likely to develop oppositional defiant disorder within 2 years of the onset of their ADHD
- ODD is a separate disorder that can occur separate from ADHD
- But It's not uncommon for children with just ODD to accidentally get diagnosed with ADHD instead. This isn't a malicious or conscious thing, it all comes back to the lack of general understanding about this disorder. Parents of ODD children will often report symptoms that match ADHD, mostly from a lack of understanding of the root cause. A child with ODD can look like a child with ADHD. If you have a child, that just doesn't to do something, because they're rebelling, that can look like a child that can't exercise self control. But the root causes are different.
- When we put together ADHD children in the combined and hyperactive category, it's estimated that 5% don't belong there, who are purely oppositional. And because they have ODD and never actually had ADHD, they will usually outgrow their ODD within 2-4 years and their "adhd" will go away
- There is a reason for this. Up until 1976, the DSM had "difficulties with regulating emotions" as a symptom of ADHD, but after 1976, they removed it and it hasn't been returned. I don't know why, as there's hundreds if not thousands of studies that say otherwise. Also because of this if you or your child has been diagnosed with ADHD, you may not be made aware of the emotional dysregulation aspect
- But if you are a doctor not familiar with ADHD, the emotional symptoms described by a parent can sound like ODD.
- And conveniently enough, the treatments that help ADHD, do help children with ODD, but it does muddy the waters
- There is a small group of children that do have both ADHD and ODD, and they will face additional struggles than the average ADHD child and their ODD will persist longer
- SCT Sluggish Cognitive Tempo: as we mentioned it's usually adults that are diagnosed with the inattentive variety, but there are children that get this diagnosis. It's estimated that 30-50% of these children are actually experiencing another disorder
- The term Sluggish Cognitive Tempo was first coined in 1984, and yet, it has not been added to the DSM.
- Barkley argues that this is a separate disorder, because the symptoms are the opposite of ADHD, yet aren't listed in the DSM. Symptoms include: daydreaming, spacey, slow moving, lethargic, motorically and cognitively sluggish, easily confused. But since they have some attentive issues, they get lumped in with ADHD, because there is nowhere else to put them because ADHD is the only attention disorder in the DSM
- Barkley says the primary difference between these two is SCT is an accuracy disorder and ADHD is a productivity disorder. That and the ADHD medications don't work for these children. They won't harm them, but they don't help them either
- In Barkley's study only 1/5 of SCT children will stay on medication after the trial. ADHD it's 92%. SCT children respond very well to social skills training, ADHD children, not so much
There's been a push to change these classifications, to a system that's been used in Europe for decades, that creates two subgroups of individuals with ADHD
Better subtyping of ADHD is
- ADHD without conduct disorder
- ADHD with conduct disorder
Conduct disorder is the more aggressive version of ODD and is described as the early appearance of lying, stealing, fighting and preying on other children
In North America we tend to consider conduct disorder as a comorbidity, another disorder that can exist alongside ADHD, but studies have shown that's not the case and that conduct disorder in these scenarios is directly tied to the root problem of ADHD and thus should be a part of the ADHD diagnostics and classification
ADHD with conduct disorder is the most aggressive version of the disease. Children with this type will experience symptoms of both the conduct and ADHD part sooner than other children will, their behavior will be more extreme and from the get go, one in five of these individuals will develop psychopathy
ADHD itself does not contribute to psychopathy, but ADHD with conduct disorder is the single best predictor of the psychopath that we know of
So it's incredibly important that when we recognize a child as ADHD, that we also look for conduct disorder. The sooner you can implement changes in their environment and day to day life to better accommodate for these things, the less impactful these disorders can be
So let's talk about the history of ADHD
ADHD has a messy history, everyone has heard the claims of over-diagnosis in the 90s and drugging all the kids up with Ritalin or the disgusting phrase "mommy's little helpers" . Anyone that knows a mom who is into that kooky new age crap has likely heard that ADHD is a new disease and is made up
But that's not true at all, it was first mentioned in 1775 by German physician Melchior Adam Weikard and then covered in detail in a textbook by Alexander Crichton in 1798 in the chapter called "Diseases of Attention"
Meaning we recognized ADHD as a disorder, before we even understood germ theory. I mean, yes Karen, it's obviously because modern parents are bad
The next big mention of the study of ADHD was in 1902 by Dr George Sill
Crichton and Sill both recognized that there seemed to be hereditary factor or that it may be caused by an injury. While they both held beliefs that in some cases it could be caused by social factors, they both argued that there may be more to that.
- 1955 The FDA approved the psychostimulant methylphenidate to be used as treatment for individuals with ADHD. This is the same chemical compound that's used in many ADHD medications today, including the one I use
- 1968 the DSM 2 came out and it was the first time ADHD was recognized in the DSM
- 1987: the 2nd edition of DSM 3 is published and is when the disorder got its current name and this was also when it was distinguished into two types: the hyperactive variety ADHD and the non-hyperactive variety, ADD
- 1990, almost two hundred years after Crichton's text book the first neuroimaging study of adults with ADHD was conducted. This study would end up on the cover of Time magazine
In the 90s we saw a big rise in ADHD diagnosis. This is the era everyone has heard about, but there's actually a legitimate and good reason for this
The studies performed and the attention they received made everyone more aware of its existence. Doctors were better able to diagnose it and caretakers and parents had become aware of the symptoms. And more medication and treatments had become available with the better understanding of this disorder.
So was there overdiagnosis? Possibly, it was still something we were learning about, and if you use hyperactivity as the primary symptom, well a lot of kids are hyperactive. And as we were mentioning before, sometimes children with other disorders may get mistaken as having ADHD. Mistakes were surely made, but on a large scale? There's little evidence to support that
But there was also something else. The number of children with ADHD was increasing. Why? Well let's get into causes
What Causes ADHD?
Well there are a variety of factors, all of them biological. This is a disorder caused by nature, not by nurture. Why? The short answer: our brains don't grow good
A child with ADHD will experience a developmental delay in these five areas of the brain
- Right Frontal Lobe (Orbital Prefrontal Cortex)
- Basal Ganglia (Mainly Striatum and Globus Pallidum)
- Cerebellum (central vermis area, more on right side)
- Anterior Cingulate Cortex
- Corpus Callosum (Primary Anterior Splenium)
These means those parts of the brain simply won't develop at the same rate as a neurotypical child and by the time brain development stops, these areas will still be underdeveloped and will never catch up. This is what produces the symptoms of ADHD.
What causes it?
- 2/3s of ADHD children develop ADHD because of genetics. Not tv, not the medication, not candy. This was determined at conception by a specific combination of genetics
- A third of all ADHD cases are acquired, meaning they are not genetic. This breaks down into two categories
- 95% of these cases occur during pregnancy, meaning something happens (usually to the mother) that triggers this disorder
- 5% of ADHD can occur after birth
What causes Acquired Cases?
We're still learning all the factors but from what we have identified
- Induced in utero: if your mother smoked or drank while pregnant with you and you have a combination of risk genes, this could unlock ADHD. Along with other substances or injures that can occur during pregnancy.
- Induced after birth:
- Halli knows the first one: Lead poisoning in preschool years
- Treatments for leukemia. All leukemia treatments cause brain damage resulting in the individual having ADHD or SCT symptoms
- Post-natal streptococcal bacterial infection. Yeah, if your brain is still developing, and you get strep, you could acquire ADHD. The reason for this is that strep bacteria has a protein coating on the exterior that is identical to proteins that occur in the brain, causing your immune system to attack both the strep and brain cells, being unable to tell the difference
The induced kinds are also more likely to be accompanied by seizures
Now social issues don't cause ADHD, but they are important for the treatment of the child
- The resources to treat your child are very much a function of the social environment around you
- The impairments that your child will experience is a direct reflection of their environments.
- Comorbidity: there are a handful of disorders that commonly appear alongside ADHD, and those disorders may have social contributors to them, like ODD, CD, anxiety and depression.
- 40-50% of the differences we see between individuals with these disorders can be attributed to the social environment the individual is in
Our Brothers and Sisters on the Spectrum
One thing you may not know is that ADHD and ASD (autism spectrum disorders) have a lot of the same symptoms in common and have a lot of the same struggles. It's not uncommon to have both ADHD and ASD, so it's not unusual to see online communities that are dedicated to both.
So shout out to them, you're one of the few outside groups that truly understands us, and y'all always have the most relatable memes <3
So exterior factors make sense, something happens that disrupts natural development. But why would the brain of an otherwise healthy child not develop?
We know it's in the genes. But why would our genes develop this way? Well biodiversity. Biodiversity is a natural process that occurs in all living things, and the more diversity the better as it makes for a more stable, adaptable and sustainable population.
This is the reason that every human is slightly different, why we have different hair and eye colors, why some of us are taller or shorter, why some of us are right or left handed
But why is a it a good thing?
One of the most famous examples of this is the peppered moth. If you ever took a biology class you have probably heard this story before
The peppered moth is a common species found in most temperate climates around the world and it gets its name due to its black and white often speckled coloring. The biodiversity here came in the form color, some of the moths were mostly white, others were mostly black, though the black ones were quite rare, based on samples from 1811.
But by 1848, near Manchester, the frequency of the black variety was much higher and by the end of the 19th century, the black variety almost completely outnumbered the white. Yet in places further from the city, the white variety was more common
This is natural selection in action. See this was the industrial age and the start of our pollution problems. As the areas around the city got dusted with soot, the white moths had a harder time blending in with their environment, and thus easy prey for the birds.
This meant the bulk of the remaining population was black, and as they reproduced the genes for their coloration was passed down and soon they took over the area.
Meanwhile in the more rural areas where the pollution hadn't quite reached, we saw the same demographics as before, the white moths being far more common. Because they could blend into the clean trees a lot better than the black.
People often mistake natural selection to mean a species evolving traits to better suit its environment, when it's more the other way around. Species will develop diverse traits and only the successful ones will be able to pass on their genetics.
This how human diversity began. We all started from the same population of humans two million years ago in central Africa. From there people traveled and explored, tribes and clans going to different places, branching out and exposing themselves to new environments, new food sources and new dangers
Those best suited to survive in these new environments would be the ones that would pass on their genetics, and slowly over time different mutations were favored in different parts of the world, until we get to where we are today. It's no coincidence that people native to areas that receive a lot of sun exposure tend to have a darker complexion. Their skin is more adapted to surviving in those conditions. Meanwhile the tribes that went north to what we would later know as Europe, those with lighter skin prevailed, as their skin could absorb more vitamin D in a climate where there was less sun exposure. And from there more mutations would happen so on and so forth
And thus it's theorized the reason for neurodivergence as seen with ADHD and autism, is just another mutation of our genetics. In eras past, we may not have survived as well, but with access to medical care, good food, social structures and houses, we are able to survive and breed.
And diversity is a really good thing! Or covid may have sent us the way of the gros michel banana.
You know how banana candies don't really taste like real banana? That's because the flavor they're based on is from the now extinct gros michel banana. The banana we all know is the called the cavendish. The gros michel used to be everyone's favorite banana and the one we primarily cultivated. When in 1950s a disease wiped them all out. Thankfully the cavendish was more disease resistant, and replaced its sweeter, richer extinct cousin
You'd think we'd have learned from that, but once again bananas are at risk, the fusarim wilt, the fungal infection that took out the gros michel, has evolved (yay bio diversity) and it has already began infecting cavendish farms around the world! But that's another story
Back to ADHD
So yeah, the grand majority of individuals with ADHD, got it through their genes, luck of the draw and all that. But these genes don't just impact the persons in which ADHD develops.
It was recently discovered that the neurotypical parents, children and siblings of individuals with ADHD all display the same size difference in these parts of the brain, except one: the cerebellum. This tell us that these differences are a part of the family phenotype, even if the family member never shows the disorder, they carry these patterns of under development. This also tells us that it's something to do specifically with the cerebellum that is the cause of ADHD. We're not sure yet what that is but we're looking into it
So, what's the genetic risks?
Keep in mind this only applies to genetic ADHD, not acquires
- If you have ADHD there is a 25-35% chance that your siblings will have the same disorder
- If you are an identical twin with ADHD, that risks raises to 78-92%
- There's a 50% chance that one of your parents also has it, and probably was never diagnosed which is why in recent years when a child is identified as having ADHD, they also screen the parents. Untreated ADHD in the adults responsible for raising an ADHD child will make an already challenging task extra challenging
- There's a 40-54% chance that your child will have ADHD
- A 3rd of AMAB children with ADHD have the acquired type of ADHD, where for AFAB the grand majority acquired their ADHD through their genetics
Role of genetics
Over 40 twin studies have been published in the last 30 years and because of this we have learned a lot about the genetics of ADHD
- Severity and symptoms of your ADHD are closely tied to your genes
- the rearing environment has 0 impact on the development and presentation of this disorder
The Actual Genes
Knowing that ADHD is tied to genetics, a full analysis was done on the human genome and there are 5-7 specific genes that seem to be the risk genes for ADHD. We're still discovering all the implications of this, but there have already been some fascinating finds
- If you have two of the specific ADHD risk genes, and your mother smoked cigarettes while you were in the womb, you are 8x more likely to get this disorder than anybody who had either one. This is known as a gene by toxin reaction. And they have found the same thing for alcohol
- They are also discovering that some of these risk genes may also be risk genes for other disorders. For example the DAT1 gene is a predictor of nicotine addiction
- They have also found that there are genes that will make your child more or less responsive to behavioral therapy. Sensitivity to psychological treatment may be in part genetically mediated
Overdiagnosis and Dosing
So, are we using more medication than ever before? Yes. Is it scandalous? No. What's the problem? There are still people that do not have access or are not being adequately treated
Prevalence of ADHD as of 2022 study shows that 9.4% of children in US have ADHD, that equals 6.1 million. And only 2/3rds of those children are on medication.
Then there's the whole gender thing. AMAB children have a 2.5x higher chance of getting diagnosed than AFAB. It is believed that a lot more AFAB people have ADHD, but since symptoms present differently in AFAB individuals, it's often missed. But we'll get more into that later
Meanwhile prevalence in adults in America is 0.96% which seems shockingly low considering this is a lifelong disorder. Then again Barkley estimated that 90% of adults with ADHD are not being treated and rates of adult diagnosis are increasing 4x more than childhood diagnosis.
Development and the Impacts
So what does it look like growing up with an underdeveloped brain? Well let's look at the impacts
All humans have a series of traits encoded in their genes that will develop as they age. If you play RPGs, these are stats. People vary in their strengths, like how different classes focus on different stats, a ranger will have more dexterity, a sorcerer more charisma etc. Except that you don't get to choose your class, that is decided during the character roll of conception. But in general the neurotypical human will all have about the same amount of stat points, just put into different areas
But as an ADHD person, we don't. And some of our stats have caps that our brains will not surpass.
The big reason behind that is that the parts of the brain that are underdeveloped house our executive functions. Executive functions are what makes humans, human. It allows for us to reflect on the past, control our urges, talk ourselves through problems, visualize and plan future events, or even come up with new, novel ideas by experimenting with different concepts in our heads. These are the things that separate us from most any other mammals on the planet and there are four circuits in the prefrontal cortex of the brain that relate to them directly
- The "What" Circuit:- The "What" Circuit is linked to working memory, so it's in this circuit that what we think starts to guide what we do. This is particularly true when it comes to plans, goals, and the future.
- The "When" Circuit: The "When" Circuit is the timing circuit of the brain - it coordinates not just how smooth behavior will be and the sequence of behavior, but also the timeliness of your actions and when you do certain things.
- The "Why" Circuit: Often referred to as the "hot" circuit because it's linked to our emotions - it's where what we think controls how we feel, and vice versa. It's the final decision maker in all our plans
- The "Who" Circuit: This is where self-awareness takes place - it's where we're aware of what we do, how we feel (both internally and externally), and what's happening to us.
All of these circuits are underdeveloped in a person with ADHD, but the extent of which each is hampered varies from person to person based on genetics, and is a big factor in accounting for differences in symptoms and their severity
Combined these four circuits are what's responsible for the performance of our executive abilities. Executive function is judged by the strength of these seven skills:
- Self-awareness: Simply put, this is self-directed attention.
- Inhibition: Also known as self-restraint.
- Non-Verbal Working Memory: The ability to hold things in your mind. Essentially, visual imagery - how well you can picture things mentally. Also responsible for hindsight, which is directly used in foresight, so both are impacted when this function is degraded
- Verbal Working Memory: Self-speech, or internal speech. Most people think of this as their "inner monologue." Used to help individuals control themselves and navigate life, to remind us of rules or advise us
- Emotional Self-Regulation: The ability to take the previous four executive functions and use them to manipulate your own emotional state. The ability to self sooth
- Self-motivation: How well you can motivate yourself to complete a task when there is no immediate external consequence.
- To ADHDers the future is nebulous thing, sure doing my homework will allegedly be good for me in the long run, but if I beat this level the game tells me right away I am awesome. When I finish a math problem in my homework. Nothing happens. If you want to see an ADHDer fail spectacularly put them in an environment where there must complete a task, but there are no consequences or rewards.
- Planning and Problem Solving: Experts sometimes like to think of this as "self-play" - how we play with information in our minds to come up with new ways of doing something. By taking things apart and recombining them in different ways, we're planning solutions to our problems.
If you never met another human being in your life you would have some level of all of these skills. That's not to say you can't enhance these abilities with practice and knowledge, but everyone gets a baseline based on their genetics
All of these will be delayed in a child with ADHD and they will never develop to the same level as that of a neurotypical adult. This results in an individual who isn't able to resist distractions, is impulsive, has difficulty accessing hindsight, thus making it harder to plan their future. They live in the moment
Studies have shown that the development of the frontal lobe for ADHD children is about 2-3 years behind neurotypical children. But interestingly, a part of the brain known as the motor strip, develops 2-3 years earlier in kids with ADHD. And this is where the hyperactivity aspect comes from. A motor strip generating behavior and a frontal lobe that's not regulating it
The 30% Rule
The real executive age (the emotional age) of the child. They may know and have skills of their true age, but they can only use those skills like a person who is 30% younger, so a 10 year old child with ADHD functions with the same self control as a 7 year old. They will know all the 10 year old things, but their ability to take advantage of this is that of a 7 year old
So when your ADHD child is 16 and wants to get a drivers license, you need to remember that this child has the impulse control of an 11 year old
At 18, your ADHD child is getting ready to go to college. Their executive age is 12. This means for an ADHD child to do well in college they need to be in an environment suited for a 12 year old, they need constant accountability, they need to be in a substance free dorm, they need to be paired up with older students. Otherwise only 5-10% of them will graduate
This isn't an exaggeration, this isn't a scare tactic for parents. It's the reality of the biological circumstances for an ADHD child. And remember this isn't because they're dumb! They know the things! It's just the golfcart vs the mustang, no matter how good a driver you are, you won't win that race without improved equipment and support
What does this look like?
There are a lot of ways these deficiencies can present, but I'll go over some of the most common
- Lack of inhibition is one of the first ADHD symptoms to present itself in a child. That child can't focus on the task at hand, is always too busy fidgeting, chatting or doing other things. They don't have the same self control as other kids their age. Despite what we would all like to believe, self control is not a learned trait. It is not the result of your upbringing and how good your parents were
- This also impacts our ability to think about the consequences of our actions before doing them. Where a neurotypical child will think about how it's rude to talk out of turn and to raise their hand instead, an ADHD child may just blurt the thought out soon as it reaches them, not considering how it could be disruptive
- This is part of what makes H in ADHD a misnomer, as that's not really the issue, the issue is the inability to regulate your behavior, it's just as children this can express as hyperactivity or restless behavior. In adults, this behavior has become internalized, and instead expresses itself as a need to be busy and doing multiple things at once, and as a busyness of ones mind and ones ideas.
- Let's take the spoons metaphor, which is normally used to represent how much energy you have in a given day, in this case we're going to use each spoon to represent the amount of self control a person has at a time.
- Neurotypicals are just born with more spoons. If you have 10 spoons you will be able to be much more disciplined than if you have say 1. Day to day life is full of stimulation, most of which you may not even realize because you have the spoons to ignore it. But with ADHD, that stimulation is much harder to ignore, they're big flashy neon signs, they're loud and demand your attention. One thing I always used to think when I saw people writing in coffee shops is how is that even possible? I love to write, but I can't fathom sitting down with my laptop in a café with dozens of other people talking, moving, coming and going and attempting to write anything cohesive. Even the idea wears on me
- If there are ten things happening around me at once, I only have the spoons to ignore one and I can't focus on any of the remaining 9 adequately. Another time this occurs is when someone is talking to me and there is any other talking within audible range, like the tv is on, or other people talking beside me. All words just turn to mush and mean nothing to me. I only recently realized this is why the bar and club thing were never my scene. I can't communicate and engage with the people I am with in those places
- Emotional dysregulation. This may present as being quick to anger, a low frustration tolerance, easily excitable, and to display these emotions much more quickly and visibly than a neurotypical person. We don't feel things more intensely, we just have a limited ability to self calm.
- In children this will look like temper tantrums, potentially violent outbursts. As adults this may look like road rage, the dismissal from jobs, not because of performance, but attitude.
- This aspect will impact an ADHD person's entire life, and is the number one factor for someone with ADHD, when it comes to troubled personal relationships, especially of the romantic kind
- Attention deficit, but this is a misnomer. It is more accurately described as a failure of persistence and can be broken into three aspects
- Persistence toward a goal: ADHD is a failure to direct behavior forward in time
- Ability to ignore distractions: ADHD people do not perceive distractions more or less than the average bear, it's how they respond to the distractions that distinguishes them
- Barkley "You and I may all hear the noise in the kitchen the person with ADHD is compelled to react to it. "Oh did you hear that! I guess they're washing dishes, maybe I'll stop in and take look. Did you know I was a dishwasher when I was back in college, that's how I earned my way" Do you see what's going on here? You all heard the dish but it was irrelevant to what we're here to do today. But to the ADHD individual the distraction is going to provoke a response and the response can't be inhibited and now they're off to the races, skipping from one thing to another to another"
- ADHD should more accurately be named EFDD, Executive function deficit disorder
- Working memory: working memory is one of those things you really don't appreciate until its gone, that is if you can remember you once had it. Everyone, if they live long enough will eventually get to experience the joys of this deficiency, but usual in their senior years, us ADHDers get early Alpha Access. Keeping things in our brains is like grasping at sand, it can slip away in an instant and then we end up latching onto the next stimulating idea.
- It's filling your cat's water dish, but then spilling some so you stop to clean it up and you notice that the floor is dirty, so you bust out the mop and figure you might as well do the hallway and the bathroom while you're at it. And when you're in the bathroom you notice the shower glass could use a scrub, and you remember you bought a new cleaner and you grab it and begin reading the ingredients to make sure there wasn't anything you have to be concerned about with your pets, and you see it has eucalyptus oil in it, and you know that some oils are toxic to cats, so you look it up and you wind up on a massive list of different essential oils and talked about which ones are dangerous to pets and there's all these oils you never heard of and
- And then 2 hours have passed and the water dish is still sitting on the counter, full.
- The water dish is still important, but you won't remember it until you see it again or your cat starts harassing you.
- This is a true story
- And the things that can distract you can be anything, maybe you suddenly remembered that you were supposed to put cheese on the grocery list two days ago but totally forgot. Maybe you receive a text and it might not be anything important, you might not even have to respond, but that can derail everything you're doing. Maybe your partner comes into the room and asks if you have any ideas for dinner. Gone
- And yet, if we get in the zone on something, we can work all day with such intensity that when we stop suddenly we're starving a realize that we have forgotten to eat anything all day
- Rejection Sensitive Dysphoria: Is a fun one to explain, people with ADHD are very sensitive to rejection, but not just that, also perceived and anticipated rejection. We ruminate, getting stuck on things in our head. We could spend an entire day with someone, having a great time, and when we go to say goodbye, we go in the wrong way for a hug. And we will fixate on that. Nothing else that day matters, because we did that and now that person must think we're a total uncoordinated loser, oh gosh, maybe I should cancel our plans next week, they probably don't want to see me again. But then I have to message them to cancel it and maybe I should just ghost them, it'll be better for them in the long, better than having me as a friend. Meanwhile the friend didn't even notice the awkwardness of the hug. This is completely illogical, but our brains do it anyways!
A lot of things I have mentioned are not in the DSM. These instead have been gathered from reputable medical sources and institutes devoted to ADHD research. The DSM lists only 18 symptoms in total, I am not going to read them all to you but they basically be summed up to
- Can't pay attention
- Can't organize tasks or activities
- Easily distracted
- An aversion to tasks that require mental effort
- Often interrupts or intrudes on others
That is it! And we wonder why it can be so difficult to get diagnosed. Barkley and his colleagues did their own research and came back with 91 symptoms
One of the many fun things about ADHD is that it comes with a bunch of extra cool freebies! a person with ADHD has an 80% chance of having one of these disorders. 50% will have at least 2 of these other disorders
- Obsessive-compulsive disorder (OCD)
- Oppositional defiant disorder (ODD)
- Learning disabilities
- Language disabilities
- Fine and gross motor difficulties
- Executive function difficulties
- Tic disorders
- Or another psychological or neurological problem
ADHD by itself is very rare. And these other disorders will need to be treated as well. I have both depression and anxiety on top of my ADHD
Can ADHD Be Cured?
The big thing to understand with ADHD is there's no cure. That frontal lobe of mine will always be a shriveled undersized blob of playdough. There's no silver bullet. It's often suggested to think of ADHD more akin to a lifelong disorder like diabetes.
Diabetes, like ADHD, has no cure. What you're doing when you treat diabetes reducing secondary harm. If you don't regulate your insulin, you risk going blind, losing digits, having blackouts etc. With ADHD, those risks are different, but they are real and some of them can be just as or if not more detrimental
But ADHD is one of the most researched mental disorders, so there are so the resources and support are endless, you just have to look. Medication, therapy and skills can work wonders, but they don't just immediately make us neurotypical individuals. They just help you better regulate yourself and help alleviate some of the symptoms
There are four key concepts to getting the best treatment for you
- Get a Good Evaluation to make sure you are ADHD and to figure out all the other comorbidities you may have.
- Families need to educate themselves. This isn't just about you. The impact to families is lesser when you no longer live at home, but you should educate the people you are closest with. Not only so they can better understand what's happening with you, but also so they can help be your wingman and catch you if your behavior or struggles change, these can be hard for us to notice to in ourselves sometimes
- Medication is the most effective treatment, Medication + Behavior/Environment changes are better. Only 20% of children with ADHD, can prosper with environment/behavior changes alone, and even those 20% do better with medication plus everything else.
- Make accommodations. Create prosthetics, artificial devices to help the person show what they know. The things in our brains that don't function so good can get a huge leg up from externalization of those processes and adopting strategies that come more naturally to your neurodivergent brain
The 3 Roles Every Parent Must Play (They need to do this).
- Be a scientific parent. Read widely and educate yourself on ADHD. Experiment with your kid since not all treatments work with all kids, keep on trying till you perfect it. Be skeptical for there is a lot of bull shit out there on the internet and especially about ADHD.
- Be an executive parent and take charge, make stuff happen, you are your child's guardian and you need to do your best to make things happen and that means making yourself the president, the executive, the decider.
- Be an advocating parent. Make stuff happen for your kid. Advocate for their needs, make sure their other caretakers understand their disorder and ways to cope.
Raising a child with ADHD costs five times more than raising a child without the condition, according to a study that found neurotypical families spend an average of $2,848 per child each year compared to $15,036 spent by families with ADHD children
Hands down, ADHD medication is the most effective treatment for ADHD symptoms to date, there's no ifs ands or buts about it. And I am going to explain why.
So remember the whole thing about genes? We have nailed down about 5-7 genes that appear to be risk factors for ADHD
- DRD4 specific gene variants, dopamine receptor
- DRD2 specific gene variants, dopamine receptor
- DAT1 specific gene variants, dopamine reuptake transporter
- DBH specific gene variants, enzyme that is involved in the processing of monoamines neurotransmitters
- MAO-A specific gene variants, enzyme that plays a role of clean up and maintenance of monoamines neurotransmitters
- LPHN3 (latrophillin gene) Gene that is connected to the G-Protein Receptors, critical part of signal transduction.
One thing you'll notice is the first 3 genes I listed started with a D, the reason for that is those genes are specifically involved in dopamine regulation
If we look at nerve cells in the frontal lobe, when one of these nerve cells become stimulated an electrical impulse will travel down that cell and when it reaches the end, a packet of chemicals, dopamine, are going to move to the outside membrane and burst
The dopamine will get sprayed out into the synapse and if there's enough dopamine it will cross over and bind to the membrane of dopamine receiving nerve cell causing it to fire, so on and so forth
This is how your brain works
So now there's just all this dopamine getting squirted outside of the nerve cell, and no one likes a mess so your brain has these little vacuums, known as a reuptake transporters. And they go around sucking up the excess dopamine and cleaning the place up
DAT1, is one of the genes tied to ADHD, it is responsible for building and working those vacuums. But if you happen to have a longer version of that gene you're going to have more vacuums, which by itself is not a problem, but it means that when that dopamine gets released it immediately gets sucked up by all those hungry vacuums before it can do its job and trigger the next nerve cell. This leaves the person in a state of too little dopamine
Why does this matter? People with ADHD have 30-80% more of these little vacuum cleaners and you can see how this is a problem. Too many vacuums reduces the number of nerves that are able to successfully fire. This is why ADHD brains work the way that they do. That whole thing about being unable to self motivate and regulate? This is why
And this is why the medication works. ADHD medication like Ritalin or Concerta, what they do is they get up in your brain and clog up some of those vacuum cleaners. Methylphenidate is the key component in these drugs and it is what is called a dopamine reuptake inhibitor
This is also why ADHD drugs don't work the same way on individuals that don't have ADHD. Your brain already has a reasonable amount of dopamine
Fewer than 10% of people with ADHD will not have a positive response to a least one of the ADHD medications available. ADHD medication can normalize the behavior of 50-65% of those with ADHD, and result in substantial improvements in another 20-30%. All dependent on the severity and presentation of your ADHD. For me, I am moderate to severe, I am on Concerta, I am on the highest dose. This doesn't completely normalize me, but I feel like it gets me 70% of the way there. It's a massive improvement, and even missing a couple days, my performance will drop dramatically
This is because this medication treats the underlying neurological issues, not the symptoms. The issue is all that dopamine getting wasted, that's what it targets. In this way, ADHD medication is more akin to insulin for diabetics, we will always require it to make up for the deficiencies in our body, but with it, it can make those impairments a lot less debilitating.
Now not everyone requires medication, based on the severity of your symptoms some people may be able to function with some new skills and changes in their environment. And that's awesome. But if you have ADHD and you're really struggling, I strongly recommend talking to your doctor about medication options, there's a reason they have been in use for more than 50 years for this issue .
This is all pretty damn cool, but it gets cooler. See there are a handful of different ADHD drugs available that can be broken down into three categories:
- stimulants (concerta, Adderall, Ritalin), many of which have been in use since the 1930s and 50s
- nonstimulants (atomexetine, violxazine)
- alpha-2 hypertensive medicines (guanfacine, clonidine)
In general, for people with ADHD, there's an even split between which medications work best for different people. Most people with ADHD will perform best on one type verses the rest, but a handful of ADHDers will be fine any of the options. What this means, is as a newly diagnosed ADHD individual there will be some trial and error to find the right combination and dosage for you.
But with all the genetic testing that's being done around ADHD, doctors may one day be able to swab your cheek and test your DNA to determine which medication you will respond best to. Which I think is pretty fucking cool. I was lucky that the first ADHD medication my doctor put me on worked, but I have had friends without the same success and have gone through months, sometimes years of different trials finding the right mix.
It's also more complicated when you add in all those comorbidities. Concerta is my primary ADHD medication, but I have also been prescribed Wellbutrin to help cope with some of the symptoms of my depression. Doctors don't like to throw a bunch of medication at you at once, there is adjustment periods for all medication, and you'll have to go through those every time you increase your dose or add something new to your care.
Misconceptions about drugs. They are not addictive when used as prescribed and they are not inhaled/injected. They are do not increase aggression, in fact they lower it. They do not cause seizures, you would have to swallow the whole bottle. They do not cause tics or tourrettes unless you are already prone to them and in that case 30% of those individuals may find those symptoms worsened
There is a belief that adhd medication could predispose ADHDers to hard drug abuse. This is a based off of one very flawed study and among those flaws the researcher did not control for conduct disorder, which is the biggest predictor of drug abuse among ADHD children and when you control for that, there is no link. 17 studies since have proven there are is no link between ADHD medication and predisposition to drug abuse
Medication is great and it will help a lot but it doesn't just magically erase your disorder. The next best thing is curating your environment for the ADHD brain. Seriously. It seems too simple, but this is massive
For all tasks an ADHDer tries to do, the issues they encounter will happen at the point of performance, using what you know. So organize your environment and your behavior so your disability is less debilitating. The only treatment that works with ADHD is the one that targets right were the issue occurs.
If your child is struggling to do homework, you are not going to fix that issue in a doctor's office, you're going to fix it at the kitchen table or wherever it is your child does homework
ADHD people have no problem interacting with the environment if the consequences are NOW and immediate. Thus create external stimuli and forces to replace what should be internal motivation and stimuli.
Expectations and Behavioral Modifications 1.5 min
The most effective treatment for a child with ADHD is creating artificial consequences that can be enacted immediately. The problem with homework is there's no consequences or reward until the next day or whenever that class is, and even then you won't receive your final grade until the end of the semester
This is where behavior modification tools like tokens and star charts are invaluable. If doing your homework gets you a star, that is an immediate reward, that is something they can work toward. Because it's now
These tools should be thought of like a ramp leading into a building, it makes it accessible to someone with a disability. Because of this, you will need to continue to use these tools throughout your child's development. You would never take that ramp away after thirty days and tell the person in the wheelchair that now they have to use the stairs. This isn't training wheels, this is accommodation for a disability
Cognitive Behavioral Therapy
Cognitive therapy is not a very effective treatment for children with ADHD, as cognitive therapy is about training a person to talk to themselves, with ADHD kids, that internal voice isn't developed enough to take advantage of this. Now with adults, cognitive therapy can be beneficial as a supplement to medication
Food and Diet
No matter who you are, eating a healthy and regular diet, will make you feel better. The same can be said for individuals with ADHD. Now people with ADHD may be more prone to poor impulse control when it comes to junk food. But the food itself isn't the problem, it's the brain, so keep that stuff out of sight to reduce it's draw
We know that food additives don't cause this disorder, but 1/20 individuals could be exacerbated a small bit by these things in their diet, but this is a very minor and trivial reaction. Changing your child's diet and pumping them full of supplements will not suddenly make an ADHD child function like a neurotypical one, you may not even notice any difference at all
So as you can see, the treatment options are endless! And that's great, but what happens when you don't get treatment?
Having ADHD is like being near sighted to the future. A person with nearsightedness can only read what is right in front of them, everything else is a blur, the same can be said for the person with ADHD, except it's their life. ADHD people can only deal with things near in time. The further out the event lies the less capable they are at dealing with it
If you're only dealing with what's in front of you because that's what exists in your mind, other things are going to fall apart, and it's not uncommon for people with ADHD to move between one crisis to the next as the dominoes fall. Each one being totally avoidable, if they had had the ability to prepare
With ADHD, intention isn't the issue. We want to do things, we know we need to, we know how important it is and we'll tell our loved ones and others that we'll get it right this time! And we truly mean that in the moment, we're just as frustrated with ourselves as you are, hell a lot more even. Because it's like why can't I remember to close the damn cupboard after opening it? It's so stupid.
This isn't really an issue I have anymore, but you know when I did? Back in that abusive relationship before my diagnosis and treatment. I would do it all the damned time. I am cooking dinner, I open the pantry to grab something, and all I can focus on is continuing the task I am already doing, the cooking, I don't have the working memory to be able to remember to close the cupboard too.
And oh man, every other day I would get yelled at for it. Despite all the negative reinforcement in the world, despite how upset my partner got, despite how many times he would remind me for 5 years, it was just something I couldn't remember to do. Do you think if it was simply trying harder that I wouldn't have done that? No one likes to upset people they care about and no one likes to be berated and yelled at. It wasn't fun for me. I wasn't doing it to just piss him off. I didn't even know I was doing it, not until he called me out.
The brain can be split into two pieces, the back part is where you collect knowledge, the front part is how you use it, performance. This is what makes this disorder so devastating because you can know everything in the world there is to know about something but when it comes time to use it, the engine doesn't turn over. You can't put the pieces together, it's like a puzzle but you don't have the cover image, and there's pieces missing
The severity of the person's ADHD plays a big part in the amount and seriousness of the issues they may encounter. Most children with ADHD have moderate to mild symptoms:
- Moderate: 43.7 percent
- Mild: 41.8 percent
- Severe: 14.5 percent, based on that 6.1 million kids statistic, that means there is 880,000 kids with severe ADHD in America alone
So let's talk about some of the consequences if you don't get treatment
- Day to Day Life
- Issues with memory: "This is the part that people who don't have this problem refuse to understand: I often cannot hold the thought long enough to write it down," / "I can have a phone or notepad in my hand when the thought occurs, and still fail. I forget things faster than I can open a browser tab!"
- Stimulation Traps: For a long time and for many people out there still today, there is this opinion that too much tv or video games causes ADHD. This is absolutely false. But what we do know is that individuals with ADHD will spend more time watching tv, playing video games, using the internet, talking on their cellphone and using social media. These things don't cause ADHD, it is the other way around, ADHD causes the person to select these activities as it's what is most engaging to us.
- Emotional Wellbeing
- Children with untreated ADHD are far more likely to develop other psychological disorders.
- Children can feel like failures because they can't do the basic things that all their peers do. They're told they are lazy by teachers and grown ups, some that choose to not invest in that child because they think that child just don't care. And you internalize these things, so even when the comments stop, you repeat them to yourself every time you make a mistake, and the ADHD brain is prone to rumination. I felt that way for most my life
- Physical Wellbeing
- We are more accident prone, our inability to control what we hyperfocus on can make us a danger to ourself and others.
- Driving: the single biggest cause of vehicle accidents is in vehicle distraction, you know what we're bad at doing? Ignoring distractions!. More speeding tickets, more car accidents, multiple accidents, worse accidents, licenses are suspended 3x more often than the average bear. There is no disorder that interferes with driving to the same degree of ADHD
- Because of this in Canada, if you are a teenager with moderate to severe ADHD you are required to be on medication to drive
- School and Work
- Under education: We will have a lot of difficulty with school and be more likely to be held back a year, a third of us will quit high school and only 5-10% will finish college
- Inconsistent Academic Performance: My dad couldn't understand how I could do so well in a class one year and so miserably the next. For my gr 9 math year, I nearly failed, somewhere around 60%. The following year I switched to applied math, a different kind of math that is taught using real world examples, applying math to real problems. I got 98% in that class.
- Problems in the workplace: more frequently fired from employment. Change jobs more frequently. More frequent episode of unemployment. More likely to have lower work performance.
- less savings, more impulse buys, more issues managing debt, more issues with use of credit cards, paying bills on time or at all. Terrible credit rating
- Social: 50-70% of ADHD children are utterly ejected from close friendships by 2nd grade
- Romantic Relations
- Higher rates of divorce
- Sex: Having issues with self regulation, ADHDers are more likely to engage in risky sexual behavior, have more partners and may become sexually active a year before other teenagers. 4x increase in STIs
- 10x increase in teenage pregnancy. ADHD is the biggest predictor of teen pregnancies.
- In Barkley's study on untreated children with ADHD, 32% of the boys had fathered a child by 19, 68% of the girls had been pregnant before 19 I guess I am lucky.
As you can see this impacts every aspect of your life and that's why there's a big push to increase use of medication and the length of time, as for most children they are on it for 3 years or less. Studies have found that childhood only treatment is useless in regards to changing the life course of these individuals. Especially as the symptoms only worsen with age
My Experience Untreated
As a person with ADHD, I managed to get through my childhood and young adult years without any devastating issues, but I also didn't go to college or drive. I was a giant introverted nerd so video games, comics and my art were all the stimulation that I needed and kept me occupied.
I never went to parties in high school, and since I lived outside of town I couldn't get into trouble unless my dad drove me somewhere or someone picked me up. My introversion, geekdom and isolation probably did a hell of a lot to keep me out of trouble in those teen years.
Even as a young adult making my first friends away from home, they were all nerds too, so a wild party was everyone going to someone's house, drinking beers and playing rock band. In a way I am incredibly lucky, because I know the impulses he's talking about. I say all the time when we talk about the Jen stuff, if I had internet at home I would so easily have fallen into that trap
I don't blame my dad or my grandma for not realizing there was something off with me. Well, that's probably not true, they did realize I was different, but I think it was mostly chalked up to me being creative. They got me art therapy and other assistance in my youth to try and address things I was struggling with, I just don't think anyone put together all the pieces and realized that it wasn't specific things I was struggling with, it was everything (except for things I was really interested in, which really made it confusing)
ADHD in Women
So I have mentioned this a couple times, but ADHD tends to present differently in AFAB women (we don't have enough research as to how this impacts non binary and trans individuals, but I imagine they face a lot of the same struggles and some of their own unique ones) and it is why so many of us go undiagnosed for long
And the reasons behind this are surprising but also make total sense: it's all society's fault
First thing to know, the cause of ADHD are the same regardless of gender. It's the same parts of the brain that are underdeveloped and have dopamine issues. But how these issues present themselves can be different based both on the biological differences between cis men and women, and the social differences
The short reason is: the squeaky wheel gets the grease and as a woman, we have been trained since childhood to not be a bother. To be polite, to be quiet.
Symptoms in boys tend to be a lot more externalized, the classic hyperactivity, fidgeting, being loud and impatient. Where for girls, we internalize things, keep up the façade and our struggles happen behind closed doors and are more alligned with the inattentiveness symptoms. We struggle with things like homework, social issues and self esteem, things you can't immediately notice just by looking at us
We lose words, can't keep our spaces cleaned. When we're emotional we're bitches or PMSing,
Oh and it's no coincidence that nearly every survivor of Jen has later found out, they have ADHD. A big reason for that is a lot of them were AFAB, their ADHD not getting noticed or treated until much later. Knowing how much of a change in perspective and empowerment I gained once I started treatment and how it made my own abusive relationship suddenly apparent, you can't help but wonder if the system hadn't failed us, would we have still wound up in the same situation?
The Cough Drop Sign
Dr. Ned Hallowell coined the term "the cough drop sign" in his 1994 book, "Driven to Distraction," based on a story a patient told him, and I think this does a great job at summarizing what it's like to be a woman with ADHD
"Someone left (a cough drop) on the dashboard of our car. The other day I saw the cough drop and thought, I'll have to throw that away. When I arrived at my first stop, I forgot to take the cough drop to a trash can. When I got back into the car, I saw it and thought, I'll throw it away at the gas station. The gas station came and went and I hadn't thrown the cough drop away. Well, the whole day went like that, the cough drop still sitting on the dashboard. When I got home, I thought, I'll take it inside with me and throw it out. In the time it took me to open the car door, I forgot about the cough drop. It was there to greet me when I got into the car the next morning, Jeff was with me. I looked at the cough drop and burst into tears. Jeff asked me why I was crying, and I told him it was because of the cough drop. He thought I was losing my mind. 'But you don't understand,' I said, 'my whole life is like that. I see something that I mean to do and then I don't do it. It's not only trivial things like the cough drop; it's big things, too.' That is why I cried."
My curling iron cable is unraveled in the bathroom right now, hanging from its hook. It has been like this for a month. I see it several times a day. It is something I think about frequently. Hell I am thinking about it right now as I sit in the bedroom writing this up. I could get up and go in there it would take less than a minute. But I won't, I tell myself I'll do it next time I go in the bathroom. I won't
Symptoms in Women
Many believe the reason for under diagnosis in women, is because our presentation does not allign with the standard diagnosis criteria as outlined in the DSM. ADDitude Magazine put together the following symptom checklist for women
- Do you feel overwhelmed in stores, at the office, or at parties? Is it impossible for you to shut out sounds and distractions that don't bother others?
- Is time, money, paper, or "stuff" dominating your life and hampering your ability to achieve your goals?
- Do you often shut down in the middle of the day, feeling assaulted? Do requests for "one more thing" put you over the top emotionally?
- Are you spending most of your time coping, looking for things, catching up, or covering up? Do you avoid people because of this?
- Have you stopped having people over to your house because you're ashamed of the mess?
- Do you have trouble balancing your checkbook?
- Do you often feel as if life is out of control, and that it's impossible to meet demands?
- Do you feel like you're always at one end of a deregulated activity spectrum - either a couch potato or a tornado?
- Do you feel that you have better ideas than other people but are unable to organize them or act on them?
- Do you start each day determined to get organized, and end each day feeling defeated?
- Have you watched others of equal intelligence and education pass you by?
- Do you despair of ever fulfilling your potential and meeting your goals?
- Have you ever been thought of as selfish because you don't write thank-you notes or send birthday cards?
- Are you clueless as to how others manage to lead consistent, regular lives?
- Are you called "a slob" or "spacey?" Are you "passing for normal?" Do you feel as if you are an impostor?
- Is all your time and energy taken up with coping, staying organized, and holding it together, with no time for fun or relaxation?
The latest research suggests that ADHD in women causes even greater emotional turmoil. Despite widespread improvements in the diagnosis and treatment of ADHD, some professionals are stuck in the past believe that ADHD primarily affects boys and men, not girls and women so women are far more likely to get diagnosed with something else instead of ADHD
This underdiagnosis also has deep roots in childhood. Girls with ADHD tend to try harder than their male counterpats to compensate or cover up their symptoms. They're more like to put in extra time or ask for help from their parents. Girls are also more likely to be "people pleasers" doing everything they can to fit in and not be a bother
Often women will run themselves into the ground trying to balance and keep up with their jobs, home, school, and children and they will do this for years before finally seeking help. This frequently because previous attempts to get help just came with disappointment or because they truly think it's just them, it's their fault
And of course add in difficulties with remembering to book and go to the often several appointments it takes to get a diagnosis.
Dr Nadeau, a psychiatrist with a focus on ADHD in woman had this to say "The most common diagnosis of a woman before she receives her ADHD diagnosis is depression. So many women have come in to my office and said, 'I've been in therapy for years and I've been diagnosed with anxiety and depression, but I am still having problems.' It's maddening, and it's such a treatable disorder. There's no excuse for that."
- Rachael Hall, a 26-year-old mother of three from Sandy, Utah, spent years struggling with anxiety and depression - and never knew why. Whenever anything went wrong in her life, she overreacted.
- She recalls falling apart during her honeymoon because she couldn't decipher a set of driving directions: "I told my husband, 'Why don't you just leave me? I'm worthless.' One little thing would just blow out of proportion. And then I would start to feel guilty afterward, and the more guilt I felt, the more depressed I got."
- The stresses of motherhood made things even worse for Hall. While she was expecting her third child, she broke down and was hospitalized for depression. Doctors prescribed an antidepressant. "It didn't work at all," she says. "It made it like I didn't care. It took away everything. I didn't feel happiness. I didn't feel sorrow."
- After the birth of her daughter, Hall began experiencing frequent outbursts of anger. "One second I would be fine, and the next second I'd be a raging banshee," she recalls. "I was so mean to the people I cared about. I couldn't do it anymore."
- Hall thought she might be suffering from postpartum depression. But her obstetrician ruled that out, saying it was too long past her delivery date for that to be a possibility.
- One day, she saw an ad for a mood disorders study and decided to enroll.
- "I got frustrated at first," she recalls. "I told my husband, 'Well, I must be on a placebo, because it's not working.' Then as soon as I started into the second five weeks, I noticed a difference."
- She didn't know it at the time, but during the second five weeks, she was taking the ADHD medication Concerta. The medication seemed to make her thinking "more logical." She was less forgetful, less edgy. "I'm just generally in a better mood," she says. "I feel happy. I don't blow things out of proportion."
Dr Nadeau says Hall's experience is far from unique.
"The pressure on women to be organized, self-controlled, to be the one who's keeping everybody else organized, is a societal expectation that's very deeply ingrained," she says. "Women feel very much a failure if they can't keep their house in order. There is a tremendous toll of having to keep up appearances, struggling, having embarrassing moments. Things like, 'I forgot to pick my kids up after soccer practice, and they were the only ones left standing out there.' It's a very public failure, and women are often not forgiven for these types of things. With a man, they'll say, 'Oh he's so busy, of course he forgot.'"
As if emotional problems weren't enough, ADHD may also bring significant financial costs, this is often referred to as ADHD tax
- "You're constantly paying for your disorganization and forgetfulness," says Nadeau. "You're losing your glasses, so you have to buy a new pair. You get a parking ticket because you lost track of time and the meter ran out. Things like that may happen frequently in the life of someone with ADHD.
- I had my own ADHD tax today. A couple weeks ago I ordered the first 5 volumes of a comic, I have been reading them as they arrive. The 5th one arrived today. In French. I was moving too quickly and didn't realize the book I ordered was french. I have done similar things with concerts, like buying tickets in toronto not here
- Lyle Hawkins, a 59-year-old mother of three, long suspected that she had ADHD, but didn't get diagnosed or treated until age 40. She regrets all those years of being misperceived as lazy and careless. But most of all, she laments lost opportunities. Hawkins married right out of high school, but she feels that she likely would have gone to college instead if she had been effectively diagnosed and treated in her early years.
- "I was from a very educated family, where education was really important. But college would have been too stressful. When you have attention deficit, everybody's on page 10 and you're on page three."
ADHD in women is complicated by gender role expectations. Society's long list of expectations for women - managing the self, the family, and the home - requires consistent coordination of executive functions.
Women with ADHD are not well-wired for these demands. But in seeking social acceptance, they are often determined to meet them, typically by masking symptoms and problems. Shame and self-blame fuel the dynamic interplay between societal expectations and ADHD's executive dysfunction. To understand women with ADHD, clinicians cannot underestimate the extent to which women measure their self-worth and self-esteem according to their success in conforming to gender expectations
- More likely to struggle with rejection sensitivity dysphoria
- Will often unintentionally isolate themselves, letting friendships and other relationships deteriorate to protect themselves from the discomfort and confusion that comes with social interaciton
- They are more likely to engage in risky sexual behaviors compared to women without ADHD. One theory for this is early recognition of sexuality as a shortcut to social acceptance. But this is double edged sword, because now you're a slut, and even if you don't feel that way you will internalize others feel that way whether they have said that or not
- tactile defensiveness and sensory overload (to being touched, and to common items like clothing material, tags, loud music, light, smells, etc.)
- I can't handle be partially wet, like if I get water on my face by while doing dishes, it will drive me fucking crazy. Like washing dishes go into it knowing my hands will have to get wet, but sometimes even with that, I'll wear gloves.
- somatic complaints, including headaches, migraines, stomach aches, and nausea
- behaviors perceived as controlling, demanding, easily irritated, etc.
- addictive behaviors, including substance use and gambling
- a significantly increased likelihood of acting on negative feelings, including self-harm (picking skin, cutting, etc.)
- Camouflaging symptoms: Research shows that women are highly motivated to hide their ADHD symptoms and compensate for them. The symptoms that are observable are often anxiety or mood-related, which can lead to misdiagnosis.
- ADHD symptoms get worse throughout our cycle, becoming more severe the more estrogen decreases
- Estrogen kicks in during puberty, around the time when ADHD symptoms become more prominent in girls. These hormonal changes are often expressed as anxiety and emotional volatility, as some moodiness is always expected with a period and especially as a teenager, and the general way doctors tend to take the complaints of females less seriously, it's easy to blow these things off as being dramatic or pmsing
- Chronic underlying feelings of inadequacy and shame are difficult to acknowledge and articulate, and more challenging for clinicians to recognize or quantify. Striving to hide their differences and reluctant to ask for help, women second guess themselves and retreat when their credibility is questioned.
- Women frequently feel like they can't just let themselves fall apart because others are relying on them, it's ingrained in women from a young age that we should be care takers and that our needs are secondary. This expectation gets internalized and you further criticize yourself for failing at your "one job"
- Women with ADHD blame themselves for being too distracted to "catch up" with daily responsibilities, so they anticipate criticism or rejections and thus censor themselves and play down their experiences.
- But masking comes with its own costs that usually result with the woman lashing out to people they live with or are closest with. Such unintended episodes leave them feeling demoralized and overwhelmed with regret. Without a neurobiological explanation, they attribute these inadequacies to flawed character.
- Many women acquired self-esteem through early academic successes. As adults, they still rely on intellect to help them compensate, but the difficulty of sustaining attention makes them question their abilities. Comparing themselves harshly to peers who seem to achieve effortlessly, they are determined to present a seamless façade. However, rigid perfectionism comes at a high price. Relentless self-monitoring is fueled by exhausting anxiety. Some women stay up most of the night immersed in obsessive preparations. But when something falls through the cracks, their high standards leave them feeling demoralized and undeserving of compassion.
- They are more likely to have experienced early physical or sexual abuse, and may manifest symptoms related to PTSD.
- Believing in their unworthiness, women may endure relationships involving emotional and physical abuse.
- As women's responsibilities increase, their psychological distress increases as well, but low self-esteem rarely allows their needs to come first. Distracted from their own self-care, women with ADHD postpone checkups and procedures, and function with serious sleep deficits.
- Chronically stressed, they may depend on prescription medications to manage anxiety, mood disorders, sleep, or pain, or they may self-medicate with alcohol or drugs.
- For far too many women with ADHD, day-to-day life is a perpetual source of shame. We're ashamed that we're always late, ashamed that we can't keep our houses clean, ashamed that the people around us seem to have everything figured out (spoiler: they don't). Mixed in with that shame is often fear - we're afraid that another screw-up or attention deficit disorder (ADHD or ADD) snafu will cause our carefully cultivated facade to unravel.
- These feelings are disempowering - they very literally rob you of your power, your joy, and your sense of self.
- Since childhood, we've heard criticisms and felt judged by the people in our lives. Unlike boys, who are often socialized to deflect criticism onto other people ("It was my friend's fault we got in trouble, not mine" or "My teacher is just mean, that's why she failed me"), girls with ADHD tend to internalize criticism. We assume we're at fault for every bad thing that happens to or around us.
- As girls grow into women, we take on additional roles - roles like wife, mother, caretaker, teacher, maid, chef, and nurse. Women everywhere are expected to take on these roles without complaint, so when those of us with ADHD struggle to keep up, we often feel like failures. We ask ourselves, "Why can't I do this? Everyone else can - they're must be something wrong with me."
- Girls with ADHD often find themselves being actively bullied - and back in the grand old 1980s and 1990s, no one did much about it other than tell us to suck it up. If it were a boy doing the bullying, some authority figures might have said, "Oh, he's just doing it because he likes you." (Setting the stage for us to conflate abuse with healthy relationships later in life).
- Often, we were our only ally. Our teachers and parents might have dismissed our complaints as tattling, or brushed them off - like mine did - with something like, "If you learned to act like everyone else, this wouldn't happen to you." We learned to blame ourselves for our own ostracism; we weren't worthy of membership in the social groups or the popularity other students enjoyed
- Some studies have suggested that the rate of divorce in couples where one of more partners have ADHD is twice the rate of the general population. Part of this may be due to the complications stemming from ADHD and sex, inattentive behaviors, "chore wars," and time-management failures. But as one woman says, "I've thought about leaving many times because I can't take the criticism... He thinks he is helping me to be a better person" when he notes her ADD-related shortcomings, but she mostly ends up feeling "unloved."
- Peer acceptance is a strong measure of self-worth in women. Their identities are defined by the strength of their relationships.
- The myth is that maintaining relationships is easier for women, and women with ADHD strive to hide their social impairments. They want and need friends, but they fear being outed as a fraud. Amber described feeling like an impostor: "If they don't invite me to join the book club, I'm a reject-but if they invite me, they'll find out I hate to read."
- Juggling complex lives, many women don't have enough energy left over to keep close friendships. Their lives require downtime to regroup. At night, they revel in the quiet moments when they don't have to be with anyone. Still, craving connectedness, they promise too much in their efforts to be accepted.
- Social expectations include social conventions like birthday cards, thank-you notes, and the like. Often, check-ins are moved from today's to-do list to tomorrow's list, until they become delayed for days, weeks, or months. Long silences do not mean a lack of interest, but friends may perceive them that way. After a gap in communication, some women with ADHD become ashamed of their avoidance, and fearful of its consequences, so they let the friendship slip away rather than try to explain their silence.
- "The night before my dinner party, I throw all household clutter into garbage bags and shove them into the closet, where they stay for months. I reject offers of kitchen help, so no one sees the crumbs in the fridge. I can't enjoy my evenings because I'm so anxious."
- Such hopelessness, combined with impulsivity, contributes to significantly more self-harm compared to men. Even more concerning is their much greater likelihood of suicidal thoughts and attempts. Recent population studies suggest that women with ADHD are more likely to die earlier of unnatural causes, especially due to accidents
Tips and Tricks
So now you know what ADHD, what causes it, the treatment options, presentation differences, untreated risks, what can you do to make it better?
There is an endless amount of awesome ADHD hacks out there now. If you get involved in a social media group for people with ADHD, you will learn stuff every day and you will feel validated and see other people's struggles and realize you are not alone. Twitter and TikTok both have big ADHD communities, just follow the hashtags to find your people. I don't personally use TikTok and twitter and is a death trap for me, but I do use Facebook and am part of a group called ADHD and Spectrum Superpeople, which is amazing
With ADHD there is no one size fits all, so everyone has different hacks to deal with their different quirks. These communities are a great place to find those and share your own. Hacks are simple things that will make your life easier. As with anything though, there will be bad information, so fact check often and if anyone is suggesting you put anything in your body, do some research, talk to your doctor. Don't make nyquil chicken
I know you guys are probably confused right now since I am a business analyst, my job is to plan things and I am always doing things. That's those 25 years of not knowing I had ADHD and working my ass off to try and compensate and still failing. Those techniques and skills I learned though become a lot more doable when you have a brain, which is how I refer to being on medication. Those are my brain pills those are what makes me function. Sometimes randomly, someone will find out I have ADHD, having somehow escaped one of my ted talks and they will be baffled. Because I appear very functional. And appear is the key word
My adhd is in the moderate to severe category. And it's my pure neuroticism and blessed interest in learning and science that has got me this far. This whole obsessive research thing I do is the only thing that kept me moving forward prior to my diagnosis. I have said before that the amount of effort it takes for an ADHD person to live a regular every day life where they eat 3 meals a day, do dishes, change their clothes, brush their hair, brush their teeth, go to work, make sure they bring their wallet, cellphone and keys , tend to pets, everything. Every single one of those is a conscious effort for us and it's exhausting.
I hack every aspect of my life to work with how I know my brain functions. I know my brain will not automatically think of everything it needs to. So I have to embed triggers in every part of my life and I rely heavily on routines and lists. Habits are hard to form with ADHD, because you have to do something repeatedly over a long period of time for it stick, but they're also invaluable, if you don't have to consciously think to do something you are more likely to do it and will have more energy leftover for other things
I could spend days telling you everything I do in my day to day life to make me appear like a functioning human, but here's a handful that work for me. These may not work for everyone, but they have been a big help to me
The number one thing though is you need to accept and own your ADHD. Read about it, talk to specialists and get to know what areas in particular are a struggle for you, because it is different for everyone
- Use clear containers or labels, if you can't see what's inside you will forget it exists
- Have open shelving and it'll help you keep everything organized and remember what you have. Take off cupboard does if you have to, it will help
- My entire life is set up so that if I suddenly lost my brain, I could figure it out. I put things in places based on my logic. All my hair products go in the bathroom. All my fish maintenance stuff goes under the kitchen sink. Because I won't remember where I put something, but if I think it about it and I can figure out where I would put it. Where's my mini paints? In my mini box. Where's my buttons, extra thread, fasteners? In the sewing drawer in the craft room. Everything needs a place because I can't rely on my brain to remember where I put it if I just put it some place random.
- And everything else is documented. All of my creative projects have notebooks and folders on my pc and it's all backed up to the cloud
- When a thought enters my brain mid conversation I have two choices: blurt it out and talk over the other person or focus on the other person and leave the thought perish. I have a bit of a middle ground, when I am in a physical setting I will raise my hand to signify I have something to say. It seems silly but it works and the people I am close with understand
- When I am brushing my teeth, I go and feed the fish. There's a reason behind this. Doing anything for 2 minutes that isn't fully engaging is torture. BUT if I can do other things at the same time, I get it done, so I brush my teeth as I walk about the house. I feed the fish at the same time, I take a few moments to look in the tanks and make sure everything is ok, I will turn on some lights in the house and then by that point I am pretty much done. I return to the washroom, finish brushing my teeth
- I clock out at 5 o clock on the dot, otherwise I keep working. I put away my work PC and then I start making dinner. This has to happen right after work, that's what I am conditioned to do or else I will sit down somewhere and get lost on my phone for hours
- I keep floss in my bedside table, otherwise I will NEVER remember to use it. Same with nail clippers and nail files.
- ADHD comes with all sorts of tics and bad habits are common. I had bad acne growing up and got into the habit of picking my skin, especially when I am anxious or if I am thinking really deeply. So I bought a UV lamp and a gel nail kit and try to keep my nails painted, as it makes the edges duller and harder to pick with. I ain't fashionable, I am just trying to not tear my skin apart.
Getting Shit Done
- Either do it now or write it down: seriously, the moment someone gives you a task or you think of something needs to be done. Either do it right now or schedule it in your calendar. Nathan talks about something he really wants, I add it to a secret list I have full of gift ideas for people. I have a story idea, I open the appropriate one note notebook and write it down.
- Create urgency, set deadlines: Since we can only keep so many things in our head at a given time, if there's no urgency we're going to focus on the things that have urgency. We're always chasing the next important task, and it's really difficult for us to see beyond that. So I create artificial deadlines and put them in my calendar to remind me
- Whenever I use something, if there is not more that one serving left in the container, I will immediately add it to the grocery list. If my hands are all gunky and I don't have my phone I yell at nathan to add it to the list
- Whenever I buy a book it goes in the bedroom until I have a chance to read it, this is to make sure I don't forget about it. Once I have read it, it goes in the bookshelf.
- For someone with ADHD to get anything that requires the remotest amount of forethought and multiple steps done, we must break down the future. Every task must be broken into its smallest components. Because something as simple a recipe becomes a tower of intimidation when looked at as a whole. I have been doing Nanowrimo for 15 years, if you don't know what that is, it's national novel writing month, and during this, those that sign up the goal is to write 50,000 words within the month. How do you handle that with ADHD?
- I'll tell you how I do it. I write 2000 words a day. Now you're probably scratching your head because 2000 x 31 comes out to 61,000 not 50,000. I do this on purpose, see the bare minimum you have to write is 1666 a day every day to reach that 50,000
- But I KNOW that I am terrible at getting my writing done on weekends or if something else is happening that day. And I know it gets harder the further into the month you get, so the more ahead I can get without burning myself out the better.
- Some days are harder to focus than others, so I will bribe myself. I will get a snack and break it into small pieces or like a bag of chips, and every 100 words I can have a chip or piece of that snack. Immediate reward.
- I break everything I do down into steps. I don't worry about the later steps I just worry about the next one in the sequence. I am making dinner tonight, the meat needs to be marinating, that is the first step, nothing else matters until that is done
General Life Management
- The most valuable tool for coping with my ADHD, is my phone. There I have access to my notebooks, lists and calendar and it's vital to my existence.
- This doesn't work for everyone. Some people don't have a phone, lose their phone, or have issues keeping it charged. For those people a physical planner may be better, but whatever it is, you need to have it on you at all times
- This is something I used to have an issue with: my phone, my wallet, my house keys, my access badge for work. I swear, I would forget one of those every time I left the house. So I combined them all into one with a case. Now I never forget my phone. I set up a charging cable at work, so now when I get to the office the first thing I do is plug in my phone.
- I have notifications turned off for most everything, the only things I get notifications for is my email, discord, signal and whatsapp. That's it. I don't need to know that Karen liked my picture of my cat on facebook the instant it happens
- I can't handle pending notifications on my phone, I have to deal with them, I will see it out of the corner of my eye and I will obsess until I do. Your thought is probably then I should just put my phone where I can't see it. Nope. Can't do that. If I can't see the face of my phone I begin to get anxious and my thoughts begin to ruminate about what could be happening that I am not paying attention to. A part of this is my obsessive need for control but another part is conditioning from my ex. Because if he messaged and I didn't respond within five minutes there would be a problem. He was insanely jealous and as most abusers are, narcissistic, so he needed to be the center of the world
- I have quit most social media, because man that's a rabbit hole I fall down fast and next thing I know I have read 6 months of r/askreddit and done nothing else with my day. They're such time traps for me so I keep my usage very sporadically. I will check facebook once a day, while I am eating breakfast. Maintaining a social life and staying in contact with people is difficult for me, facebook helps me in that way and let's others know I am still alive and posting memes. After that no more social media unless I have 5 minutes (and only 5 minutes) to kill I might scroll instagram. But I only do that when I know that within 5 minutes a trigger is going to go off that I'll have to go attend to.
- Group chats, I am in only a handful of group chats and the ones that are really active remain muted. Remember what I said about having to attend to my notifications immediately? I get anxious if I am constantly getting pinged with messages and I am also not able to do anything else while that is happening. If I really need to focus I will mute everything
- If I am in the middle of something I don't open links unless I really really want to. Because I know my task will be interrupted for an indefinite amount of time and I may get sucked into a black hole. (this is a reason I NEVER go on to youtube unless I know exactly what I am looking for, because that's a quick way for me to lose a day.) Checking a link at 10am on a workday could derail me for the entire day unless something really demanding of my attention comes up. I always pay attention to my work email and have the notification sound turned on for this.
- And then every night around 8pm, sometimes earlier, I turn my phone to DND. No notifications. I am often on my computer so if I am feeling up to it I might leave signal open in case Nathan sends me a message and the only other people I talk to on there regularly is Courtney, Jake and my brother.
- This entire spiel brought to you by the fact that I looked at my phone while typing the rest of this and saw a notification
- I must always be stimulated, you will never find me doing only one thing at once. There is always music, if there isn't music I am watching something. Music provides a backdrop to drown out everything else, so I am not distracted by ever creaky floorboard or kid screaming outside. It helps me focus and provides me with security. When I go out into the world I never do it without headphones, I get far too anxious, and it drains my introvert batteries super fast
I hope any of that was helpful to someone out there and maybe it will help you feel a little less alone and a little less broken <3
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