Adult ADHD Does Not Exist in Some Places

Here is a story I have heard too many times. I received an email message last week from a woman in East Tennessee who had suffered enough from effects of ADHD, only to suffer more from the disappointing and sometimes insluting responses from uninformed mental health professionals. I don’t blame the professionals, as we are all naive until we are not. Those of us who specialize in helping adults with ADHD need to reach out to communities who are not informed about the disorder and the complementary roles of different professional disciplines that can help. We need to insist that our local mental health professionals have access to education about ADHD.¬†Recognition of adult ADHD is relatively new…just under three decades…and more work lies ahead to bring services to under-served communities.

For the sake of efficiency and privacy, I trimmed a little of K’s email message and deleted the name of a mental health agency. K gave me perimission to use her email message in this blog.

I am located in Jonesborough, TN (near Johnson city and Kingsport). I have been to many different counselors, psychologists, and psychiatrists in this area, and I keep getting the same result. Mostly people who have information on ADHD that is decades old and have no clue what to do with it. I keep getting told things like, “You can’t possibly have ADHD because you did so well in school,” “Adults can’t have ADHD. It’s only a childhood disorder that you grow out of,” “Adult ADHD is very rare,” and many other ridiculous things. It is very frustrating to go to a professional and know more about your disorder than they do. I have done lots of research on Adult ADHD, read many books, etc. and I wish I could just treat myself, but that doesn’t work very well ūüôā It is also very frustrating because, everyone I call says that they treat adult ADHD, but then when I come for the appointment, they don’t have a clue. I have recently been asking if they specialize in ADHD, and you would be surprised at how many say they do before you make the appointment, and then when you come, it turns out that they have almost zero experience with it. I have had therapists tell me that if I would just “try harder”, I could do it, or “there is nothing we can do for ADHD except medication”. I even saw an ADHD coach in Asheville, NC, and after working with him for several months, mainly making lists and schedules that I could never seem to stick with, he said, “well, I gave you all of the tools, and you wouldn’t stick with it, so I don’t know what else to do for you”. It has been very frustrating to say the least.

I just recently made an appointment at _____ thinking that, since they are the largest mental health provider in this area, they would have at least one person who could help with ADHD. I called and asked for someone that specializes in ADHD, and they told me that they didn’t have anyone specialized, but that they saw a lot of adult ADHD, and many of their practitioners could help. So I scheduled an intake, and they said they would place me with someone who could help. I saw her yesterday, and she told me that ADHD in adults was practically nonexistent, because you grow out of it as you get older. She said that no one in their practice saw many patients with ADHD. She went on to tell me that she had never treated a patient who actually had ADHD, because they all actually have bipolar disorder. By the end of 45 minutes, she told me that I had bipolar disorder, and I “definitely don’t have ADHD”. She claimed that my “hyperfocus” was actually “goal directed behavior”,¬†that my hyperactivity was hypomania,¬†and that I need to be put on mood stabilizers. This was despite the fact that I was diagnosed with ADHD at age 7, and re-diagnosed as an adult about 5 years ago with combined type ADHD. After doing some research online, it turns out that ADHD is commonly mistaken for bipolar disorder, especially in women. It is very frustrating that, apparently, in our area ADHD is being commonly misdiagnosed as bipolar and that the knowledge level of practicing psychologists¬†is so inadequate.

I have looked, and there does not seem to be any support groups for adult adhd here. It would be great to start one! Though there might not be very many people if they are all being misdiagnosed. I tried going to a support group in Asheville, NC for a while, but it’s about a 1.5 hour drive, and it just wasn’t feasible to go all of the time.

I have requested that the Tennessee Chapter of NASW (National Associatoion of Social Workers) offer training on adult ADHD for professionals in East Tennessee, as they did in West Tennessee in 2017. 


March Madness and Unmanaged Attention

Sunday night my wife asked if I would like to go out for a sandwich after working all afternoon on taxes. I was glad to get up and leave the house. As we approached the traffic light where we would normally turn left to Murff’s Craft Brews & Burgers, she asked, “Don’t you want to be in the other lane?”¬†

“Yes,” I replied, shifting abruptly from the right lane, to the left lane, and then into the left-turn lane at the light, all in one skillful maneuver. I was like a point guard penetrating the the lane in the NCAA playoffs. I asked my wife if she thought I wasn’t focused. Her answer was correct. Yes, I was focused, so focused on taxes and March Madness that I was on the road to nowhere, as if I did not know the way to a familiar watering hole.¬†

ADHD is not a deficit of attention, but an attention management problem. I was failing to shift my attention from an excessively focused state to open awareness. Once I pulled my head out, I was able to re-direct my attention to the road and make my skillful move into the turn lane. So, don’t tell me I can’t focus.

Open awareness may be more elusive to individuals with ADHD than the capacity for focusing. With all we know about attention management, we still focus too much on getting focused. We don’t give sufficient attention to the problem of failing to cultivate open awareness. Open awareness is where we notice both what is inside and outside of us, and where we also notice where our attention is going, which is necessary for intentionally directing our attention. If I had not been so totally focused when driving to Murff’s, I would have been more prepared for the left turn.

Normally, a few sudden turns will trigger my wife’s motion sickness, another understated hazard of being married to ADHD. She thinks I’m a poor driver, but I have never wrecked a vehicle when she was in the passenger seat, and I’ve never gotten a speeding ticket with her in the car…and I’m not defensive, of course. I’m a skillful driver, as I demonstrated last night. She’s just gets frightened too easily.¬†

We arrived at Murff’s with normal appetites, and no motion sickness, only to learn that Murff’s had run out of food! No kidding! The restaurant had run out of food and was closing early. The only comparable experience I can recall was one evening when Murff’s had run out of customers by 8 pm and decided to lock up and go home, just as we were arriving. I can relate to Murff’s; the restaurant appears to meet the criteria for an ADHD diagnosis.¬†

The evening worked out well for me. My generous wife let me choose a sports bar where I could get seafood gumbo and see the end of the Duke-UCF NCAA playoff game. I watched a UCF player drive the lane to the basket…lefthand layup…shot rejected. It was like my first shot…driving the lane to Murff’s…lefthand turn…then right to Murff’s…first shot rejected…Murff’s was closing…game over.

March Madness continues. I will drive to my accountant’s office this week. I am better prepared this year to be ahead at the buzzer and not have to make a last-second shot. ¬†¬†

Traveling with ADHD

Now that I’m beginning to look like a senior citizen–perhaps because I’m a senior citizen–I’m having a new experience in airports. Airline employees sometimes volunteer unsolicited help when I travel alone now. Mild confusion, once inexplicable and annoying to neurotypical airline personnel, is more often treated as a problem of aging. That’s great news for Boomers traveling with ADHD‚Ķassuming you can tolerate being pitied‚Ķpoor thing!

I returned to Nashville from Los Angeles last week, and a nice young taxi driver from Ethiopia drove me home. He had immigrated to the U.S. only six months ago. When we arrived at my house at 10 pm, he lifted my suitcase from the back of his taxi while I grabbed my backpack. Then he asked, “Do you have everything? Do you have your cell phone?”

I felt for the lump in my pocket. “No, I don’t think I have my cell phone,” I said. He leaned over the back seat of his minivan and retrieved my phone from the floorboard.¬†

“I always ask,” he said. I tipped him and thanked him for that, and for telling me his story of how he came to the U.S.¬†

Dealing with my neurological difference can seem insurmountable at times, but imagine trying to integrate into our culture with dark skin and an African accent in the current political climate, not to mention learning a new language well enough to work. I admire his courage. 

I could see my breath when I exited the cab. I had left my favorite jacket in the Landmark Theatre at Westwood Plaza in Los Angeles. The jacket was never turned in to Landmark’s lost and found.¬†

I hope that whoever found my jacket needed it, can wear a large size, and likes black fabric with black leather sleeves. If a UCLA student is reading this blog while wearing my jacket, with a Levi’s tag inside the collar, please contact me. It is colder here than there, and I will gladly trade a lighter jacket for it.

The best ADHD travel story I know starts at the bottom of page 75 in my book Living Well with ADHD. I’m grateful to Eric for sharing it. You can share your best ADHD travel story in the comment section below.¬†

Some of the Parts, or Sum of the Parts?

One thing I find fascinating about ADHD is the connection among various features of the disorder, and how that reality parallels the connectedness, or lack thereof, among parts of the ADHD brain. The seemingly separate features of ADHD are all part of one whole, just as separate musical instruments are coordinated as one symphony performance. The brain’s conductor (executive function) coordinates activity in a typical brain, like a symphony conductor coordinates activity of musicians. But an impaired conductor cannot coordinate a musical performance.¬†

Features of ADHD include forgetfulness, disorganization, inattention, impulsivity,  emotion disregulation, and difficulty activating and sustaining effort. These are parts of one disorder. 

Memory and attention are interactive. You may forget what your partner told you and get accused of not caring, but that might not reflect a simple memory problem. You might not have been present enough to process what your partner said. When your attention is pulled this way and that way, with no inhibition or regulation of input from many sources, you may hear the words without processing a message. The same outcome may occur when your attention is laser-focused on something that overrides your partner’s words. Then she asks you the dreaded question, “What did I just say?” If you have a sense of humor, you might improvise a creative answer to make her laugh. If you have no sense of humor, you might get angry that she is quizzing you like an attorney in court.

If you are not mindfully present enough to process and file a message in your memory, there will be nothing in the memory bank to pull up later. 

Activation (opposite of procrastination) and attention are interactive. If you cannot effectively inhibit attention to all that is vying for it in the moment, you may become immobilized and appear indecisive. If all tasks are equally important, choosing where to start is complicated, and prioritizing is inconceivable. Either way, you fail to start, or you jump impulsively into whatever grabs your unmanaged attention with no regard for priorities. 

Impulsivity and emotional reactivity are interactive. You may get hooked into believing that something external to you caused your emotional reaction. So the fix is external, with no regard for the internal problem (reasoning hijacked by emotion). The meaning you make is not recognized as problematic, as thoughts have become facts. Being impulsive, you react aggressively or defensively to the person or situation that you believe caused your arousal.

I’m often asked, “Isn’t everyone like this?” Most people have some of the parts some of the time. Adults with ADHD are the sum of the parts. They have been like this much of their lives, and are like this in different settings, to the extent that the sum of these features impairs their daily lives. Learning may be affected, or relationships may suffer. Adults with ADHD may underperform at work or become workaholics who neglect their families. Impulsivity may lead to financial or legal problems, or injuries from accidents.¬†

¬†We are like cats. All cats are alike in some ways, but I’ve never had one cat who was just like another. Observe a group of adults with ADHD, and you will see individuals who might share little in common except for the features that affect them. Effects can vary widely. ADHD grows up in different homes with different parents, different siblings or no siblings, different levels of support or rejection. It marries different people, some who are understanding and supportive, some who are inflexible and critical.¬†

I can say with confidence, after 13 years of leading an ADHD support group, that group members recognize each other as being in the same “family” despite our differences. We accept our differences because we are different and wish to be accepted. When people tell me, “You don’t look like you have ADHD,” I still don’t know what to say‚Ķbut I never thank them.¬†

Demystifying the Task of Organizing Tasks

Do you make to-do lists and then ignore them, lose them, or get derailed after the first task? I’m most productive when I start my day meditating first, and then writing my task list. I prefer pen and paper, using one sacred notepad that I keep nearby‚Ķexcept when I lose it. If you prefer using your mobile device, be mindful of risking the out-of-sight-out-of-mind problem. How often do you scan your entire list, or your calendar, on an electronic device?

There is more to prioritizing than creating a task list. The time you protect for making the list should be on your calendar. It may be your most important, non-urgent task. Non-urgent tasks are easy to neglect. Brains like mine are drawn like a magnet to urgency. God only knows what I’m forgetting in this moment, while pushed to meet my blogging deadline.

Starting your day by jumping into a task with a microscopic state of awareness interferes with open awareness. Start your day in an open state before engaging in selective attention. Prioritizing requires both states of awareness. Going from an open state to focused attention is easier than shifting from one object of focus to another. Doing is more stimulating than planning. Prioritizing tasks requires patience and inhibition of impulsivity. If you neglect to prioritize the task of prioritizing, you may remember a critically important priority after it is too late to begin the task. Feeling horrible about having used your time unwisely, you may distract yourself unwisely with negative self-talk. That’s where a meditation mantra can help: let it be‚Ķmove on.

Beginning your day with a wide angle lens is important for living well with ADHD. You have an attention management problem, not an attention deficit. Broadening your awareness is no less important than focusing it. I have a harder time with open awareness. I can focus too well at times and lose awareness of time, other priorities, and other people. Poor attention management not only contributes to inefficiency, it can make you appear unconcerned about others. 

Modern television studios use a small mounted camera for a director to employ for scanning and directing multiple robotic cameras. One robotic camera may show a wide angle view of the entire set, and another may focus on the face of a show’s host. We direct our visual attention in a similar fashion, first determining where to direct it, and then shifting from a broad view to a focused one. Scanning for where to direct your visual attention determines what you see. Scanning is like prioritizing.¬†

Give your task list the time and attention it deserves. Expect occasional setbacks, but don’t waste time criticizing yourself for wasting time. Just return the wheels to the tracks in that moment of recognition, before the self-criticism engine starts. It takes seconds to get back on track and far more time to lecture yourself. The moment you have completed a task, direct your attention back to the task list, immediately, before your brain gets hooked by something urgent and less important. Just note what grabbed your attention and add it to your list if it is important. Then keep moving forward.

Now, back to my task list… 

Why We Spin

Do you have trouble deciding what to do first when you have many things to do? No one task seems more or less important than another. So you mentally spin like a roulette wheel, as if the ball is going to land on a number for you. You feel overwhelmed and immobilized. Adults with ADHD often feel like there is way too much to do, even when our workload is not that different from the workload of others and should be manageable.

If you have ADHD, you prioritize horizontally; each task is as important as all the others. What that means, in reality, is that we don’t prioritize. Prioritizing requires attention management, and your attention manager goes to sleep on the job. That is what ADHD is at the core, an impaired attention manager. It works inconsistently because of your neurological difference. If you¬† take medication for ADHD, you may have an idea what it is like to organize and prioritize your work.

Whether you take medication or not, recognizing this problem points to an adaptive solution. Take Stephen Covey’s advice and schedule time for something important but not urgent. Instead of jumping indiscriminately into the first task that grabbed your attention, only to jump to another before finishing the first, you can schedule time for prioritizing. Of all people, you
need to pause before starting any task and consider your tasks for the day. You cannot do that when your awareness is locked up in a selective attention state.

We call it attention deficit, unfortunately in my opinion, because we have an attention management problem. In fact, it may be an attention surplus. The problem seems to lie in our limited ability to inhibit attention. Since you don’t have the attention manager of a neurotypical, prioritizing should be your first task of the day. Remember that you are impulsive and likely to jump into a task randomly, without regard to its importance. But I believe you can be impulsive and still know when your impulsivity can cause a problem. Scheduling prioritizing time is a way to prevent your ADHD from sending you into spinning.

I’m at my best when I have a task list. I keep a spiral notepad for my daily task list. Spiral notepads come in many colors. You can choose a particular color for your task lists so it is distinguishable to you and your family. The only problem I have had with this strategy is that I tend to grab the first notepad I find, often using a new one when I already have one in¬†use. I’m still a rule violator at heart!

I plan to label and date a current one, always returning it immediately to my briefcase after updating it, and avoid using a fresh one when my current one is missing. I vow not to use a black for anything else when I cannot find a colored one. Colored notepads will be reserved for other purposes, like ideas and drafts for writing projects. To use a colored notepad for a task
list, or a black one for drafts of my blog, should draw a penalty flag. My brain may need a referee, perhaps an ADHD coach, as much as it needs an attention manager.

If you don’t know about professional organizers and ADHD coaches, click on this link:

Seeing Ourselves from a Distance

Great novelists are teachers of life lessons. Viet Thanh Nguyen is a master of metaphor and simile, and author of the Pulitzer Prize winning book, The Sympathizer. In an interrogation scene, he describes the problem of being too close to one’s experience to see it.¬†

‚Ķfor we are the ones most able to know ourselves and yet the ones most unable to know ourselves. It’s as if our noses are pressed up against the pages of a book, the words right in front of us but which we cannot read. Just as distance is needed for legibility, so is it that if we could only split ourselves in two and gain some distance from ourselves, we could see ourselves better than anyone else can.

Reading this passage reminds me of how we can be so unaware of the effects of ADHD symptoms on others. We may be too nearsighted. To see our experience as others might observe it requires mental flexibility. To learn from our missteps requires the courage to observe our missteps with an open mind and tolerate feelings of embarrassment without retreating. 

We can be so single-mindedly focused that we lose awareness of what is on the periphery of our selective attention. We can seem inconsiderate, not because we don’t care, but because we lose awareness too easily. For example, we can be so focused on a story we are telling that we don’t notice that the listener has other things to do. I was speaking to the owner of a restaurant last week who had other customers besides me‚Ķimagine that! It was one occasion when my wife and part-time attention manager should have kicked me under the table. I was on a roll when my listener interrupted me to get back to work.¬†

The mindful speaking deficit for adults with ADHD is this: following our own thoughts while speaking, and trying to be succinct, requires extra mental effort and selective attention. We lose the big picture when we are too focused at the wrong time. For sure, engaging with others is where life happens, but it is not all that is happening. To someone whose selective attention is locked in place, it is all that is happening.

Our attention needs a manager, the absence of which is central to the disorder. There is no deficit of attention, just a deficiency in attention management. That is why boosting dopamine with medicine can help. It wakes up the manager. 

Maintaining some kind of daily practice of mindfulness can help us to be mindful of where we are directing our attention, and whether we are even directing it at all. But it does not cure ADHD. I’m at my best when I wake up in the morning and say to myself, “Today I have ADHD.”¬†

Remembering Forgetfulness

I was sitting in my doctor’s waiting room yesterday morning, waiting for a routine checkup and¬†making a list of medicines and supplements that I take routinely. I’m now taking only Celebrex, vitamin D, and one other supplement whose name I could not remember‚Ķthe one I take for memory problems. I had forgotten to take it yesterday. Imagine that!

A few years ago while writing Living Well with ADHD, I was browsing books on my shelves, searching for information that might be pertinent for a chapter I was developing. I came upon a book I had not read. I wasn’t sure where it came from. After pondering the question and skimming a few pages, I vaguely remembered purchasing it, but I did not recall when. The book was useful, and I’m glad I searched and found it. The title: In Search of Memory. I’m not making this stuff up!¬†

Tomorrow morning, as today, I will wake up with ADHD, and it will be Groundhog day again. I need to remember that I forget! Maybe I will write the following message on a post-it note and put it on my bathroom mirror: “Remember that you forget!” I should write a note to myself right now, reminding me to write the reminder on a post-it note tonight. First, I have to go buy some post-it notes. I will add that to my expanding to-do list, one that keeps growing faster with additions than shrinking with deletions.

I was seconds from posting this blog when my MacBook’s power went off. I had forgotten–only minutes after seeing a warning that the battery was low–that the battery was low. So it goes. It is charging now, and I am imagining how nice it would be if I could recharge my biological memory!¬†

Wise Effort

Pushing back against uncomfortable feelings is unwise for two reasons: (1) there is no switch that turns them off, and (2) trying and failing to squelch them makes them worse. Wisdom is knowing how to relate to them. 

Being anxious about anxiety compounds anxiety. Being angry at yourself for getting angry obstructs learning to act skillfully when angry. Thinking you are worthless for having low self-esteem is practicing low self-esteem. 

I think of emotions as the color of life, hence the title of chapter nine in my book, Living Well with ADHD. There is a certain beauty in the full range of emotion. Watching a sunset brings on what you may label as a “good feeling,” and it is no less fleeting than a “bad feeling.” Having a friendly relationship with an uncomfortable feeling allows you to learn from your experience; whereas, believing that it is a problem leads to unwise effort and more discomfort, not less. For example, revenge may bring temporary comfort, but vengeful thought and action feeds anger in the long run. Self-defeating action usually follows.¬†

Realistic and non-judgmental appraisal in the face of momentary discomfort is wisdom. Labeling feelings as good or bad is just extra thinking. The labeling doesn’t change anything for the better. You can feel bad about a mistake or failure without questioning your worth. You can only start (or re-start) right where you are. Accepting the uncomfortable feeling allows you to put the wheels back on the tracks promptly without unnecessary suffering. ¬†

Judging performance is not the same as judging the self. If you cannot accept the discomfort of a disappointing performance, you will not learn anything from it. If the “self” is to blame, you will either criticize that self, or feel sorry for the poor thing‚Ķneither is productive.

What is the self anyway? It helps me to think of “self” as my own construction, an image I’ve created, one that I sometimes color with certainty about what others are thinking. After all, I’m an expert on what other people are thinking about me at any given time‚Ķaren’t you? Embracing certainty about what others are thinking is an example of unwise effort.

Uncomfortable feelings have value and should be respected. If you can be curious about them, and get up close enough to notice what those sensations really are, you might discover that they that are actually tolerable. In a sense, they are empty of content except for your conjecture. The notion that they are intolerable is just something you say to yourself while tolerating them.

Try this: Next time you get a shot or have blood drawn, turn your attention toward the needle’s prick instead of away from it. Get up close and discover what the nature of your pain actually is when you allow it. You just might relate differently to it, even though that brief insertion of a needle is no different than before.¬†

Feelings are just feelings. When you try not to have them, you will think and act unskillfully. “If you’re not willing to have them, you will,” says Steven Hayes, author of Get Out of Your Mind and Into Your Life. Willingness to experience life fully requires acceptance of your experience as it is‚Ķincluding your feelings as they are.¬†

Your Personal Experience

Can you recall times in your life when someone presumed to be an expert on your experience, or your intentions? You didn’t listen to me because you don’t care‚Ķyou would have remembered if it had been important to you‚Ķyou hurt me on purpose.

I recall a moment when I knew with certainty that no one in the universe shared my personal experience, only similar experiences. Standing beside my brother on a spring day in 2011, minutes after our father had taken his last breath, I awakened to the reality of a private experience that would never be repeated. I hadn’t just lost my dad; I had lost a relationship that no one else had. As close as the three of us were, I didn’t have my brother’s relationship with our father, and he didn’t have mine.

My brother and I spoke at our father’s memorial service, describing the same person from our different experiences. I felt a special connection to my brother that day, recalling precious moments in our shared history. It was the same history, but not the same experience. Furthermore, each person attending the funeral stood alone with a personal experience of my father. And as we stood together in respect for a life that we knew from the outside, not one of us was an expert on my father’s personal experiences.

Married for 62 years, Mom knew Dad better than anyone. She knew when he was worried about something. I could never tell…he tried not to show it…but her experience informed her of the signs. Still, her experience was not his. His efforts not to appear worried may have been his way of protecting her. I cannot be certain about his motives.

The next time someone shares their expertise about your intentions, you can try, if you wish, to comprehend why thy are so certain. You might even ask, “What makes you think that?” Confidence in your personal experience can help you avoid being defensive or angry in response. You can be curious instead, which may help the speaker suspend certainty, or make you aware of something useful. Practicing mindful awareness…of self and other…and keeping an open and flexible mind, are good for your relationships and your emotional wellbeing.

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