December 8, 2011
According to the National Institute of Mental Health, 4.1% of the U.S. adult population has Attention Deficit Hyperactivity Disorder. I’m one of that 4.1%; in August, I was diagnosed with ADHD, primarily inattentive. Like most adults diagnosed with ADHD, I had ADHD as a child, but my symptoms did not become problematic until I was under so much stress that my coping mechanisms were no longer sufficient. In my case, that stress was graduate school, and I spent much of my first two years severely impaired. The worst part of it was that to an outside observer, my difficulties looked for all the world like laziness, while from the inside, everything felt overwhelming.
The DSM-IV states that for an adult ADHD diagnosis, “There must be clear evidence of significant impairment in social, school, or work functioning.” Before graduate school, I wouldn’t have qualified for a diagnosis, because I didn’t feel impaired. I rejoiced in the strange ways my brain works, the tangential intuitive leaps, the great creativity, and the ability to keep many tasks going at once. Since the symptoms of my iteration of ADHD include issues with self-motivation, lack of focus, and difficulty working in advance, graduate school made it feel less like an adventure and more like a serious disability. I compared experiences with another recently diagnosed graduate student while writing this article, and he agreed with the particular difficulty of ADHD-inattentive with graduate school work.
Both of us were asked to leave our first research groups because of the effects of our ADHD symptoms. I often lost my train of thought with my research entirely, taking a full week to complete tasks that I know should have taken a few hours at most. The feeling of inadequacy when compared to student who could do productive work 12-15 hours a day was punishing, as was my negative self-talk about my lack of productivity. I intellectually knew I was intelligent, but when I couldn’t focus, when I was doing poorly in my classes, when I was falling behind on my grading... I felt like I wasn’t smart enough, and that I never could be smart enough.
I felt inadequate outside of graduate school as well. I’d been living outside of my parents’ house since 2006, but I couldn’t seem to get on top of the basic tasks of self-sufficient adulthood. My house was never clean, and I couldn’t find the motivation to care. Dishes were the worst; I would leave one meal’s dishes to deal with later, then another, then I’d reach a tipping point where I’d feel like I could never finish the dishes and just leave them there. I was also failing at feeding myself. I couldn’t seem to plan ahead well enough to make meals for when I was hungry, and even when I did, I convinced myself that I needed to get things done for school and I didn’t have the time to make food. My friend also experienced this difficulty with planning and acquiring food; he solved it by ordering in too often, while I went the equally unhealthy road of eating far too little.
In retrospect, it was not only my ADHD that was causing the chaos in my life over the past two years. My version of ADHD has performance-related anxiety along with it, and when my ADHD caused me to perform poorly in school, my anxiety would act up, which would make it even harder for me to focus, which would make the anxiety worse, and eventually I’d lose the ability to do anything but curl up on the couch, not drink the cup of tea next to me, and stare at the internet. Since this was keeping me from pursuing the science career I’d dreamed about since I was 10, I developed depressive symptoms. I didn’t notice until later, but I stopped enjoying things. I’d been an amateur jazz musician in college, and I didn’t listen to music much. I didn’t read books for pleasure. I didn’t feel like dancing, or making new friends, or really much of anything.
Having my official diagnosis helped a lot. The staff at CAPS made it very clear that I wasn’t lazy, I was having legitimate problems, and that they would be there to help me succeed with my ADHD however I wanted. I’ve enjoyed being part of the ADHD group at CAPS, where we talk about our experiences, think about new strategies, and work on improving our focus and relationship to the world using mindfulness meditation. Many of the other members have similar stories; we’re all very smart people doing very difficult things, and we all suddenly couldn’t cope. The support group got me started on a lot of strategies that help me greatly. My two favorites are using timers to break extended tasks into short bites, and “thinking like a waiter”.
By using timers, I can get a rational understanding of how long tasks actually take, which keeps me from falling into the pattern of thinking that I can never finish them. For example, a full kitchen of dirty dishes takes about fifteen minutes to clean. Once I was able to conceptualize that, the cleanliness of my kitchen became far less stressful. “Thinking like a waiter” is the concept of doing small things as you see them, and not giving yourself time to put them on a growing mental task list. E-mail correspondence doesn’t get forgotten, coffee cups don’t get left in my office to mold, and great ideas don’t get lost because I forgot to write them down. Strategies don’t solve everything for me, but they help a lot.
As of this writing, I’ve started the second week of my medication trial. The psychiatrist at CAPS and I decided on starting with Concerta, an extended-release form of Ritalin, and so far, it’s been working extremely well. The first improvement I noticed was that I could filter out background noise. I was able to notice that the HVAC in my office was on, but it wasn’t a distraction, and it didn’t keep me from focusing. The pervasive brain fog that had plagued me for months lifted almost immediately. I could focus on things when I wanted or needed to, and I could just as easily stop focusing on them. Fortunately, I appear to tolerate them extremely well; the only side effects I’ve had were an odd twitch in my right eye the first day and a sharp loss of appetite. I lost five pounds that I wasn’t actually interested in losing in the first four days on the medication. The other grad student who helped me with this article is on Adderall tablets. He’s seen a lot of the same positives as I have, but a few different side effects. At times, he’s felt his heart racing for no reason, and he’s had problems with a dry throat.
Although both of us have experienced a great improvement during treatment, we both have some nervousness related to talking about our ADHD to specific people. The other graduate student is anxious about telling his advisor, since he feels like he’s on thin ice with him already. His greatest fear is that if he tells his advisor, he’ll respond that if he’s having so many problems with ADHD, he should leave with his master’s and try working a normal job instead of continuing in academia. I leave his identity unmentioned for this reason, but thank him for volunteering his experience. I’m worried about telling my mom that I’ve started taking medication. When I was telling her about my experience with counseling and my diagnosis, she was vehemently against the idea of me going on medication, even though I hadn’t mentioned the possibility of talking to a psychiatrist. I hope that if she finds this post, any uncomfortable conversations that follow will at least be based in a knowledge of how severe my symptoms have been, and not an assumption that I’m using the ADHD as an excuse to be lazy.
Now, I’m starting to enjoy things again, listening to more music, learning about new ideas, and socializing with new friends. I’m really looking forward to getting back to fully enjoying my ADHD. At its best, the ADHD brain has some powerful gifts. I’ve missed being able to appreciate the fact that my brain doesn’t have a box to think outside of, and the powerful, chaotic creativity that drives my work. I know that I’ll never be truly detail-oriented, but at the same time, I won’t trip over details when trying to understand the full scope of a problem. I can keep multiple tasks running in my mind, but I can also access hyperfocus, a unique, strange, and intense state of absolute interest and focus. All of the treatment, both pharmaceutical and psychological, won’t make me stop having ADHD, but it will make my ADHD an asset rather than a profound disability.
Do you see aspects of your experience in mine? If you’re distressed by your brain, there are free resources on campus. CAPS, in the Michigan Union, does ADHD screenings and counseling. The evaluation takes two to three sessions. The drop-in ADHD group on Monday at noon has been an extremely valuable resource for me. There are staff psychiatrists at CAPS, and there’s a waiting period of a month after diagnosis for medication evaluation. An ADHD diagnosis can also entitle you to formal accommodations through Services for Students with Disabilities. If you have trouble completing exams in the time allotted due to distractions or mental blanks, more exam time or a quiet room for exams is a typical accommodation. I meet with an academic coach there, and she has been extremely helpful in helping me recognize where my ADHD was causing me difficulties in time management.
ADHD is a real disorder that can cause significant amounts of distress and impairment in everyday life. It is not an excuse for laziness; it’s a difference in the brain. Adult ADHD is often not obvious because the public concept of the disorder is that ADHD is for small, hyper children, not intelligent adult graduate students who suddenly can’t cope with their workload. Furthermore, ADHD isn’t a state of being “abnormal.” I vastly prefer to say that I’m not neurotypical. Being typical is fine for some things, but when you’re working on difficult creative problems, having typical thought processes can be a detriment. The way my brain works might not be common, average, or pedestrian, but when it works with me instead of against me, it’s a powerful advantage.