me and ADHD

Hey! It hasn't been a whole year since I last wrote! Whaddaya know!

So, since it is a fairly small circle of people who still check my blog for updates, I'm going to assume most of you who are reading know that I now have not just one, but two sons who have been diagnosed with ADHD. The thing about this situation which has me thinking and perhaps even obsessing, lately, is that if two siblings have ADHD, it is likely (maybe 60% or more likely; the sources I found didn't all agree on an exact number) that at least one of their parents has it. When we first had Ethan evaluated, and they asked who else in the family had it, we were just like...??? [insert blank expressions here] We tried thinking through all of our close relatives and what we knew of them, and we couldn't think of anyone who had experienced similar problems as Ethan in school. Yet, it was likely one of Ethan's near relatives had ADHD if he had it.

Then, we had Samuel evaluated, and it hit home for us that ADHD does NOT always look the same from person to person.

Initially, I didn't think Samuel had ADHD because his behavior struggles at school did not look the same as Ethan's had. I had guessed Samuel would get a diagnosis of Oppositional Defiant Disorder (and thought to myself, "I wish there was a pill for that like there is for ADHD!").  However, Samuel's diagnosis came back as not just ODD, but also ADHD, and the psychologist said that if we tried treating the ADHD, maybe we would find the ODD easier to manage.  Low and behold, on a small dose of Ritalin, Samuel has gone from going to the principal's office nearly every day and receiving multiple suspensions, to functioning normally in his classroom most (I'd estimate at least 80%) of the time. Everyone, including the principal, the special ed department, his teacher, and us, has been amazed. Once we had read the psychologist's report and started to see the differences between Samuel on medicine and Samuel not on medicine, we could recognize the ADHD symptoms (many of which were, indeed, similar to Ethan's) that we hadn't been able to pinpoint before, in the midst of all the defiance.

Samuel's evaluation included recommendations of books to read as part of our "next steps to take." I'm pretty sure we received these same recommendations when Ethan was diagnosed a year and a half ago, but this time around, I actually picked up one of the books (if one can consider pushing the "send to Kindle" button "picking up"). As I read, I found myself thinking, "Maybe I have ADHD!", but not in a serious sort of way. I laughed with my mom and Heath about it, saying, "Does every parent who reads these books suddenly think they have ADHD, too?" I know there is a tendency to read about a disorder and to start identifying yourself with it as you study it.  I've heard that students studying psychology tend to do this. So, although I did read up a little more on the Internet about adult ADHD, I didn't take it too seriously. Heath and I did decide maybe I should mention it to my "meds lady" the next time I went in, though.

Speaking of my meds lady... I have talked a little bit on my blog about my treatment-resistant depression, and I have intended to talk about it even more, but you know... I seem to only blog once or twice a year so I don't manage to fit it in. Also, one of the things that happens with depression is lack of motivation, so that tends to get in the way. But suffice it to say, I have treatment-resistant depression (the name is pretty self-explanatory, but if you'd like more detail, see this blog entry), and this is where my meds lady (an ARNP with special training in prescribing psych meds, who works under the supervision of a psychiatrist) comes in.

So, the next time I went to my meds lady, we talked about how things weren't going so well anymore, how all my personal markers for whether or not my depression is being well-managed were slipping, if not completely obliterated. I also let her know about Samuel's diagnosis, which had occurred since I had last seen her. She suggested I try increasing one medicine, but if I didn't see a response, that I should call and let her know, and she would write me a prescription for methylphenidate to see if it helped. Yes, methylphenidate (generic Ritalin), the same medicine both my boys are taking for ADHD. It is sometimes used to augment depression meds, and since two of my boys are now taking it and responding well to it, she thought it might be worth trying for me. At this point, I did bring up the thoughts I had while reading the ADHD parenting book, and we discussed a little bit whether it was possible I had ADHD myself. I tended to think not, since I always got good grades and was rarely in trouble at school. Didn't people with ADHD struggle to get through school, if not behaviorally, then academically? However, I was willing to try the medicine if it might help stabilize my depressive symptoms.

After a couple of weeks, increasing the dose of a medicine I was already taking hadn't helped, so I called to get the script for methylphenidate. And it seemed to work.  Really well. I checked back in with meds lady two weeks later, and we decided that since it was helping, then great! We would continue with it. We discussed a little more what tendencies I have that could reflect ADHD, but there was no sense of urgency to decide whether or not I might actually have it. Ultimately, if the medicine makes me function better, I don't suppose we need to define why.

But in these last few weeks, as I've continued to take the medicine and notice an improvement, I've started to be bothered by the why of it. I've started to wonder, would this medicine simply make anyone perform better? Is it really okay for me to take this? Am I just cheating at life? Life is hard for everyone, right? What justifies me taking a medicine that focuses and energizes me so I function better, any more than anyone else who might desire the same effects?

I've started to read up a little more on adult ADHD and what it looks like. And it has been startling to discover that there is quite a lot of correlation between the struggles I've had in my life and ADHD symptoms. Of course, there really isn't such a thing as "adult" ADHD. If one has ADHD, one has it as a child as well as an adult. However, the difficulties experienced as a child with ADHD sometimes resolve so that the person's symptoms don't cause significant problems in their adult life; or conversely, someone can go through childhood and adolescence without experiencing much difficulty which would bring their ADHD symptoms to light, only to discover as an adult that ADHD symptoms they previously were able to manage or compensate for now seriously impair their life. It is also interesting to note that adult ADHD symptoms tend to reflect hyperactivity less often than childhood symptoms, and tend to reflect the inattentive and/or impulsive aspect instead. Also, females more often have "inattentive subtype" ADHD, which we used to know as ADD, or ADHD minus the hyperactivity. This subtype often goes unnoticed or undiagnosed since it doesn't force confrontations with others via hyperactivity.

The first thing I thought of when questioned about my own history and anything that might indicate ADHD was that I do have trouble keeping up with housework. I am certainly disorganized in that area. However, since I always managed to remain organized in my school work, I thought my lack of organization at home simply reflected that it wasn't a priority to me. But yet, it's really, really hard for me to keep my house clean. I honestly think this is an area where it is harder for me than most people. I have come up with strategies to make myself more effective at it -- morning and evening routines or setting a timer, a la Flylady, or offering myself rewards for completing blocks of time or tasks. But there are times that none of my strategies work, and I fall hopelessly behind. Some of this I have come to understand as a symptom of my struggle with depression or anxiety. There is a lethargy and paralysis that comes with depression. Even if I want really badly to get something done around the house, it's like there is a huge invisible hurdle in my way. It feels impossible. I can't make myself do it. And the more I don't do it, the more paralyzed I become, because now there is self-recrimination to deal with, too.

The question now, though, is this: Did I become depressed because I wasn't able to handle my responsibilities, or am I unable to handle my responsibilities because I am depressed? I always assumed it was the latter. But here's the interesting thing: when I take the ADHD meds, it doesn't hurt to clean. I can tell myself it needs to be done, and I may feel hesitation or dislike of doing it, but I can make myself do it. There isn't static in my head keeping me paralyzed.

And that's something else I didn't realize: I guess not everyone has static in their head. What? Really? Yes, really. You know how some things you never think to talk about or ask about because they are assumed? I assume red looks the same to you that it does to me. I assume hot feels the same to you that it does to me. I assume the background noise in your brain is the same as mine. You mean you don't have to sort through that and filter it all the time? WHAT??

Yeah, so there's that. I didn't know it was there until it wasn't. It's disconcerting, this new awareness.

Now that I look back on life and evaluate it through the lens of possible ADHD symptoms, I see that there are many things that might have come out as problems caused by struggles with attentiveness, but I managed to find ways to compensate. Typically people with ADHD struggle with keeping track of their finances. I do not allow us to ever be late on a bill or to overdraw our checking account, and I haven't for years, so I considered this to be a symptom I lacked. However, I used to have a huge problem with getting overdrafts on my checking account. No matter how much of a priority it was for me to not overdraft, I could not seem to keep my checkbook balanced. I would celebrate a month or 2 or 3 that would go by without an OD, keeping track on my calendar, but inevitably, I would get another eventually. But then I got phone access to my checking account so I could check the balance and which transactions had gone through daily, and eventually Internet access for those same things, and we signed up for overdraft protection with a credit card to back up our checking account. I set up automated emails to let me know of the balance every morning, and to email me if it dropped below a certain amount. Additionally, I still login almost every day either on my computer or phone. I also set up automated payments for all our bills and made an elaborate spreadsheet to keep track of when paychecks will be automatically deposited and when bills will come out, to ensure there is enough in the account. I check that spreadsheet against the checking account balance and transactions that have gone through several times a week, if not every day.

Systems and tools like these are conveniences for anyone who uses them. But in my case, I simply could not get by without them. If we were still in the stone age of balancing our checkbook solely in our registers all month in between statements, and keeping track of paper bills and envelopes and mailing in payments -- I would still be getting overdrafts and late payment fees frequently. And berating myself for it.

As for school work, I did do well with my grades and behavior in school. But I didn't necessarily pay good attention. I managed to get by with extreme procrastination and bad study habits because school was easy for me. Eventually, it caught up with me. I had some classes in college that were panic-inducing wake up calls. It was startling to not have things come easily. Still, I managed to get through most of my classes pretty easily and drop the ones I didn't, and somehow still emerge with a degree. But as I entered deeper into adulthood, got a full-time job, bought a house and car, and eventually had kids, it became a stark reality that life was not going to be easy anymore. I may have been pretty good at school, but it seemed like I sucked at being an adult.

So, now I am finding myself re-evaluating everything. Have some of these struggles been because my brain actually works differently than the vast majority of people, and it is truly more difficult for me to conform to the expectations of society because of it? I know there is something different with my brain chemisty than the average person, which my depression meds have helped to normalize. But is it just depression? Or was it ever really depression? Was it ADHD instead? Or a little of both? I still don't know what to think. I have a lot to think through. Some of the medicines that have been effective in treating my depressive symptoms work by increasing dopamine, much the same way that stimulants do to treat ADHD. So those medicines could have been helping with either situation.

And by the way, did you know people taking stimulants tend to not eat as much because they no longer crave the dopamine rush that they get from eating? Unmedicated people who have ADHD tend to be overweight, because they are low on dopamine and constantly craving the dopamine that eating will release. So, there's that.

I'll try to update later as I, hopefully, gain more clarity. But no guarantee, since I've already exceeded my once-a-year average blog rate. :-)