Mark comes to therapy saying that he is depressed. He has been trying for the past several years to start a start-up business but is getting nowhere. Not because his idea isn’t solid, but because he fails to get the legwork done. He needs to send off a business plan to potential investors but hasn’t completed it because there’s always another new idea that pulls him away. He fervently pursues it for days or weeks until that gets pushed to the side by yet another one. He looks back on his life as series of unfinished projects, feels like a failure and is seriously worrying about money, only adding to his stress and depression.
Have you ever been diagnosed with depressed, I ask. No, he hasn’t. Maybe we need to take a look at that.
When I was in graduate school a 1000 years ago, there was no Attention Deficit / Hyperactivity Disorder (ADHD). There was something called Minimal Brain Damage that was found in kids who were hyperactive and couldn’t focus, and the belief was that they would outgrow the condition when they hit puberty. We now know that they don’t, and in fact it’s likely that they inherited the disorder through one of their parents who acted the same as child, was never diagnosed, and probably suffered with the same problems.
These days I see a lot of folks like Mark. Some have been recently diagnosed, and physicians refer them to help them learn how to work around their disability. Others were diagnosed long ago – in 3rd grade, in high school – but are still struggling to organize their lives. Others, like Mark, have never been, but show up because they feel depressed, and anxious, or because they having trouble on their job. They don’t make deadlines, are missing meetings, have piles of papers stacked along the walls of their offices.
Sometimes the ADHD comes quickly to the surface in couple therapy. Here I meet and hear tales from spouses frustrated over years of living with someone who forgets, who doesn’t follow through – the lights get turned off at the house because they forgot to pay the electric bill, they miss or show up late for the parent-teacher conference. The ADHDer is always apologizing and saying that they are doing their best (and they usually are) and will try and do better; the spouse rolls their eyes and says they’ve heard this countless times before.
While ADHD is only 5-6 % of the population, its effects can be potentially devastating if it goes unrecognized. Here are some of the common symptoms that show up in adults:
Depression and anxiety.
Depression and anxiety.These run hand-in-hand easily with ADHD. You’re depressed because you always down on yourself – you start a 1000 things and finish few of them; while your peers of equal or lesser intelligence march ahead with their lives, you seem to be treading water. You’re anxious because you always have 10 things on your plate, numerous deadlines that seem overwhelming. You’ve often painted yourself into a corner regarding money, relationships, things-to-do.
Procrastination. Yes, there are many causes of procrastination, but those with ADHD have made procrastination into a lifestyle. They put things off till the last minute, partially because they have forgotten about them until someone lays down the law or the lights get turned off, but mostly because they’ve learned that the last-minute pressure helps them focus rather than getting scattered as they normally do. They actually are at these times able to get things done, albeit with much angst on their part and trepidation from those watching on the sidelines.
Risk-taking. If you’re driving a 100 miles an hour down a dirt road, you stay pretty focused on what you’re doing. Throw in the impulsivity that goes along with ADHD and the idea of driving to Florida with your frat brother even though exams start next week sounds like a pretty good idea. Driving a 100 miles an hour to get there seems even better.
Relationship problems. So the lights do get turned off or you forget to come to the teacher conference, or even to pick your kid up after school. Your partner feels like you are unreliable, don’t give a damn, can’t ever be trusted, and that she is always having to follow up behind or do it all herself. She, in her mind, can never afford to go off duty and comfortably hand things off to you. A lot of the time she feels like she is living with an irresponsible teenager.
Do the easy, put off the hard. The taxes need to get done, but instead you spend the afternoon weeding the garden. Why? Because its easier, requires less concentration. This is where Mark gets stuck – following the new idea but putting off the harder and more boring business plan. The hard stuff stacks up until…
All or nothing thinking, trouble with setting priorites. All or nothing thinking is "I have a great idea for the Great American Novel. Let me write it today!" (and not surprisingly you don't finish today and by the second day you've run out of steam) or "Gee I just spent 3 hours working in the garden, it's 3:00 already, the day is shot. I guess I'll have to work on my resume first thing tomorrow," rather than working for an hour before starting dinner. Tomorrow the same thing happens again, the resume gets put off and put off.
Trouble setting priorities means that its hard to determine whether the resume or garden is more important because it feels like there is always a hundred things that should be done. Again the default often becomes doing the easier or the less boring, more exciting.
Get lost on the computer. Computer games are the ideal environment for those with ADHD because it provides that lethal combination of enough stimulation to keep you engaged, clear rules and structure, and immediate feedback about how your doing. But the online world as a whole is a strong temptation. When you get bored, the bane of ADHD, there’s an endless supply of new stimulation to surf through. And if you have to work on a computer, as most of us do, its all to easy to drift off into Salon.com, YouTube videos, or tracking down the ideal pet med and have trouble pulling out. Computer life can become addictive – another thing your partner will probably complain about.
Stacks o’ stuff. Piles of papers all over the place. Bills are buried somewhere in there.
Self medication through drugs. If you’ve gotten to adulthood with undiagnosed ADHD you probably discovered somewhere along the line that certain drugs seem to slow you down and make it easier to focus – alcohol, pot, and the best of all, cocaine. These may work, sort of, but the danger is always there of them taking over, impairing other parts of your life, increasing the depression and anxiety.
Knowing what may be wrong doesn’t give you an excuse for what you do and don’t do, but an explanation to help connect the dots in the new way. Looking through the ADHD lens, you have a better explanation for why things have gone so wrong, why you struggle with things that others don’t. But the next step is to do something about it.
If you have any of these symptoms, go get checked out. There is no one test for ADD; it’s more a process of looking at behaviors and ruling out everything else it could be. Some docs are reluctant to just put you on ADD meds and see if they work. They will probably ask you to get tested by a psychologist / specialist first to rule out other possible causes.
Medication absolutely helps. As a colleague of mine who has ADHD and specializes in diagnosis of it says, not taking ADHD is like not wearing glasses if you have poor eyesight. What I hear folks like Mark say is that with medication they can suddenly not only concentrate better, but can actually see the logical steps to what they need to do next, eliminating much of the scattered mind, inability to set priorities that they live in most of the time. Like lots of other psychotropic drugs you may have to tweek dosages or try different meds to find what works best.
But medication is only part. The other is building healthier routines – learning to tackle the hard stuff first thing, taking a timed break to help you get recentered, coming back, patting yourself on the back, using the easy, fun stuff as a reward. There plenty of websites, even on this one, on organizational skills, as well as books. Take your meds and then not only get the book but finish reading it. Ditto with websites -- check out info online, but don’t get lost doing just that and little else. The goal is behavioral change starting now, not next year.
Finally, it also helps to have a sideline coach – someone to help remind you of deadlines, paying bills, picking up the kids, help set priorities. This can get tricky – there’s a fine line between coaching and being a scolding, nagging parent. The key is for the ADHD person to say how the other can help, rather than the other doing so out of their own frustration. You want an equal and helpful partner, not a better parent of a better teenager.
Again the key is action. Push against your ADHD and don't procratinate. Don’t continue to let your life go by unfinished.