The real deal with ADHD and women (as told by a psychologist with ADHD)

“You’d forget your head if it wasn’t tacked on.” When I was a child, my grandma said this often, but her admonishment neither left me feeling insecure nor helped resolve the forgetfulness. Her words went in one ear and out the other, like most things I heard.

When I was five, my mom brought me to a stoic, no-nonsense pediatrician. She had noticed that my pants were often damp with urine while I continued to play, seemingly unaware. Dr. Bioctin asked me, “Do you FEEL when you have to potty?”

“Yup,” I answered, truthfully.

“Well, then why don’t you go to the bathroom?” He asked.

“I dunno.” I looked at the floor, quietly, too young and too lacking in self awareness to answer him. I couldn’t then explain that I was far-too fixated on my sand creations or my world of make-believe to allow new information (that I had to pee) into my awareness. My brain too-easily dismissed information that came its way, including the sensation of needing to go to the bathroom, when it was engrossed in something interesting.

When I was in second grade, the teacher had concerns about my penmanship and carelessness. How could someone smart enough to learn her multiplication tables be too dumb to notice that she had skipped an entire row of problems on her test? Or how could someone who could do three-step mental math equations continually interchange how to write “2’s” and “5’s”?

I was a girl. It was the 80’s. Since I was quiet and filled my boredom with devouring worksheets and doodling, instead of poking the kid next to me, I skated-on through the years under everyone’s radar. By third grade, the teachers knew enough to throw more worksheets at me and let me sit in a corner with another kid and write creative stories when I was bored. This was progressive for the time.

In fourth grade, I got in a fist fight with a boy, and the recess teacher let me off the hook without question and assigned detention to the boy who liked to kick chair legs with his boredom. I was, after-all, a smart and quiet girl. I’d imagine teachers often looked the other way and lovingly patted me on the head when I forgot homework, turned in crumpled and half-done papers, and left out entire sections of essays. “Oh, silly Angelica,” they probably smiled.

At home, my mom cried. Literally. “I have to tell you to clean your room EVERY SATURDAY! And you never do it! It’s as if you don’t care! I do everything around here, and I give you one simple job!”

It wasn’t that the room-cleaning was particularly overwhelming or confusing. Although there was some of that. Bluntly, making my bed and hanging up clothes was simply not something that EVER occured to me.  My mind was instead pondering how lungs breathe and whether magic was real. And if I was going though the list of steps-to-clean-a-room that my mom wrote for me, I’d sooner create a castle of lint than engage in the monotonous and predictable act of putting shirts on  hangers. My mind wandered in its natural state unless there was something super engaging to harness it. And folding underwear didn’t fit the bill. All the yelling and guilting in the world couldn’t change my brain’s inclinations.

ADHD- Inattentive Type

Inattentive ADHD is a sly devil. It looks innocuous and is hard to diagnose since it doesn’t have the hyperactivity and disruptive behaviors that characterize the other type of the disorder, ADHD impulsive/hyperactive type.

The two types of ADHD look so different that the makers of the DSM V even debated whether or not to make ADHD inattentive type a completely separate diagnosis from the ADHD we most aften think-of, ADHD impulsive/hyperactive type. But they ultimately decided that both types were in fact versions of the same disorder. I believe it, as I often joke that half the females in my family have inattentive type ADHD and half the males have the other type, so there’s no way they’re not the same, largely genetic, disorder.

People with inattentive type ADHD have the following characteristics (from healthline.com):

-missing details and becoming distracted easily
-trouble focusing on the task at hand
-becoming bored quickly
-difficulty learning or organizing new information
-trouble completing homework or losing items needed to stay on task
-becoming confused easily or daydreaming frequently
-seeming not to listen when spoken to directly
-difficulty following instructions
-processing information more slowly and with more mistakes than peers

Those with ADHD are often labeled “careless,” “spacey,” “dreamer,” “forgetful,” and/or lazy. Sometimes, when their actions end up inconveniencing others (tardiness, not being automatically helpful, forgetting occasions, etc.), they are also labeled as “selfish.” However, they may have a great deal of care and concern for other people despite that certain important details are lost on them.

“Why would you DO that?” My best friend’s mom gasped, “The coffee table is ruined! You didn’t use a coaster, and now look at the ring your glass left! You just don’t care about other people or their things! When will you stop being so selfish?!”

When I was older, I got a car. I cared about my own conveniences and abilities to drive that car, but did that stop me from locking my keys in the car twice a month and completely ruining the battery by leaving the dome light on? No, because “caring” or “not being selfish” has nothing to do with it.

About a month after I got my license, I began using a keychain the size of a small dog so I would stop losing the keys in my room. Or were they in my bag? Or left on the counter of the store I was just in?

An epiphany: Not everyone is like this?

“You always land on your feet,” my mom observed one day. “But I have no idea how, because you never have a plan. Last minute this, forgetting that, not even noticing details….” She was referring to the fact thay I had applied (this was at a time when parents didn’t do their kid’s college applications for them) and had been accepted into my first-pick college. Never mind the fact thay I had accidentally applied to the WRONG school when it came to my second choice (wait- there is a difference between the University of Michigan and Michigan State? Details.). And never mind that I completely forgot about my scheduled date to take the ACT, and had to pay $70 to reschedule it. I would have forgotten about the new date too, but I had plastered a sign on my TV reminding me about it every day until the test date (That was also at a time when kids’ mistakes in high school were not rescued or managed by parents. I called to reschedule, paid for the re-take, and was responsible for getting my own butt there. No one was going to remind me… The lack of parental rescuing is something that I still attribute to much of my ability to function to this day.)

In grad school, one of my supervisors noted that I probably shouldn’t use report templates if I don’t proof-read them afterward to make sure I changed all the important facts.  Proof-reading afterwards! What a novel idea for a 23 year old with 18 years of education under her belt!

That same supervisor had me do a section of a cognitive functioning test (the Woodcock Johnson) in front of several other students. He was simply demonstrating how to administer the test, not trying to embarrass me. However. The test he chose was a verbal memory task that did NOT include instructions ahead-of-time that the goal was to memorize the words. Passive-memorization? Ummmm…. no. My brain does not engage new info (it was already engaged in performance anxiety and managing my impression in front of peers) unless I INTENTIONALLY tell it to do so. I think I got 3 out of 12 correct.

My roommate chose me to be her guinea pig for learning how to administer another IQ test, the WISC. After four painful hours of squeazing my brain like a sponge, my scores revealed the profile expected for someone with ADHD: “Processing speed” (doing things quickly without making mistakes) was 2-3 standard deviations below everything else, and “working memory” (remembering stuff while introducing new stuff into my brain) was second worst. As with many (but not all) ADHD people, my verbal and performance skills were off the charts, there to compensate for deficits and effectively offer the illusion that nothing was wrong. (Same for my ACT and GRE scores. These overall scores were high, so no one gave any thought to the fact that I had run out of attentional resources and BOMBED the last subtests. I mention this in case anyone has a kid who may fit this pattern of testing, and therefore fly under the radar.)

And somewhere around my third year of grad school, a lightbulb went off, finally, that some people don’t have to cue themselves to “turn their brains on” or “shift your focus to this,” or “now try to remember that.” I had gone my whole life having to actively and intentionally engage my frontal cortex, and here it dawned on me that not everyone had to do that. Other people are automatically cued- to notice where they are putting their keys or the fact that they should turn the oven off or put important papers in a certain spot. AUTOMATICALLY!?  How had I been compensating for this deficit, and how could I continue to do-so?

The overwhelm, inadequacy, and despair 

The same year my husband and I moved from the Midwest to the East Coast, we had our second son (our first wasn’t even two yet.) and I began a new part-time job.

Up until this point, my little tips and tricks and mental games and cognitive abilities had allowed me to keep all the balls in the air. Now all my internal resources were tapped. My little “to do lists” and “charming apologies” were CRUSHED under the weight of all the unmanageable (to me) tasks in my life. And it didn’t help that my husband’s new job left him off my radar for 60 hours a week.

The list of things for a parent and main household-runner to remember is seemingly endless. ADHD or not.

Another parent may have thought ahead: “On monday,  I’ll do babysitter phone interviews and three loads of laundry, on Tuesday I’ll schedule my kids’ newborn and two year check ups together since I don’t work, on Wednesday I work late so we will order pizza and order the birthday party gift on Amazon, on Thursday I have to grocery shop and get the kids new shoes at the store next to the grocery store, and on Friday I need to call Aetna when I get of work at 1.” But I, lacking automatic  planning and organization skills, did not handle my list of tasks so well. Suddenly pummeled by the realization of all the things on my life list simultaneously, I would panic.

And I’d MAJORLY work myself up if I THEN remembered ONE more thing during this already-stressed state. Often times my husband would get an earful of overwhelm and inadequacy disguised as anger. “You never HELP ME!” I’d shout even as he was up to his elbows in dishes. And God help him of he were to reason, “All you have to do is order the birthday present on Amazon! What’s the big deal?”

To my husband, this stuff seamed legitimately reasonable to handle. To me, and especially when the kids got older and then homework and extracurriculars were added to the list, it was not at all easy. It was impossible to grasp and organize, let alone execute without getting sucked into something more neurologically gratifying (Facebook articles? READ: an accessible phone is the devil for someone with ADHD.).

And there were growing pains involved in the realization that “life” was SO much harder and than I had imagined it to be, and in the figuring out how to manage it all. One time, at my wits end about the homework and packing lunches and permission slips and volunteering and show and tell and gym shoe day and ice cream money and blablabla that hung vaguely in the back of my mind, I started suddenly tearing up when talking to my son’s kindergarten teacher. She hugged me and told me, “It’s okay. Lots of parents forget their kid’s book order due dates.” She patted my back, and I narrowly avoided a socially-awkward sob-session.

Sometimes people with this type of ADHD  have such a sense of overwhelm, inadequacy, and boredom, that their inner world mimics the feelings of hopelessness, worthlessness and emptiness of depression. I am lucky enough to have never struggled with guilt or worthlessness. Sure, I have a strong sense of accountability to change behaviors to the best of my ability when they inconvenience others, but I have truly escaped the hopelessness and self loathing common to so many with ADHD.

I have often wondered why this is the case, and I think some of it is brain chemistry and some of it is the feedback I have gotten in my little bubble of childhood and life. My parents and peers and teachers were, sometimes astonishingly, not often annoyed or condemning of my shortcomings, but rather matter-of-factly expectant that I would bail myself out if need-be. Other than the room-cleaning tears, I don’t remember ever getting the message that I was less-than, even when I would have to pay a locksmith for the second time that month or I’d forget to turn in my homework and have to take partial credit. This attitude of “acceptance despite accountability” made me feel like I never had to make excuses, bolstered my comfort level with being authentic/humble, and thus fueled more positive relationship feedback. I suppose my “bubble,” probably because of their own ADHD, valued “kindness” and “integrity,” more-so than consciensciousness. And even now, my husband betrayed not an ounce of judgement both times I lost my ID in an airport, but rather waited patiently while I called a million different counters to get it back.  This is all worth mentioning as the number one concern for people with ADHD is their risk for accompanying depression, and a family’s ability to balance accountability with acceptance is critical for staving this off.

Learning to cope as an adult:

20160204_180502

The essential toolkit for an ADHD mom: Scratch paper for making lists, masking tape, and her family’s willingness to let her tape everything she knows she will lose/forget to the fridge.

I do think I’m, for now, in that sweet spot of being able to manage things (until the demands get harder once again when the kids are teenagers).  I have accomplished this only because I intentionally incorporate strategies (sometimes time with my kids is so lacking in stimulation that I want to crawl out of my skin. So I have to practice intentional mindfulness, or put on an audio book in the backgound, or reward myself for ten minutes of reading minecraft books with a cupcake.), lists, forced habits and forced PRACTICE into my life.

The third time  I left the oven on in our new house, I immediately engaged in some brain training.

“What are you doing? You’ve been walking around the kitchen with earbuds in for the entire time the boys and I have been watching Aladdin,” My husband asked.

I removed an earbud. “I’m giving myself discrete trials to pair the behavior of walking away from the oven with the behavior of touching the knob, even when I’m thinking about something else. Duh.”

I think my husband turned on his heels and went back to the living room. But what the heck was I really doing? Basically, I was listening to a book since the most common mental state I am in is deep concentration/absorption, and in this mental state is when I inadvertently place my keys in a strange spot, forget my computer at work, and yes, forget to turn the oven off. By repeatedly pairing touching the oven knob with leaving the oven  (an act that would cue me to either keep it on or turn it off), I would rarely leave an oven again without attending to the knob. If I was being really ridiculous, I could have offered myself an M&M each time I did so.

I did these repeated pairings with the keys too (Come in the door; put keys in corner of counter, over and over, even when distracted by something else in my ear.), but I did it when my husband wasn’t home.

Planning ahead, remembering, and not being overwhelmed by the endless stream of to-do tasks is a little trickier. In grad school, I had forced a habit of writing down each and every thing I had to do that day (from writing half a report to going to the gym to buying toilet paper) each morning. But in real-adult-parent life where I’d rather gouge out my eyeballs than wake up earlier, I write things down before bed.

The problem is, the stuff of real adult parent life is infinitely harder to manage than grad school. In school, you get a syllabus. You know exactly when your exams are and when papers are due and there are few changes and surprises to upset the apple cart of intentional planning. In adulthood, suddenly a kid gets a fever and you need to reorganize the whole day.  Or you see a book-order in a back-pack and it sidetracks you for 30 minutes, so suddely you don’t have time to go get milk before Martial Arts. And if organizing is not automatic and simply applied whenever necessary (but instead is a forced habit that you do before bed), some apples roll off the cart.

In addition to planning and organizing, I also needed help focusing on what I needed to focus on (instead of letting my mind wander to something more gratifying or engaging). When going down to the basement to switch a load of laundry leads to being enticed by the need to magic-erase all the smudges on the staircase, the to-do list never gets smaller.

Nowadays, knowing that the kitchen-to-laundry route in my house and the office-to-mailbox route at work are both minefields of distractions, I know to literally chant my agenda as I go along. “Get stapler, then go back. Get stapler, then go back. Get stapler, then go back.” When you pin down your distraction traps and get used to doing those silly chants, you’d be surprised how much gets done!

A most-important lesson:

In terms of “adulting” with ADHD here is the most important thing I have learned that a textbook never told me:

Nothing will become automatic (packing lunches, remembering to wipe the counter, planning your day, not getting distracted by the phone when you are supposed to be doing something else, attending to an only-mildly-stimulating conversation, noticing details, etc.) by simply telling yourself to do it or being yelled-at/nagged by another person.

New habits take legitimate practice and repetition. And those with ADHD typically need to be cued to practice (whether that cue is a strategically-placed post-it note, an alarm, or a verbal reminder).

For seven months in 2013, I put an abstract picture of a zipper on the wall behind my office desk. It was art to everyone else, but to me, it was a reminder to zip my lips and enclose myself in the conversation. Like the act of mindfulness, if I noticed my mind wander, I would INTENTIONALLY  “zip” back to the present. I rarely interrupt any-more, and bonus- I am infinitely more present and engrossed in what my client is saying, simply from cued practice. Someone the other day gave me an amazing compliment- She said I was so good at remembering details of what she said- names of her friends, time lines of events, etc. I know the reason I remember each and every client’s stories is because I intentionally practiced being fully present to the extent that my brain is in “flow” when I am at work. I have trained my brain to capitalize on my tendency to hyperfocus when someone is talking while stifling my urge to hyperfocus on something I want to add to the conversation.

In grad school, I had to pair my favorite existing morning habit (eating oatmeal) with making a to-do list. Eating the oatmeal was rewarding and something I did anyway, so I piggybacked on that habit and soon grew to associate making my daily list with eating oatmeal. If I sat down to eat witbout making my list, it felt weird. Only by repetition did it become habit.

And, since it means so GD much to my husband, I now make looking at the calendar and wiping down the counter a habit which is associated with my morning Coke Zero.

There is so, so much more I could say on this subject, but I think 2000 words is enough for now.  I hope that this sheds some clarity on inattentive type ADHD, especially in females, and makes those that manage it feel not so alone.

From the therapist that was actually a little nervous to write this and also feels that it is worth mentioning that medication is extremely helpful as well…And one more thing, I plan to write much more on ADHD and relationships someday because personal and professional experience.

For more on kids, couples, and psychology, find OTYC on Facebook.

 

 

 

 

 

 

 

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3 thoughts on “The real deal with ADHD and women (as told by a psychologist with ADHD)

  1. Love this! I think even those of us without ADHD can all to some extent appreciate what you go through on a day to day basis, especially as the responsibilities pile up and life gets more hectic. Besides, it’s hard to find a cute planner that won’t get destroyed in a purse….or forgotten to be used… Thanks for giving me some insight into the brain of my ADHD boyfriend. I’ve always joked he could lose his keys in an empty shoe box. You’ve given me lots to think about. Keep on keeping it real!

  2. Thank you for this. I always coped with my inatentive ADHD well academically & flew under the radar, but coping as an adult, and especially as a mother, has been infinitely harder. Watching my inatentive hyperactive ADHD 8 year old daughter struggle has been worse, and my own struggles & coping mechanisms only seem to make things worse. I have every intention of starting something like your zipper idea for focusing on my children & trying to infuse some calm into the chaos. If I knew you, I think I’d hug you. Thank you so much.

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