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We like irrational. We’re at home in uncertainty. We’re at ease where others are anxious. We’re relaxed not knowing where we are or what direction we’re headed in. A common lament we hear from parents of teens with ADHD makes the point: “What was he thinking? He must have lost his mind!”
This is why the word “deficit” in the name of our condition is such a misnomer. In fact, we do not suffer from a deficit of attention. Just the opposite. We’ve got an overabundance of attention, more attention than we can cope with; our constant challenge is to control it.
The second that we experience boredom—which you might think of as a lack of stimulation—we reflexively, instantaneously, automatically and without conscious thought seek stimulation. We don’t care what it is, we just have to address the mental emergency—the brain pain—that boredom sets off.
The child, say, has trouble getting dressed in the morning. You can ask your daughter to go upstairs and get dressed only to find her fifteen minutes later still in her nightclothes, lying on her bed engrossed in a conversation with her doll.
In our world, we recognize only two times: “now” and “not now.” We hear “We have to leave in a half hour” as “We don’t have to leave now.” “The paper is due in five days” becomes “It’s not due now,” and the five days might as well be five months.
Because they tend not to be hyperactive or disruptive, females of all ages remain the most undiagnosed group. You have to be a savvy parent, teacher, spouse, supervisor, or doctor to pick up inattentive, non-hyperactive ADHD in a girl or woman.
Trouble sharing and playing with others early on, but at the same time, a desire to make friends. As life progresses, social problems
In adulthood, this translates to seeming gruff, awkward, rude, self-centered, unfiltered, or aloof; but it is really just the undiagnosed and untreated ADHD that is causing the problems. This is why we call ADHD such a “good news” diagnosis: Once you know you have it, and you find the right help, life can only get better, often much better.
Transparency, to the point of being honest to a fault. The person who is incapable of “kissing up,” intolerant of hypocrisy, often tactless, politically incorrect, and heedless of repercussions and consequences…is often dealing with ADHD.
From drugs and alcohol, to gambling, shopping, spending, sex, food, exercise, and screens, we who have ADHD are five to ten times more likely than the person who does not have ADHD to develop a problem in this domain.
For whatever reason, people with ADHD often are lightning rods for whatever can go wrong: being the one kid caught with weed when twenty others had it; the adult or kid who gets scapegoated, blamed, and disciplined more than anyone else; the one who disrupts the family event, or business meeting, or class discussion without meaning to.
If one parent has ADHD, the risk is one in three that a given child will have ADHD. If both parents have ADHD, the risk is two in three for a given child. However, those are just averages.
In fact, the diagnostic criteria for ADHD found in DSM-5, the official diagnostic manual, have inadvertently created a lot of confusion. People often ask, “Do I have ADD or ADHD?” Technically, there is no longer any such thing as ADD. You can only have ADHD.
Hank is more exasperated than anyone, which only fuels his incessant self-recrimination. He’s tried antidepressants, which did nothing but reduce his libido, diminishing one of the few pleasures in his life. He’s tried psychotherapy, which ironically caused him guilt because he felt he was frustrating the psychologist and making the psychologist feel incompetent.
After millennia of moral (It’s all a matter of willpower; suck it up); religious (Give your suffering up to God or “Whate’er He gives, He gives the best”); or philosophical (Control what you can, accept what you can’t) explanations and remedies for mental anguish, we now live in an era when we can assess the actual substrate in which the action occurs, namely, your brain and its attendant nervous system.
But you can also get trapped in the TPN, doing a task from which you cannot disengage. This is the hyperfocused state that people with ADHD can fall into. Far from being helpful, it can keep you stuck in one task, unable to shut down the screen, turn off the TV, or move from one paragraph to the next. This is the often unrecognized downside of focus. Incidentally, the reason that
When you allow your mind to wander from a task, or when you finish the task, or if you pause too long in anger or dismay while doing the task, the TPN in your brain defaults to a different connectome. Not surprisingly—given that we default to this state—this other connectome is called the default mode network (DMN). The DMN allows for expansive, imaginative, and creative thinking.
people who have ADHD or VAST are also particularly prone to head toward gloom and doom in their minds because they have stored up in their memory banks a lifetime of moments of failure, disappointment, shame, frustration, defeat, and embarrassment.
problem when ADHD enters in is twofold. The first is what’s called the anticorrelation property of the two networks. Imagine a seesaw. In a neurotypical brain, when the TPN is turned on and you’re on task, the DMN is turned off. But in the ADHD brain, the fMRI shows that when the TPN is turned on, the DMN is turned on as well, trying to muscle its way in and pull you into its grasp, thereby distracting you. In ADHD, therefore, the DMN competes with the TPN, which in most people it does not do.
Another extremely common problem when caught in the DMN is what we call “pirouette syndrome,” a circling back to make sure you’ve done something you’ve already done. Some people pirouette to be sure they’ve locked the front door, or didn’t leave eggs boiling on the stove;
Me
Of course, catastrophic thinking is a form of rumination. Your boss throws off a comment that you perceive as a slight. The rear part of the DMN spins into overdrive, looking back at what she said, taking it apart, wondering what you did to deserve that. Was it really a pointed dig? Then you beat yourself up, thinking back, ruminating on what you might have said or done to provoke the comment. You take apart every imperfect thing you said or did at work, reliving the embarrassment. There’s more than enough angst to go around.
All the time
The point is: Focus on anything external to yourself. Activating the TPN will shut down the DMN. It’s difficult to do because the DMN is seductive
Once you learn to ride a bike, you can stay off bikes for decades only to get on again and ride off with hardly a quiver. Hence the expression “It’s like riding a bike” to describe a skill you need to learn only once to have learned for life.
Based on Schmahmann’s research, and based on the findings from other MRI studies that show that the central strip down the midline of the cerebellum—called the vermis—is ever so slightly smaller in people who have ADHD than in people who do not,
We who have ADHD or VAST characteristics tend to fall in love in a hurry—with a person, with a subject, with a project, with a deal, with a plan. Sparks fly, and before you know it, we’ve forgotten how lost and forlorn we were because we’re immersed in whatever it was that caught our attention.
In 2018, a large study of studies, compiled by Dr. Samuele Cortese from the University of Southampton in the UK, looked at 133 randomized research papers on the effects of medication on ADHD. The results were conclusive that medication for ADHD is effective, not 100 percent of the time, of course (no medication works 100 percent of the time), but on average from 70 to 80 percent of the time.
Stimulants can be divided into two main categories: methylphenidate type, commonly packaged as Concerta, Ritalin, Focalin, Metadate, Quillivant, and OROS-MPH), and amphetamine type, which you might recognize as Adderall, Dexedrine, Evekeo, Vyvanse, and Mydayis.
There are non-pharmaceutical ways to increase dopamine—some healthy, like exercise and engaging your creativity and being connected to others or to a higher goal, and some counterproductive, like bingeing on carbs; using drugs like alcohol, cocaine, marijuana, and Xanax; or engaging in compulsive activities like gambling, shopping, sex, or workaholism.
When it comes to the two types of stimulants, the difference is this: methylphenidate type drugs (like Ritalin) raise dopamine levels a little higher than NEP. In the amphetamine type drugs (like Adderall), it’s the reverse. Amphetamine drugs have a greater effect on NEP than on dopamine, though also only by a small amount.
Originally released in 1966 as an antiviral agent, Amantadine is another stimulant-like medication worth mentioning. It was also originally used to help with Parkinson’s symptoms like tremors, stiffness, and attention difficulties. Amantadine has an effect on the dopamine system; it acts weakly like a dopamine surrogate.
rejection-sensitive dysphoria, or RSD. This is extreme emotional pain triggered by the perception, real or imagined, that a person has been rejected, ridiculed, or criticized by important people in their life. RSD may also be triggered by a sense of falling short, such as failing to meet their own high standards or the expectations of others. Rejection sensitivity is often a part of ADHD.
Often, a person with RSD and ADHD is hypervigilant, trying at all costs to diminish these feelings. This can lead to misreading the cues of others, or withdrawing from their lives to avoid the anticipated slights.
Our ADHD drugs used to work an average of four hours. Now long-acting versions can help patients remain relatively symptom-free for up to twelve hours.
ADHD drug, and the concerns are valid. In fact, ADHD drugs are listed among the top drugs abused by high school and college students. It’s important to note, though, that ADHD stimulant drugs are mainly used inappropriately by those not even diagnosed with ADHD. These “neurotypical” abusers use them to stay up to study, or mix them with other drugs of abuse, like alcohol and marijuana, to intensify the high, among other reasons only teenagers can come up with.
For far too long, it was considered okay to call those of us with ADHD imbeciles, morons, and idiots.
