I was diagnosed with ADHD in Oct 2021. It took nearly 2 years of waiting to get the diagnosis. It explains a lot about things in my past, which I may or may not divulge at another time.
For the uninitiated, here’s a brief summary of how it breaks down for behaviour.
It manifests in a spectrum of behaviours, broadly grouped into 2 categories:
- The AD part – Attention Deficit: Inattentiveness, loss of concentration, difficulties starting/remaining on task/completing tasks, forgetfulness (usually affects short term memory), and time-blindness (not noticing the time/misjudging the time, so you end up late or missing events is common).
- The H part – hyperactive: fidgeting/restlessness/always on the go, high speed thoughts, vast amounts of ideas (whether good or not) at high speed. This also includes impulsiveness (acting without care of consequences), interruption (frequently not waiting your turn or talking over others in eagerness to say what’s on their mind).
The above symptoms are not an exhaustive list.
Some people have the AD part, some the H part, and some (most commonly), both (“Combined Type“). I have Combined Type ADHD.
There’s a lot more to it, of course, the medical basis underlying what’s happening, and the “what’s going on in our heads” (thoughts and emotions), and the massive overload of emotional states that come with it.
Emotions
Emotional states include frustration, being overwhelmed, guilt, shame, worthlessness, elation, hyper-focus, complete apathy, avoidance, rage and everything in between.
Isn’t this just everyone?
While all people get this, it’s fleeting. In ADHD it’s all the time. (5% vs >80% experience this constantly or most of the time, according to Dr William Dodson MD).
For people with ADHD it never stops. Our bodies are constantly in fight or flight mode on a hormonal (i.e. biological chemical) level – all systems set to go (hyperactive) or run (inattentive because self-preservation is what the body wants, thinking is thrown out the window), often at the same time. It is very tiring, resulting in commonly being tired. Others are often “wired” (i.e. hyperactive) and don’t sleep/have less sleep because of this.
What’s going on with hormones?
In effect, consumption or ingestion of dopamine (for pleasure/satisfaction) and noradrenaline (AKA epinephrine) is not ingested in “normal” amounts or regularity in the brain. That’s what the meds help with – they regulate and assist with the transfer and dosage levels of these two hormones, at levels comparable to normal brain function.
Are meds the only solution?
No, but they are the most tried and tested effective way to help people with ADHD to cope. They help the brain regulate the normal ingestion of the hormones dopamine and noradrenaline. Since they are also open to abuse they are Schedule B drugs, regulated internationally and only prescribed (initially, at various trial incremental levels [called “titration”]) by trained psychiatrists.
There are three drug formulations available. I have tried all three at various dosages and none of them had any positive benefit or effect. 12% (according to Dr William Dodson MD) are drug treatment resistant. I am one of them. There are no other medical alternatives.
So what are non-medical alternatives?
You can’t replace the missing hormone levels issues without the meds but some behavioural coping strategies are available, typically taught and honed with the help of a specialist ADHD coach. You will not be able to overcome the medical issues, but you may be able to work out coping strategies that work to circumvent the symptoms (how ADHD affects your behaviour). This works best with medication + coaching together.
In the absence of medication the brain is still in fight/flight mode, making the coaching that much more difficult., but with time and skill, it all helps.
Will I ever be “normal”?
That’s an existential question. What is normal? But seriously, ADHD is both a blessing and a curse. You get the good stuff (when you find a skill or task that you enjoy, the dopamine flows like crazy and you’re “in the zone” and it’s amazing), but anything outside of that is terrifying, frustrating and overwhelming. Your behaviour is lizard-brain – fight or flight. Coping is difficult and many people are seen as erratic, unreliable and careless.
Apparently, this results in frequent school detention for disruptiveness, obstructiveness, missing school, all seen as having “bad behaviour”.
In adults, speeding tickets (because of impatience), addictions (drugs, alcohol, gambling etc. – because you are chasing the dopamine high that may never come), being obstructive/defiant and other antisocial behaviour as common. Job hopping/getting fired a lot, apparently are common. Prison is surprisingly common, and ADHD is routinely underdiagnosed.
These are sanctions because of the effects, without dealing with the cause of the issue. You’re not naughty or nasty – You have a genuine underlying medical condition and the world is overwhelming and yet responses are misunderstood and perceived as hostile and aggressive – which they are, but if you’re not asking what’s going on/not aware, you’re judging a medical response with a societal expectation that doesn’t know there is a medical cause.
And yes, ADHD is classed as a disability under the law (in the UK, anyway).
Joy and satisfaction: Dopamine
If you don’t ingest dopamine, joy is hard to experience. Imagine a joyless life. Hard, isn’t it? But that’s quite normal for me. Joy is rare, satisfaction at best. Mostly it’s “meh” and often apathy. If almost nothing gives you joy, living is quite a miserable experience.
On the other hand, when you find what makes the dopamine flow (and you have to really work hard to find out what triggers that for you), it’s amazing. You can go for hours on something, you are productive and probably won’t eat or get up for breaks. The time flies. It’s the best feeling in the world, but it’s so exceedingly rare (unless you are lucky enough to work often with the things that trigger that feeling).
Some people with ADHD love “boring” or repetitive tasks, which most people hate. I personally love a puzzle, or challenge. Many people hate these slow, laborious tasks. I can’t say why some slow boring tasks work for me and others don’t. I’ll take a stab at saying, “there is a foreseeable end in sight, you know what the outcome is.” Maybe the drip-drip-drip of getting 1 step closer to the goal in a puzzle or challenge works, maybe it doesn’t.
The drip-drip-drip of dopamine from social media “pings” works for many (which is why social media is a drug), and the “ping” and “like” alerts are built to feed on that, so you come back for more. It doesn’t work for me, and I don’t miss it when I parked my Facebook and stay off most social media. Mostly the pings are a distraction and an annoyance, meaning I can’t get anything done (it’s hard enough without distractions). Most of my notifications are turned off.
It’s arbitrary when the dopamine trigger works and when it doesn’t, but if you identify what works for the you, harness it, it’s a rocket engine waiting to go, but if you get it wrong, the rocket ship will blow up on the launch pad (frustration, overwhelm, distractions, leading to self-esteem issues and more).
And another thing!
This post previously ended long before now, but I keep editing it. Why? Because there’s always “and another thing” to add. You’ll hear this a lot from people with ADHD. We lose track of what we were saying, go off on a tangent (because the brain is over-firing at high speed), and sometimes we even come back to what we were saying, but mostly we forget. It’s kind of funny and kind of a embarrassing.
We over-explain or give much more detail than people wanted or expected, not always on the subject we were talking about, because we want all the details laid out, and don’t filter very well, or judge social situations (and the high rate of cross-over with ASD [autism] may be a factor. That’s the impulsiveness in action too.
Get to (or stick to) the point!
When you want just the top line details, you will probably not get that from someone with ADHD, so please be patient with us and work with us to get what you need, honing down little by little. What you want is in there, we just need a little help whittling it down.
Which is why this post is much longer than I hoped for, highly detailed but still, hopefully useful.
Mike Ruttenberg on testing, data and everything 