[Bibliophile]

The racing thoughts, inability to wait his turn in a conversation, talkative nature and the loudness could be signs of Combined type. The stereotypical inattentive type are daydreamers and aloof. My opinion would be to definitely try meds before anything else. Most teenagers and adults grow out of the obvious hyperactive symptoms, i.e. jumping out of one’s seat or constantly moving the body, by late teens or early adulthood so perhaps he was attributed with the wrong subtype?

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[Bibliophile]

As he is 14, I think he has the right to make the decision after being informed of the options. Behavioural modification/counseling may benefit him for task completion. But, medication may be the right route for him also. Try and see. If it helps, continue. If not, look for something else. So much of treatment is trial and error.

My own experience with stimulant withdrawal saw a drastic reduction in school performance for many years until I was able to develop coping strategies and even they are not foolproof. I stopped taking meds in Grade 7, having been diagnosed in Grade 4, and went from B+ to D student overnight. My decision to stop taking meds was to assert personal control over my situation and I am not comfortable taking medication. I made it through two university degrees with a LOT of difficulty and shifts in focus. I should note that I am a combined type and not inattentive type, which some view as completely different disorders from one another, e.g. Dr. Russell Barkley. The stimulants help with my need to move about and ability to continue with a task for a longer period of time, but that is it. They don’t help me start tasks or stay on topic/task.

I read somewhere that stimulant treatment of the ADHD-PI subtype has a lower likelihood of being beneficial than for the combined type with other treatment options seeing higher rates of improvement, but I can’t remember the source.

The good news is that the should be little to no impulsivity from the disorder, which can cause quite a bit of havoc for developing ad keeping social bonds, spending limits and other responsibilities, as this is not usually an associated impairment with that subtype.

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[Bibliophile]

@callmecrazy I disagree with you 100%. Marriage is not about thrill seeking but building a stable partnership. It might be advantageous for rearing kids, for stabilizing ones lifestyle, whatever. Las Vegas hookups aside, it is not about thrill seeking. What makes modern civilization work is that human beings do altruistic tasks for the greater good of the whole. This self sacrifice is counter intuitive to the urge to pursue fun. The problem that ADHD poses is that individuals who suffer this think primarily in the present or immediate future. This leads to actions that may have horrible repercussions for others down the road. Some might consider this pursuing fun, but other would label it as selfishness and not in the best interest of the whole.

While parenting is fun in the sense that it continually presents new stimuli, it requires the individual to do what is best for others, even when it is not fun. This might mean thinking down the road which ADHD sufferers have problems doing.

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[Bibliophile]

While it is true that many people with ADHD have problems with the law or develop habits, that is not a defining characteristic. The former would be due to the impaired executive functions leading to impulsive and sometimes inhibited behaviour, i.e. not thinking of the consequences of speeding, breaking and entering, stealing, getting into a fight, etc. The habits often develop as a means to self medicate with stimulants or because a need of more stimulation, be it gambling, sex, compulsive spending, etc.

I should note that I find that the inattentive subtype, often dubbed ADD, appears to be a completely different problem for the individual than what is experienced by the ADHD combined type based on the degree of impairment discussed on the Boards here. The inattentive subtype would most likely lack the impulsive urge that might put them in positions of committing crimes. ADHD combined subtype often lacks emotional regulation leading to opositional defiance or outbursts of anger that lead them into trouble.

You could very well be bipolar and not ADHD. What you have to ask yourself is what you wish to treat. If you are bipolar and wish to diminish the alternating states of hypomania/euphoria and depression, look for treatment for that. If you want your impulsivity and inattentiveness treated, go the ADHD route. It is very possible you have both disorders, but how you go about treating them is up to you.

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[Bibliophile]

Marriage and having children are two different issues. I have no issue with people with severe ADHD getting married as long as their spouse recognizes their nature going in of course. However, should an ADHD sufferer have children? I myself considered this. I think if the debilitating nature of the disorder is such that the ADHD person would be a poor parent or that the children would be raised in an unsafe environment, please DON’T have kids. While ADHD can be a very severe problem, it is not in the same league in terms of limited abilities as Down syndrome, autism, and many other disorders. So I think it is up to the discretion of the would-be parent to decide whether they wish to pass along the disorder to the next generation or not. They could certainly adopt if they choose.

I too think that there is so much disagreement on this board because of the vast variation in the severity of the executive function impairment.

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[Bibliophile]

Also, don’t compare yourself with other ADHD people. Remember that there is quite varying levels of impairment between different people diagnosed as ADHD. For example, I marvel at anyone who can learn a musical instrument as I cannot stick with something long enough to come close to mastering one (Malcolm Gladwell states in Outliers that you need 10,000 hours) or even getting good. Many of us also have comorbid conditions, which makes matters that much worse. I think that I have noticed a difference in abilities to achieve based on statements from the website of those that identify themselves as inattentive only and those that are combined type, with the latter seeming to be the underachievers as adults.

Figure out what you do well and enjoy and TRY to do that. There are loads of unpleasant tasks in my present job and I just have to try and slug through it.

I don’t have advice on the negative thoughts as this plagues me as well. I think that we have failed at so many different things that we wanted to achieve over the years that we develop a negative outlook on life or our abilities. We just have to keep trying. Tweak how you go at a task to see if the outcome will be positive this time.

Ask others what they think you are good at if you can’t think of any yourself. You would be surprised what people say, especially in a workplace.

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[Bibliophile]

I think he is looking for you to assess what specific outcome you want the medicine to help you with. It won’t help you start or finish anything on its own. You have to ask yourself, “how will this drug help me achieve my goals?” It might allow you to sit there longer and work on something, thus, completing a task. Dr. J probably just wants you to think strategically and map out what your desired outcomes are and what the best ways of getting there might be.

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[Bibliophile]

My issue is not whether ADHD exists or with the varying degrees of impairment, but with the inability to point at a root cause. I certainly agree that it involves an impairment of executive functions, but what causes that impairment? Why is ADHD used to identify people with different executive function impairments or only partial executive function impairment? How come some sufferers have comorbid conditions (ones that are not associated with emotional state, e.g. cognitive impairment) while others are just distractable?

My problem in a nutshell is that we are labeling the disorder based on the symptoms alone and not the cause of the disorder itself. And possibly there are multiple causes of these similar symptoms that have to be determined so that disorders can be placed into a taxonomy.

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[Bibliophile]

Using doodles as wrapping paper sounds pretty neat.

But you are implying we can control our hyperfocus, which is not usually the case. For example, when I get stuck analyzing something, it is most often done at an inappropriate time or all the time and on something that may not be that relevant to what I am supposed to be doing. It is not that I want to hyperfocus on that, but that is what my brain has decided to do. You say to yourself, I should really move on to something else, there are other things to get done, but you can’t shift your brain to do it. Worse is when you don’t even realize that you are hyperfocusing and the time slips by and you don’t hear those around you.

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[Bibliophile]

I find that as a Parent with ADHD of two boys, one definitely with ADHD and learning disabilities, it is more important to have a set routine for me to cope let alone the children. The moment that there is any deviation in my routine, the ADHD symptoms take over and everything goes to pot, e.g. bedtimes end up being way later than they should, cleaning tasks don’t get done, homework gets forgotten, etc. My kids also respond positively to routines too though. They like to know where they will be when as well so it is a win-win situation when it works.

Timeouts very rarely accomplish anything in our house. They lead to screaming, panicking, and escalate matters in a lot of cases. Often they will refuse or be unable to sit for any length of time and their emotional state goes completely out of whack. The exception to the case is when the boys need to be separated.

Positive feedback works if the task is not too difficult or long to accomplish. Behavioural modification seems only to work while it is offered. Reward systems only work if the time period is short and the behaviour is almost immediately forgotten with no reward in place, i.e. there is no weaning of the behaviour. The threat of removal of privileges works initially, but they soon forget what the consequence will be.

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[Bibliophile]

I should qualify my last post by adding that while my doctor was very understanding with respect to treating the ADHD, she was reluctant to treat the comorbidities, e.g. anxiety and dysthymia (mild depression). A lot of physicians believe that treating the ADHD first may see relief in the comorbid conditions so that is how they approach it.

Oh, and I am in the GTA as well.

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[Bibliophile]

If you have a family doctor, start there. They can always refer you to a specialist if need be. Obviously, someone who is knowledgeable is best. Try to figure out what you want the meds to provide to see if you will also require behavioural or other therapies to achieve your goals. My own doctor was very supportive. It is a long process, so don’t rush things (easier said than done for someone with ADHD, I know.)

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[Bibliophile]

I agree that people with ADHD can succeed given the right setting and support. I also agree completely that the impairments each of us contend with vary in intensity and type; although to be ADHD the impairments would have to be associated with impairments of executive functions or inattention and behaviour monitoring.

Sure, there are situations when being unable to maintain a train of thought will lead to brilliant insights seemingly out of left field. Other times it will lead to losing ones train of thought while pitching a new technology or focusing on a minor detail instead of the big picture. The environment is the key to success.

For day to day tasks, e.g. housework, paying bills, programming the kids’ activities, etc., and business related activities, e.g. ensuring tasks are completed on time, ensuring tasks are completed with the appropriate detail and scope, ensuring that tasks follow accepted format, etc., ADHD detracts from one’s success because staying on topic or focused and monitoring time are difficult activities for the ADHD brain. The business setting will dictate how rigid the rules are as well, which may play up to a person’s strengths or allow for some degree of inattention.

Not every person suffering from ADHD is a gambler, drug addict, divorcee, or math failure. I agree. However, I feel that the person would most likely be better at doing what there strengths are if they didn’t have to deal with the ADHD symptoms. The exception is the environment or task that REQUIRES random thinking, not sitting still, and trial and error.

I ask you, is jumping from one thought to the next really thinking faster? How do we measure that? I know we feel like our minds are racing, but is that just because of the constant flurry of thoughts or is it really processing faster? How could we even measure and what would the baseline be?

We can all point to anecdotal examples of either side. For example, Walt Disney was very much a LINEAR thinker but still creative and visionary. Would he have accomplished as much as he did if he was not staying on task or found it difficult to finish a project? How much patience was required to refine ideas and implement them?

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[Bibliophile]

I wanted to add rash decision-making to my list of impairments that are not beneficial. Jumping to a decision, while it can be a time saver, might also be inappropriate for decision-making in a business setting or when evaluating product.

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[Bibliophile]

I totally agree with you, Wgreen. I find little positive in my inability to stay on task, listen to others effectively (unless I am truly interested in what they are saying) or for any length of time, or repeating tasks day in and day out (which is required in most jobs). This schism in ADHD outlook makes me wonder if it is a case of people with varying levels of impairments describing their own situation. Sure someone with just a little inattention and with a laissez-affaire lifestyle may say their ADHD has made themselves more bohemian and creative, while another sufferer who cannot finish a book or television programme as it is too hard to sustain interest or focus or who is completely worn out by spending time in a club or party because of the overabundance of stimuli will say it is crippling and something they really wish they didn’t have. We must also remember that people with ADHD are notoriously poor at self assessment so there is also the denial aspect to the overly positive approach.

There is nothing wrong with positive thinking or saying “I can do good” or “I am creative” but there is something wrong with attributing that ability to achieve with a cognitive impairment. I think many of us achieve in spite of our ADHD, not because of it. There are of course some professional exceptions, but they are not the norm.

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