Friday, July 15, 2016

Thoughts for the week #8 - ADHD testing

In keeping with the theme of brains (braaaiiinnnssss) for blog topics this week, today I am reporting on my experience getting tested for ADHD as an adult. Sorry, this is another long one.

First, a definition:
Attention-deficit/hyperactivity disorder (ADHD) is a brain disorder marked by an ongoing pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development. - National Institute of Mental Health
Generally, there are considered to be two types of ADHD, though they have a lot of overlap. Inattentive type is also known simply as ADD and is often characterized by difficulty sustaining attention, failing to meet deadlines, difficulty in organizing tasks, easily distracted, and a proclivity for losing things. Impulsive-Hyperactive type is characterized by fidgeting behaviors, difficulty keeping seated/still for extended period of time (most commonly demonstrated in classroom environments), inappropriate physical activities (running around when they shouldn't), interrupting activities and conversations, and having trouble waiting. There is also the Combined type, which is some kind of combination between the two.

Based on my own experiences, I believe that it almost doesn't make sense to differentiate between the types. I have almost all of the symptoms for the inattentive type and some for impulsivity/hyperactivity. I was never one to run around, but I am most definitely someone who can't sit still or comfortably for very long. I am impatient and have to fight myself so I don't interrupt people/events. I think that I can sometimes talk a LOT without any sense of whether it's been too much. I could also describe how my thoughts work as hyperactive. It's too difficult for me to wrangle my thoughts to stay focused. I also think that there are various degrees that someone could experience a disorder like ADHD. Someone might have it very mildly, so much that they are able to compensate for it in other ways and never worry about needing additional support. I wish that more disorders were researched in a way that considered them "normal" variations of brain activity, but the classifications are needed for insurance and liability purposes, unfortunately.

My psychiatrist described the way that medication for ADHD works like this: as it was tested and the dose was lowered (initially was a drug for raising blood pressure), side-effects like "calmer" thoughts were reported in only some subjects. The drugs are technically stimulants, but it seems that some brains process them in such a way that it calms things down just enough to make operating a whole lot easier. If a feeling of stimulation like too much caffeine is felt, that means the dose is too high. They eventually figured out that there was something about the brains of those people that was different than expected and the diagnosis of ADHD was born.

When I was 17, I started going through a neuro-psychological evaluation to test for a possible learning disorder. The testing was initiated by my parents after I'd recovered from a very bad depressive episode, but was still struggling in school. What I found then and now is that a lot of the signs of a learning disorder overlap with mental illnesses like depression and anxiety. The obvious examples are inability to focus and meet deadlines, but there are many others. Part of the testing was to rule out depression & anxiety as potential factors in my reduced academic performance. The evaluation included a variety of tests, things like:

  • verbally tell a story based on pictures presented to you
  • write a story based on pictures presented to you
  • solve a puzzle made of different geometric shapes
  • various "never, sometimes, often" questionnaires
I believe the testing took at least two sessions. The end diagnosis with Executive Functioning Disorder. This can exist with ADHD as well as independently, but it's more of a symptom than an actual disorder. I believe I was not diagnosed properly, but the end of the report basically deferred to my public school to do evaluations in a classroom environment. That is something the school wasn't really willing to do even though they were legally bound to do it. Fuck them.

At my current psychiatrist's suggestion, I am undertaking testing again. As an adult and since this is a focused test just for ADHD and not anything else, it's mostly discussion with the doctor and one of those questionnaires. My husband filled one out based on behaviors he's seen in me, and I filled out one for myself. After two meetings, the doctor concluded that yes, I do have ADHD and I get to try out a prescription to help. Hooray!

The part that I love about learning about ADHD and mental illness is knowing the ways in which I function are not my fault. Obviously I am responsible for myself and my behaviors, but when I screw up, it's often not "I didn't try hard enough", it's just my brain screwing something up so that I can't do it properly. It's important for me to be aware of these "shortcomings" so I can learn to work around them, like the key system I mentioned in my last post. Obviously, those workarounds are not always foolproof and they often waste a lot of mental energy that I really wish I could expend just doing things without all the processing time and effort

Also, obviously, I will take responsibility for my mistakes either way. It's not always easy to tell if my mismanaged communication is "just me" not coming at something from the right angle, or my brain function preventing me from doing so. I can certainly learn to do better and makes changes, but whether those changes will stick is up to the disorder, not by my choice. My experiences have certainly helped me to be more patient with others and consider that their brains process information differently than mine. How I share information may not be translatable to their learning style and I have to be conscious about taking a different approach if someone doesn't understand me. I think that awareness has made me a better tech support person.

Some people probably think it's a cop-out that I like to blame some of my problems on disorders/illness, but I think that's a misunderstanding in how mental illness and brain disorders affect our behavior. It's something I think we should all learn about in school so that teachers are more adaptable to their students' learning styles and educational needs, and students are more vocal about their challenges. Maybe with the right adaptations in our environment, medication isn't even needed, but I certainly see no shame in taking it.

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