adhd

ADHD and Me

I was diagnosed with ADHD at 35 years old. I describe my experience, break down the testing and the explain the disorder. I also speak with a student who has ADHD about his experience and Dr Gail Saltz about how the medication is prescribed.
dr gail saltz
Dr Gail Saltz

Prodigy – ADHD and Me

So I’m going to tell a bit of my story in the beginning of this episode. There is some self diagnosing and I want to say that I’m not a psychologist so take it with a grain of salt.

 

My name is Lowell Brillante and this is Prodigy.

 

In the 4th grade my mom decided to homeschool me. She wasn’t strict so I lacked the structure school provided but loved the freedom.

In the 9th grade I convinced my mom to send me to school and was enrolled in a small christian academy.

It was awesome to be around so many new people but there were so many rules. When I got in trouble for something minor like not wearing a belt it just pissed me off. 

A year later I was at a friend’s house with some classmates. As a joke I grabbed a girl’s car keys, hopped into her car and sped down the street. I was going too fast at the first curve. The car went off the road and hit a tree. The impact felt like it rebooted my brain. When my operating system loaded I  found  myself in a hazy atmosphere  of yellow interior lights  diffused by  powder from the airbags. A warning sound was beeping. What had I done? The feeling that hits you a second after a life altering screw up is surreal. Your first thought is “please let this be a dream.” but it wasn’t.

I ended up with a lot of community service but ultimately avoided serious consequences.

In the beginning of 11th grade I transferred to public school. With less rules I got into less trouble. Classes were easy but I despised the busy work. I spent most of my free time with friends, working out and chasing girls. I managed to graduate with decent grades and go to college. I wanted to be a doctor so I enrolled in pre-med. Organic chemistry was a prerequisite considered to be a difficult class that filtered people out. It was my first experience with real failure. Turns out you have to actually study to learn the material.

I ended up switching to communications and graduating in 5 years with the minimum possible grades. School just wasn’t my thing I guess. I had septoplasty to fix a deviated septum and discovered that the pain medicine made me good and content in the moment. I lived with my parents, had no job, and got hooked on drugs.

Thankfully I had an excellent support system in my family. I was able to recover unlike many who were less fortunate.

My parents loved me but definitely wanted me out on my own. I liked the video production class I took in college so I started freelancing as a videographer. I was optimistic but my work was average at best and I lived with a constant void inside of me.

My parents paid for me to regularly visit a psychiatrist so during one appointment I told him what my symptoms were and he said I might have ADHD and wrote me a prescription. It made me think, wait do I actually have it? I’m not hyperactive, I can focus when I want to. Stimulants definitely helped me accomplish things but made me jittery. I thought the medication was supposed to make you calm if you had ADHD.

No I definitely don’t have it, I’m just broken. The medication was helping a lot. I learned how to build a website and ranked it to the top of google. 

I was getting a lot of business but abusing the medication. I’d stay up for days working then crash and sleep for an entire day. 

I ended up getting a job offer to work for a small agency and took it. Me and my dog packed up a uhaul and drove to atlanta. I no longer had access to my psychiatrist so I quit.

I fell back into a comfortable routine of doing the bare minimum. I had originally told myself I’d stay for a couple years before seeking a better job. I ended up staying for 6 years before I really felt I had to get out.

I had an opportunity to get into podcasting so I took it. I enjoyed the work and performed well but still couldn’t find the motivation to excel at it. I knew I probably needed to see a psychiatrist but I couldn’t bring myself to actually do it. I felt a strong mismatch between what I perceived my potential to be and what I actually accomplished. I started using reddit and while browsing the ADHD group I slowly began to realize that it was actually a real possibility.

At the beginning of lockdown, I finally had enough and made an appointment. On april 26th of 2020 I was given a series of tests by a clinical psychologist.

I was administered the wechsler abbreviated scale of intelligence test, a portion of the wechsler adult intelligence scale, the trail making test, the letter number sequencing test, ADHD rating scale and the minnesota multiphasic personality inventory.

On the intelligence test I scored 120, the 91st percentile. For the trail making and letter number sequencing tests I scored in the 20th percentile. So 80% of people in my age group did better. This sharp difference between my intelligence and working memory implied a severe impairment.

I was diagnosed with ADHD, predominantly the inattentive type.

After getting the diagnosis and learning the symptoms of ADHD a lot of things in my past made sense. Getting in trouble at school was impulsivity. I could focus for hours on end but only when I was interested in the material, otherwise it was the bare minimum. Substance abuse was self-medicating a lack of norepinephrine. My poor memory was inattention.

When I started taking the medication correctly things changed. My mood stabilized. I had an eagerness to learn and create that filled the void in my life. 

I made a pitch for a show and spent weeks creating a pilot episode. I was very nervous sending it out. Failure at this point would crush me.…..but the show was greenlit, you’re listening to it right now. 

Medication didn’t make my life perfect, I still struggle with focus and motivation, but it’s more manageable. And I’ve learned strategies that help reduce the negative aspects I experience.

I wanted to tell my story to illustrate that ADHD is not always obvious and that the symptoms can cause serious issues in your life. 

Let’s break down what the disorder actually is so we can understand why.

 

Attention

 

ADHD stands for attention deficit hyperactivity disorder. Attention Deficit Disorder used to be diagnosed separately but later it was determined that the 2 aren’t different, just that hyperactivity  exists on a spectrum of severity.

Attention is the process of selectively concentrating on one source of information or thought process while filtering out others. For example when you’re reading a book the whole text is in your field of vision but you can only focus on a few words at a time. In order for information to get into your working memory, you have to focus your attention on it.

Working memory is the same as short term memory except it includes the ability to manipulate information. Short term memory is considered only for storage. When you focus your attention on something it enters your working memory. Working memory is limited in capacity. The 2 types are auditory and visual. They’re considered to have separate but related capacities. I can’t listen to 2 podcasts at the same time but I can listen to a podcast and drive at the same time. However listening to a podcast and driving will decrease my attention to both.

If you recall what it was like the first time you drove on the highway, it took a lot more focus. Through repetition and practice, driving required less attention. The ability to perform repetitive tasks without focusing on the details is called automaticity.

Once information is in your working memory it can be encoded into long term memory and retrieved when needed. Working memory is incredibly important and some studies have shown it to be a more accurate predictor of academic success than IQ.

Cognitive flexibility is the mental ability to switch your attention about 2 different concepts and both simultaneously

Lastly is inhibitory control. This is the ability to suppress impulsive behavior. Like if someone is tailgating you and you get the impulse to slam on your brakes.

These 3 processes of working memory, cognitive flexibility and impulse control make up what psychologists call executive function. There are several different models of executive function that are relatively similar but in my opinion this is the one that explains it best.

People with ADHD have problems with their executive function. Executive function determines our behavior, thoughts, decisions, emotional regulation and ability to learn. So while ADHD initially doesn’t seem serious compared to other disorders, it’s actually extremely significant. 

Executive functioning happens in the frontal lobe of the brain. It’s responsible for problem solving, memory, impulse control, planning, attention, language motivation, perception of time and social behavior. 

Since the frontal lobe is responsible for all these behaviors the rate of people with ADHD who also have another disorder is high. 2 or more disorders is called comorbidity. ⅔ of children with ADHD also have another disorder.  The most common ones associated with ADHD are Oppositional Defiant Disorder and Conduct Disorder. As I was researching this I just now realized I may have had oppositional defiant disorder as well.

Symptoms of ODD include the following: easily loses temper, angry and resentful, hostility toward authority figures, refusal to comply with requests, purposely annoys others, blames others for mistakes.

I recall an incident in grade school that is a good example of this. We had a substitute coach that day and I didn’t like him. I said something rude and he requested that I run laps around the field. This made me angry so I fomented a small rebellion. I convinced half the team to go hold our own practice on the adjacent field. The next day I was removed from the baseball team and told I had one strike left before expulsion. I knew I probably wouldn’t last long so I took the opportunity to go to public school. 

This caused me trouble over the years but I’ve grown out of it.

 

Testing

 

Let’s take a look at the tests that are administered to diagnose ADHD. The first test given to me was an intelligence test. 

IQ stands for intelligence quotient. It’s a scale for measuring intelligence compared to others in your age group. The french government commissioned Alfred Binet to create it so they could identify children that needed special assistance in school. Binet was clear that intelligence is too broad to quantify with a single number and that it should only be compared with children of the same age and background. When it came to the US, Stanford Psychologist Lewis Terman standardized for Americans and in 1916 the Stanford-Binet IQ test was born. It calculated a person’s score by dividing their mental age by their physical age and multiplying by 100.

Psychologist David Wechsler believed the test was too limited so in 1955 he created the Wechsler adult intelligence scale. Instead of scoring based on mental to physical age, it compared your results to others in the same age group. It scores IQ based on 100 being the fixed median. It also provides sub scores in verbal comprehension, perceptual reasoning, working memory and processing speed. 

I took a version of this test and scored in the 91st percentile for intelligence giving me a full scale IQ of 120 which is pretty good.

I was also given select subtests to measure my working memory. The first is called the trail making test. It measures your attention and cognitive flexibility. I was given a paper with 25 circles placed randomly. Inside each circle was a number or a letter. The numbers were 1-13 and the letters were A-L. The test was completed by drawing a line connecting all the circles. The required order was 1 A, 2 B, 3 C, 4 D and so on.The test is scored based on how quickly you complete it. The other subtest I was given for working memory is called the letter number sequencing test. I was read a mixed sequence of numbers and letters and my task was to repeat the sequence back with the numbers in order, then the letters in order. Both tests showed a severe impairment in working memory.

I scored in the 20th percentile for working memory which indicates a severe impairment. That alone wouldn’t be an indication of ADHD if it matched my other scores. The massive gap between working memory and intelligence implies that my working memory is faulty and is an obvious indicator of ADHD. I was diagnosed with primarily the inattentive type, so essentially I have trouble controlling my attention. 

 

Flynn Effect

 

While writing this episode I realized that the psychologist who administered the test used a version from 1981. There are 2 more recent versions. The reason this matters is due to the flynn effect.

The Flynn effect is a substantial increase in intelligence scores over time. The Wechsler test I took shows approximately a 3 point increase per decade. There are many theories for the reason for this. The main one is the increasing literate society. Flynn gave an example in an interview with the guardian. He asked the interviewer “what do dogs and rabbits have in common?” The interviewer said they’re both mammals which was correct. Flynn said that a boy from the early 1900’s would say the dog hunts the rabbit so our understanding increases over time.

The other interesting thing from Flynn’s research is that the intelligence score of underdeveloped countries is increasing faster than developed ones. This negates the argument that lower IQ scores mean a disadvantaged race is genetically inferior. If you listened to the 3rd episode of Prodigy “The source code” he was responding directly to Arthur Jensen who actually praised Flynn’s critique.

There’s a lot of different studies on what the cause for the increase is and why it’s declining but the main question is, is intelligence actually increasing or is it due to environmental factors like better education, literacy and nutrition. Flynn passed in December of 2020.

The most recent version of the test was published 27 years after the version I took. So according to the Flynn effect I probably would have scored lower. There are other tests used to measure cognitive ability but we’ll cover those some other time.

 

MMPI-2

 

The other test I was given is the MMPI-2, It’s the 2nd edition of the minnesota multiphasic personality inventory. It’s the most widely used measurement for adult psychopathology. What’s interesting about it is that it has validity scales to determine if a subject is providing misleading answers. It’s used to help with differential diagnosis. Oftentimes disorders can share symptoms so the test helps to differentiate one from another. Adhd can easily be misdiagnosed as anxiety or depression which is one reason why some adults don’t realize they have it.

My results showed no diagnosable psychopathology. 

It’s important to note here that if you take this test you should answer honestly or it can invalidate your results or skew your diagnosis.

ADHD can even effect your sex life. Common reported issues are hypersexuality, hyposexuality, difficulty achieving orgasm. Impulsive behavior can lead to unsafe sex.

Although ADHD is an impairment of neurotypical functioning, it can have some positive effects. Impulsiveness can lead to quick action and willingness to take risks can lead to greater payoffs. Richard Branson and Bill Gates are extreme examples.

Enhanced creativity is common because one of the main symptoms is divergent thinking which is the ability to produce creative solutions that greatly differ from one another. Da Vinci, Picasso and Van Gogh were all rumored to have ADHD.

Neurotypical people often have a linear thought process which makes it more difficult to make cognitive, creative leaps but they are better at convergent thinking which is a sustained form of creativity. The ability to hyperfocus on interesting subjects can mean extreme productivity and quick reactions in emergency situations.

If you can nurture the positive aspects and compensate for the negative ones then it’s perfectly reasonable to live a happy, successful life.

 

Months ago when I was diagnosed I got in touch with another podcaster who has ADHD. It’s been a constant struggle for him but he’s really smart and is in school to be a physical therapist.  His friends call him Ziggy.

 

Ziggy:  Especially when you’re young, you don’t really notice anything, because you don’t really have any sort of people to compare yourself to.

Ziggy: Do you think that you are normal? But it’s until, adults, namely teachers step up and say, you know what, relative to the other kids, we think that he may be a bit more hyperactive. He may be a bit more disruptive during classroom time. Maybe you should guys look to get him checked out, for ADHD, once high school started hitting and I actually had to put in effort outside of class when I was on my medication, I realized I can’t, I am physically unable to make any sort of progress with what I need to do.

Ziggy: That’s when you realize, Oh, the way I function, isn’t quote unquote normal. And when you have that moment, that chemically, and you realize I’m not normal the way I think isn’t how everybody else thinks sucks. And you’re like this is not my potential.

Ziggy: This is not where I can go with my life. But. Without any sort of chemical assistance, there is a hard ceiling looking back at high school. I never really knew my full potential until I was really consistently on the medication because I refused to be on the medication in high school. I hated the way it made me feel.

Ziggy:  I just stopped taking it simple as that because I had my psychiatrist and I also had a counselor and she worked with me to develop coping mechanisms or develop tools that would help me function better without the use of medication. For example we found that working out before I studied was very beneficial.

Ziggy: Instead of trying to study before my evening training, I would study after my evening training. And yes, I may be up a little later, but I’d be able to focus and get more done in that time. And we found that, for whatever reason, there’s a select few songs that worked very well in helping me retain focus.

Ziggy:  In college. My freshman year, I tried to do it without medication. I couldn’t manage it. It was me not doing anything. And then me, with all the stress and the pressure just cramming, for the week before my finals, it was just, going 48 hour, 52 hour days of just being awake. It was just, it was never going to work.

Ziggy: And I went to a bad place with drugs and stuff which is not a good place. And then that was in there for about a year, beginning of this most recent year, beginning my junior year. I kinda just got help and I got to a better place and I talked to psychiatrists and I said, you know what? I need to get back on medication.

Ziggy: It’s been a few years. Let’s try to reevaluate me, got me back on a good, better place. Helped so much with school. I’ve noticed that while I was on the Adderall, I was getting shortness of breath and I felt like my chest was tightening and very quickly, that was unnerving to say the least. And we talked to my psychiatrist and he said, let’s take a break.

Ziggy: During that low period. My first years of college, I felt obviously I felt like I w I was depressed. I had depression being in bed and not being able to physically get out of there until six to six in the evening, getting out, eating, maybe watching an hour TV, then going back to bed at 10 o’clock and doing it all again for weeks and weeks on end.

Ziggy: I see. Now what I’m now not on the medication anymore. For a few weeks, I’ve noticed myself falling back into that. And it seems like that the stimulant helps me just function throughout my day, because it is very easy to not do something, especially when you’re on ADHD. When you have ADHD, it’s very easy to just get distracted easily.

Ziggy: And if something requires a little bit too much effort, at least for me, I feel like I just resort to where requires the least amount of effort in terms of impulsivity, negative connotation. I put a positive connotation on the word. What do you get? You get spot Naty. You’re more willing to do things outside of the box.

Ziggy: You’re more willing to be a little bit more adventurous with what you do. And maybe the flip side is that you don’t take more risks. No risk, no reward kind of mentality. Instead of doing something that’s boring, let’s just jump off a cliff. Let’s do some fun.

Ziggy: Obviously the thing is you can’t focus, but it feels like there is a other end of the spectrum that you can get to without being on medication. Like you’re, hyper-focused. Unlike somebody that doesn’t have ADHD by that. If you’re very passionate about something, ADHD person is going to be a lot more inclined, a lot more motivated to put all of their resources into that and all of their effort into that one thing, if they’re really passionate about it,

 

To help understand the medication aspect, I talked to Dr Gail Saltz. She’s a psychiatrist, psychoanalyst, best selling author and has appeared on dozens of major shows. She’s also the host and executive producer of the podcast Personology, which psychoanalyzes your favorite historical figures.

 

Gail: medication only works while you’re taking medication. It doesn’t change. Brain structure or function over the long haul, such that you’re at some point gotta be able to taper off of medication and still have those particular benefits. That’s one thing to strongly consider when you’re thinking about medication.

Gail: So it’s, I guess what I would call a band-aid. Whereas as I spoke about the CBT, the cognitive behavioral, Treatments are ma our permanent coping tools that do make change, that the person can always keep with them. And so I would say as a young person, for example, with a new presentation if it’s mild, you definitely would try to stick with psychotherapies and coping tools.

Gail: If it’s moderate, you still would want to start with. Coping tools and psychotherapies to, to try to make changes if it’s severe and it’s, really interfering in the words, this is a kid who can’t academically participate and it’s interrupting relationships or more over it’s. The impulsivity is such that.

Gail: It’s dangerous, which is something we really strongly consider an adolescents. Then you really want to consider medication right away.

Gail: And also, I should say about the previous question that. Sometimes you have a kid that you treat with psychotherapy and you get them to adolescents. And some of those features that are more have to do with risk taking and impulsivity then become a real concern because basically in adolescence, the amygdala is on overdrive.

Gail: That’s, the part of the brain that amongst other things says that really felt good. Let’s do it again. And the, and the frontal cortex is not fully developed. So the ability, the cognitive ability to say if I do this today, what will happen to me tomorrow? Consequence is not fully developed.

Gail: So adolescents are at real risk and that’s why often it’s felt important to medicate them. During that high-risk period, for example, driving and or drink, use of drugs or alcohol, sexual behavior, things that adolescents may do and not be able to manage the potential risks of impulsive behavior, therefore it’s dangerous.

Gail: So you might want to medicate them through that time, but then take them off, as an adult. So that. That’s the concern. And of course, as a young child, you don’t want a child to fall so behind academically and not be able to manage whatever would keep them developmentally in the game and acquiring knowledge.

 

There are 2 classes of medication that are prescribed to treat the symptoms of ADHD. The first is stimulants.

Gail: You’ve heard of Adderall or Ritalin, but there are other stimulants as a category that generally affect. The nor epinephrin neurotransmitter system, usually most many of them are nor up and norepinephrine re-uptake inhibitors, which means that they Aleve more norepinephrine around in the synapse to be used.

Gail: It’s effectively like increasing your norepinephrine noradrenaline level. And so it seems. Counterintuitive that a stimulant would now allow you to slow down and concentrate more effectively and feel less hyperactive, but that’s exactly what it does. And it’s effective for about 70 to 80% of people with ADHD.

Gail: It does have the, the issues that arise are. And choices have to do with how long, an acting agent you want to use. There are short acting ones that are like four to six hours. They’re longer acting ones that are like eight to 12 hours, but none of them, last that long, they work right away.

Gail: That’s a plus the negative is that as soon as you’ve come down off of it, they stop working. They have the potential for abuse. They have the potential for addiction. And tolerance therefore. And so over time, one might need more of them to achieve the same goal. They do have the potential for side effects.

Gail: Some people tolerate them very well. Other people have a lot of difficulty side effects have to do, they can generate more anxiety, jitteriness and for someone with a propensity to an anxiety disorder might not be able to tolerate them. They can increase ticks. They can. Cause loss of appetite and weight loss, which can be a real problem, particularly for children.

The other class of medication is non stimulants. 

Gail: The other. General class of drug are non-stimulants and many people may have heard of Strattera, but there are other non-stimulants, they are longer acting. They have to be taken for several weeks before they become effective, because you have to achieve a blood level. For them to be effective over time, you take them all the time, as opposed to stimulants.

Gail: You might, for example, if you’re having problems with weight and so on you might take, in fact, it’s often recommended to take a drug holiday. So like a student might be off it for the summer or not use it on the weekends to also help prevent tolerance, but non-stimulants are used all the time.

Gail: There are of course side effects with every drug non-stimulants are no exception when can, there is a concern particularly in young people of increased thoughts of suicide or suicide risk. There are. Gastrointestinal side effects that can occur with Strattera and other non-stimulants. So there’s a combination of different side effects that one would have to see, but it’s usually someone should be monitored closely for mood and suicidal ideation.

Gail: Aside from that it’s often well tolerated. It’s often not as effective as the stimulant category. But it is therefore it’s a second line treatment for those who probably can’t tolerate stimulants

Is it over diagnosed or underdiagnosed?

Gail: It definitely used to be underdiagnosed. As most mental health issues have been. Yeah. These days in children, in the words I, it’s still probably underdiagnosed and adults who were just unaware that’s what they struggled with in school, and an early life, because it doesn’t present in adulthood, it presents in childhood.

Gail: They might not have known what the issues were and just thought I, and I often see this adult, they thought they were stupid, a bad student a. A screw up. Just a bad kid is the feedback that they got a difficult kid and sadly that can really shape. What happens to you as an adult? When in fact they were struggling with ADHD, but today I would say, many more people in general and schools and teachers in particular are very aware of the diagnosis.

Gail: It’s probably the most common diagnosis in the classroom today. And so I think it’s being diagnosed often, much more appropriately in terms of numbers. Is it being over diagnosed? I can’t say that. I wouldn’t say that it’s being over-diagnosed, but I would say that it may medication is needed sometimes, but it’s maybe overmedicated in the sense that not enough people try cognitive behavioral therapy or psychotherapy.

Gail: Alone to look at the improvement. Why? Because it’s more expensive generally speaking, right? It’s number it’s numerous sessions. It’s not, here’s a medication. People who are Wanting and needing a quick fix. And and it’s very effortful to go through psychotherapy. I think some people aren’t aware that’s available.

Gail: They think it’s only medication. I think many people don’t see. A mental health professional with their child. They see their pediatrician and that’s what the recommendation is, here, because a pediatrician doesn’t do psychotherapy we’ll give you medication. So I think the likelihood of being medicated is probably more common than ideal.

Gail: You don’t really want to have to be committed to medication for life. You’d like to use it when you need it and learn some things and make brain changes. Basically, this is what I’m talking about that allow you to at some point not need it.

Gail: academically, for example a lot of the teachings have to do with methods of organizing work. Which is one of the biggest, as a big issue for academically, for kids and later in work for adults. That might be a very specific methods of underlying sorry underlining directions circling particular word types that drive, what you’re going to do, highlight those words.

Gail: So they’re basically teaching executive function skills that are not intuitive because that’s an issue. Executive function is a specific area that is often affected for those with ADHD. And so it’s specifically teaching those kinds of organizational skills that don’t come naturally and reinforcing them.

 

Check out the YouTube channel “how to adhd” for some helpful tips. 

Next week’s episode will be about gaming. I talk to an esports psychologist, a speed runner and others about the world of professional gaming.

Dr Gail Saltz’s podcast called Personology is starting a new season. It psychoanalysis your favorite historical figures. I’m a producer on it and a big fan. I’ll link it on the episode page.

I have so many questions to ask and ton of really interesting topics to cover. So subscribe to the show, because I’ll be back next week with another episode of prodigy.

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