Untangling the ADHD Conundrum
Dr. Elena Estanol Ph.D., M.F.A.
Down the Rabbit Hole…
Imagine feeling like you need a tow truck to get out of bed each morning, snoozing several times, until you can’t do so any longer, your head seemingly filled with a viscous substance that prevents ANY communication of wiring to happen appropriately. You feel as though you are trying to move through molasses. Yet… the night before it seemed nearly impossible to get your brain to quiet down, to fall asleep.
As you stumble into the bathroom to brush your teeth, it takes you a few seconds to realize you are brushing your teeth with hair gel rather than toothpaste. As you spit it out and rinse your mouth, to replace the whole process with toothpaste and then splashing your face with cold water you wonder if you will ever have a “good” morning.
You see your pills next to the brush and take them, as you know this is the ONE action you can take that will change your day. If you have set up a good routine then they will begin working within 20-30 mins and you may just have a smooth day.
Other days may seem like they are pulled straight out of a comic strip, and if you were to share it with anyone they would be on their stomachs laughing. The thing is, you DON’T share, because YOU are too EMBARRASSED to ever mention what a train wreck you are (or feel) to anyone around you.
Once you catch your groove and get dressed and ready, IF you have done your preparation and routine correctly, then you will have things ready by the door, all packed, and perhaps even a post-it note on the door reminding you to grab your lunch.
However, if you haven’t figured out how to manage your life, mornings can be some of the most chaotic and stressful times in the world.
A wild goose chase in search of shoes, keys, wallets and any other important piece of equipment you may need for the day ahead. Not to mention, gathering your children’s items, their lunch packs and school bags.
Making sure they have matching shoes, socks… (we’ll have to forget if they don’t match, just make sure they are wearing them), and comb their hair.
Perhaps the trickle of dominoes toppling over, as you miss breakfast, grab a sugary snack and set yourself for an all-out evening binge that puts the nail in the coffin of a truly disastrous day.
IMPAIRMENTS & STRUGGLES
While this may sound like a cartoon-land sketch, this and worse is the reality that many ADHD families face every day.
Yet interestingly many times people present to therapy and treatment with complaints that we may not associate with ADHD. Things like anxiety, major depressive disorder, lack of self-esteem, lack of confidence, frustrations at work, underperformance, distress, overwhlem, and a general lack of enjoyment and contentment.
ADHD is a neurobiological condition that impacts attention, concentration, working memory, emotional regulation, planning, organization of time and space, time management, prioritization, impulsivity, hyperactivity, restlessness, drive for new endeavors, problems with motivation, procrastination and follow through, distractibility, daydreaming, eating, sleeping, learning, persistence and consistency to name a few.
The training most mental health professionals receive on ADHD is minimal at best and non-existent at worst. Most of us need to pursue additional training and specialization to be able to fully understand and treat this disorder.
While the label of “Attention deficit & Hyperactivity Disorder” is the agreed upon label by the DSM-V, I personally don’t believe it is the correct label.
If I had to choose I would describe it as “Attention Surplus Hyperactivity Difference”. Why?
Because, people with ADHD don’t actually have an attention deficit. In fact they are trying to attend to way too many things at once and the issue is that they are UNABLE to prioritize the MOST important one that demands their attention. INEVITABLY things fall through the cracks.
As one of my brilliant clients quipped to me after I suggested that he “forgets” tasks; his correction: “I don’t forget, I fail to remember at the appropriate time.”
This was perhaps the most accurate description of what we call “forgetting”.
Perhaps the biggest thing we struggle with as clinicians is being able to “diagnose” and “pinpoint” WHAT EXACTLY to attribute the impairments and what is the correct treatment.
DSM aside, making this diagnosis is extremely difficult because it can masquerades and co-exists with a lot of things!
Among them: anxiety, depression, defiance, PTSD, lack of motivation, overwhelm, failure to thrive, spectrum disorders, eating disorders, impulse control disorders, mood disorders, thought disorders, learning disabilities, and personality disorders, to name a few.
Having a deep understanding of the multiple presentations of ADHD is key, as well as common presentations by gender.
A few clues: be observant of variations in presentation. If I had to narrow this down to ONE THING it would be: INCONSISTENCY.
Sometimes motivated and in action, other times they can’t get up from the couch. Chasing “shiny” things, difficulty making decisions to the point of annoyance; Lack of confidence, and severe self-judgment or self-deprecating statements.
When they have been in the wrong environment for a LONG TIME you will see:
HOPELESSNESS, VICTIMHOOD, and BITTERNESS.
I also used the word “difference”. The reason for this, is that I am not entirely convinced that this is a “Disorder”. Yes, I am keenly familiar with the “impairments” it causes; yet these are only judged against our current societal functioning. I believe ADHD brains function in uniquely different ways and this difference in wiring also brings with it a fair amount of gifts.
Creativity, innovation, sense of humor, playfulness, spontaneity, openness to new experiences, razor sharp hyper-focus, persistence & perseverance (also otherwise known as stubbornness), curiosity, imagination, ability to go with the flow, present-mindedness, out-of-the-box thinking, empathy, sensitivity, unique perspectives, ability to connect seemingly disconnected ideas often generating a novel approach or discovery, boldness, wit, pizzazz and courage.
However the gifts are hardly ever mentioned, and focus is heavily placed on impairments, which only highlight their sense of inadequacy, difference and chips at their self-esteem and confidence.
If we truly want to help ADHD individuals thrive in their lives we need to take a whole-person approach. We need to get over our insecurities as clinicians and recognize that in order to thrive and experience success they will need significant support and resources for a period of time.
Therapy and medication are helpful approaches, yet they are not enough. We need to empower them with practical tools and strategies that are separated from the mental health sphere through coaching, support & accountability groups, psycho-education, and specialized training in working memory, meditation, nutrition, lifestyle interventions, and exercise.
Over the years many therapists & parents have asked why therapy is not enough. Well picture the client I described above, add emotional dis-regulation, lack of confidence, interpersonal issues, inability to communicate or read cues properly, overwhelm…
And what you get is “guacamole”. You begin to spin along with the client and pretty soon feel the same overwhelm and hopelessness.
It is difficult to remain task oriented on organization or time-management when someone is falling apart due to a relationship explosion, the frustration over losing their keys, and showing up 30 min late. Coaches work to specifically teach skills and address issues related to organization, time-management, motivation, perseverance, task-completion, homework, sleep, and provide a structure for accountability and follow through.
In our center, several clinicians have pursued specialized coach training. Clients are matched with a coach and a therapist so we can collaborate, as well as a nutritionist or wellness coach.
Education for parents, partners, and significant others is as crucial as a personal understanding of the disorder. Psycho-education, support & accountability groups as well as working memory training may become part of the treatment. We don’t do everything at once, but rather stack it, so they are actively working on particular things and gaining skills one piece at a time.
We honor and recognize the power of therapy in stabilizing clients, AND we have seen the power an integrative approach to clients with ADHD can completely transform their lives.
We delight in coaching and providing education to clients who are currently working with other therapists outside our agency or support them individually or in groups.
Do you want more in depth education about ADHD? Do you have clients you would love to partner with so they receive better and faster outcomes while continuing to work with you? Are you or your child struggling with ADHD?
Contact us. We want to partner to support your clients “live and thrive with ADHD” as well as support you to do the best job for them!
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