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This is a long-overdue post on what it’s like to have adult ADHD/ADD. I was presumed “precocious” as a child, so my smartypants ADHD behaviors really went unnoticed. When I got to the adult grind of office work, I started having panic attacks, in part because I was massively overstimulated and unable to function appropriately (I still work best home alone.)

Is this my brain on stimulants, or is it an anemone that’s been manipulated beyond recognition with Photoshop?

I was diagnosed with adult ADD at age 23 or thereabouts. I started off with Concerta and it was a huge improvement. About 10 years later, as a PhD student, I switched from Concerta to Adderall (and then to Adderall XR.) Where I saw a 100% improvement in symptoms with Concerta (methylphenidate), I had a 1000% improvement on Adderall (dextroamphetamine-amphetamine salts), and even slightly better on the extended release formulation.

Yes, everyone has attention deficits, and ADHD is way overdiagnosed. It’s taken quite some time to figure out how to best express what the difference is, but the bottom line is this:
not everyone has attention deficits that are disabling.

By disabling, I mean that ADD can make it impossible to function at a normal level due to executive dysfunction in addition to problems with inattention, hyperactivity, and impulsivity. It permeates every part of my life, making everyday activities more difficult, and can cause great personal distress. That’s how I interpret “disruptive and inappropriate for developmental level” in the DSM definition of ADHD, slightly modified below to show only the symptoms that I exhibit. All symptoms must have been present for at least 6 months, but adults going for diagnosis need to present evidence from childhood as well.

Six or more of the following (9) symptoms of inattention:

Inattention (7)

  1. Often does not give close attention to details or makes careless mistakes in schoolwork, work, or other activities.
  2. Often has trouble keeping attention on tasks.
  3. Often has trouble organizing activities.
  4. Often avoids, dislikes, or doesn’t want to do things that take a lot of mental effort for a long period of time.
  5. Often loses things needed for tasks and activities.
  6. Is often easily distracted.
  7. Is often forgetful in daily activities.

Six or more of the following (9) symptoms of hyperactivity-impulsivity:

Hyperactivity (6)

  1. Often fidgets with hands or feet or squirms in seat.
  2. Often gets up from seat when remaining in seat is expected.
  3. Is often “on the go” or often acts as if “driven by a motor”.
  4. Often talks excessively.

Impulsivity (3)

  1. Often has trouble waiting one’s turn.
  2. Often interrupts or intrudes on others (e.g., butts into conversations).

In addition to the symptoms…

  1. Some symptoms that cause impairment were present before age 7 years.
  2. Some impairment from the symptoms is present in two or more settings (e.g. at work and at home).
  3. There must be clear evidence of significant impairment in social, school, or work functioning.
  4. The symptoms do not happen only during the course of a Pervasive Developmental Disorder, Schizophrenia, or other Psychotic Disorder. The symptoms are not better accounted for by another mental disorder (e.g. Mood Disorder, Anxiety Disorder, Dissociative Disorder, or a Personality Disorder).

I have the majority of symptoms from all categories and the severity is basically disabling for me. A more specific diagnosis would be ADHD, Combined Type. In addition to several diagnostic interviews (which all yielded positive dx’s), I’ve also taken the CPT II computer-based test. The results further substantiated the claim that my brain is simply screwed up in the departments that control attention, impulsivity, and (to a much lesser degree) hyperactivity. To make it all the more interesting, some of my bipolar symptoms overlap with the ADD symptoms, which made bipolar harder to detect for a long time.

To the symptoms above, I’d add inconsistent academic performance, low self-confidence and self-image, generalized anxiety due to cognitive deficits, executive dysfunction problems, underemployment, memory issues stemming from inattention, chronic insomnia, “noise” in my head, and delays in learning social norms of behavior. Almost all of these issues faded away almost as soon as I started taking stimulants. The symptoms that overlap with bipolar also improved substantially.

The meds made an enormous and unquestionably positive difference in my life. I only realized how unnecessarily difficult my life had been when I started meds. The drugs don’t just help with attention; there’s really so much more to it due to the pervasive effects of ADD symptoms. Being medicated solves a lot of problems for me and my quality of life is much better as a result.

People who don’t have AD(H)D typically cannot fathom how hard I work just to appear normal, suppress blatantly inappropriate behavior, and do certain everyday tasks that most people take for granted. It takes 5 times as much work for me to do anything when I’m off meds. Throw a bipolar episode on top of that, and I can barely function enough to get by. Fortunately, I’m pretty tenacious. Strategies I use to deal with ADD on a daily basis is the subject of another post, over on A Canvas of the Minds.