A Story of Overcoming Inattentive ADHD
“I thought I’d have things much more together than I do now!” “Brenda” told me. Indeed, at 31, she seemed bright, self-aware, and like someone who knew what she wanted. But she came to me, she said, because she was feeling anxious and depressed about where she was in her life. Her last relationship had ended six months earlier, her career wasn’t going very well, and she had a traumatic childhood.
She filled me in on all of this and then said, “What I really want to understand is why I keep sabotaging myself.”
“Sabotaging yourself?” I replied. “How do you do that?”
“Well, I’m always late with everything I have to do. I procrastinate constantly – even when I have plenty of time. I struggle to make everything perfect. And I’m late to practically every meeting. At my last review, my boss told me that while the work I do is great, I miss a lot of important little details, and she’s really concerned about my performance. ‘Inconsistent,’ she called me.” Self-reproach was written all over her face.
“That must have been so painful.”
“It was,” she said, tears coming to her eyes. “My last therapist said I have a fear of success, that I was turning everyone into my hyper-critical mother.”
I had another hypothesis. “Tell me, what’s your desk like? I mean, is it cluttered….”
“Oh my God! It’s a disaster! That’s another thing…I’ve got piles of my projects stacked everywhere…at home too.”
“Do you have trouble finding things?”
“Every day, umm, my keys, my glasses, my phone….”
“Do people tell you things that you know are important, and you tell yourself that you’re going to remember it this time, and then you completely forget, and you don’t know why, and they get mad at you?”
She stared at me. “How did you know?”
I looked back at her, smiling. “Have you ever considered you might have ADHD?”
ADHD-PI – A Problem That’s Underdiagnosed
If you’re like most people, you probably think a person with Adult ADHD, or Attention Deficit Hyperactivity Disorder, is someone who’s fidgety, kind of speedy, talks too much, very outgoing, takes too many risks and gets into all sorts of trouble.
Few people realize that describes only a portion of adults with ADHD. Despite the fact that hyperactivity is in the name, most adults who have ADHD aren’t hyperactive and may never have been — even as children.
There are in fact three subtypes of ADHD: Predominantly Hyperactive, Predominantly Inattentive, and Combined.
Predominantly Hyperactive is the one we’re all familiar with. People with the Combined type have aspects of both hyperactivity and inattention, and often show very few hyperactive symptoms as adults.
Finally there’s ADHD-Predominantly Inattentive, (also known as “ADHD-PI or “Inattentive ADHD”) who may never have done anything more hyperactive than compulsive doodling.
What Causes ADHD
ADHD is a glitch in the brain – something wrong in the wiring or the chemistry. And again, despite its name, it’s not actually a deficit of attention; ADDers can concentrate just fine, thank you, in many circumstances.
What ADHD is, is a deficit in the brain’s ability to easily, naturally and subconsciously direct, regulate, control and prioritize attention.
Every moment, your brain is flooded with information coming from within and without — everything from the words on this page to the sounds in the room, to the thoughts and emotions you are having, down to the sensation in your big toe.
From all of this information, your brain is constantly comparing and carefully calibrating how important each bit of information is, how much of your conscious mind it deserves to get, and whether it’s important to remember. Most of this work is done totally without you thinking about it. And that’s a very good thing! If you had to think consciously all the time about what you need to pay attention to, the way you did when you first learned to drive, you’d be too exhausted to live.
This “executive secretary” in the brain, working quietly and unassumingly in the background, is responsible for making our daily lives run smoothly. In many ways it manages and directs us. If you’re a “neurotypical” person whose “executive secretary” is working properly, it makes you feel, for example, long ahead of time, when you are starting to run late to catch a plane — and you speed up your day accordingly. It makes you notice and get energized when your boss mentions in passing that he or she needs something done by tomorrow. Your focus naturally shifts. What you were doing up until then starts to feel less interesting, or at least less compelling, while the things you need to do for your boss become more so.
In people with ADHD, however, this inner executive secretary is off-kilter. If you have ADHD, rather than consider all sorts of subtle factors (like the departure time of your flight, the distance from the airport, likely traffic, and the look on your boss’s face), your executive secretary tends to automatically assume that the most important information is coming from the strongest stimuli. So whatever’s loud, close, new and novel, urgent or intrinsically interesting automatically gets almost all of the attention. If there’s nothing loud, close, novel, urgent or intrinsically interesting, it’s hard for the secretary to kick in and do its job.
What’s more, in people with ADHD (especially the Inattentive type), their brain and central nervous system don’t filter out signals coming from within to the same degree, so inner thoughts, feelings and impulses come through “louder” and more insistently than they do for other people — making it hard to hear and discern subtle signals from others.
This throws all sorts of systems out of whack. Like a virus in an otherwise powerful computer, ADHD creates weird, seemingly inexplicable difficulties in otherwise intelligent and sane people, and generally gums up the works to make ADD’ers work harder than other equally intelligent people to succeed at life.
Seven Common Signs of ADHD
Many people think that ADHD is practically synonymous with hyperactivity and impulsivity. But that is a misconception. Adult ADHD is marked by a set of symptoms and behaviors of which hyperactivity and impulsivity are only two, and not even the most important. Having any of the following symptoms wouldn’t be much of a problem, but put them all together (as they usually are) and you have something that really gets in a person’s way.
- Disorganization – ADDers are often surrounded by clutter and chaos. They seem to attract it. Nothing ever seems to get put away. When it is, it is replaced with more clutter. ADDers often feel totally overwhelmed and hopeless about the messy piles around them.
- Forgetfulness — ADDers have a tendency to lose or misplace their keys, wallets and phones. They also forget appointments, forget what people request of them, and even forget sincere promises they’ve made — which makes other people very angry, since it looks, to a neurotypical person, like they just don’t care, or like they’re being deliberately or unconsciously “passive-aggressive.” I think most people who are called “passive-aggressive” are probably suffering from undiagnosed ADHD.
- Distractibility — Not surprisingly, it’s easy for ADDers to lose their focus on things. In people with Inattentive ADD, their own thoughts tend to feel a lot louder and more important than what comes from outside themselves — which can make people with Inattentive ADD brilliant at abstract ideas, yet totally lost dealing with physical reality.
- Trouble starting tasks and following through on them to completion — Anything requiring a lot of thought and a complicated multi-step process over a period of time, such as a school project or work report, or redecorating a room, can overwhelm people with ADHD — and then they may stop in their tracks for months, even years. People with ADHD also frequently lose interest in a project halfway through and not be able to complete it. And sometimes, the strangest little things — such as mailing a letter at the post office — can become a huge, seemingly insurmountable block.
- Difficulties with time management — Being late for everything. Procrastinating. Missing deadlines. Spending hours doing something you didn’t mean to do instead of the thing you HAD to do. Because of their disability, ADDers have a very tough time with time.
- Inability to handle boring tasks — Almost nobody likes paperwork. But for ADDers, complicated yet meaningless and boring tasks like paperwork feel like torture, and they can’t get them done in a timely manner to save their lives.
- Inconsistency — ADDers are consistently inconsistent. This can drive other people crazy, because they never know when the ADDer will come through. It also makes it hard for other people to believe that ADHD is a real handicap. People who are paralyzed can never stand up and walk, but people with ADHD sometimes do great work, which makes other people understandably feel that they’d do better if they only tried harder.
With all these difficulties, no wonder many people with undiagnosed ADHD often have low self-esteem and are either chronically anxious or chronically somewhat depressed. They’ve been getting the message their entire lives that they’re not meeting expectations. They forget to pay bills and then get late notices. Their bosses and spouses and co-workers are all disappointed in them. They underachieve and don’t know why. All they know is that they’re working harder than everyone else, it seems, just to live and get the normal tasks of life done, and they do them worse than almost anyone they know.
In fact, ADDers often go through life with a constant underlying sense of dread, always wondering when the next thing is going to happen that in their mind proves once again to the world how incompetent they are at meeting life’s challenges.
Inattentive ADD Causes Special Problems
People with Inattentive ADD have an added problem. A study of Predominantly Inattentive children found that unlike hyperactive children, who knew the social rules of the playground but were too impulsive to follow them, kids with PI didn’t pick up on social cues and didn’t know how to react the “right” way to get accepted into other children’s games (and they tend to be less physically coordinated as well). So they were left alone on the sidelines. Growing up, people with PI can be great at close, one-on-one relationships; being tuned into their own inner world so much, they often learn to be very good at tuning into other people’s inner worlds. But they don’t know how to relate in more goal-oriented and less personal settings. This of course can make the typical work environment a very painful place for people with PI.
In some ways, it may be easier to be a person with Hyperactive ADHD than to have Inattentive ADD. Hyperactivity and impulsivity often leads those who have those symptoms into serious trouble, especially when they’re young. But if they get harnessed to a goal, their energy level and lack of inhibition can help them succeed (even if they wreak havoc in the process).
But in people with PI, all of their great ideas ricochet inside the pinball machine of their minds, unable to escape into the world of action. They can never begin, or take more than one or two steps, toward the goal they can imagine so vividly. As the years go by, they feel worse and worse about what they haven’t done.
Why Therapists Don’t Pick Up on ADHD
Because of their difficulties, people with every type of ADHD frequently end up in therapists’ offices. But even though it’s not that hard to screen for ADHD, too many therapists miss it, especially ADHD-PI.
Why does this happen? I believe it’s because of some very deeply held assumptions in the field of psychotherapy.
Most therapists are strongly rooted in the idea that their clients’ problems are caused by unprocessed thoughts, emotions and beliefs usually left over from childhood, and that listening, reflecting, relating, and working through these old unresolved painful emotions and erroneous beliefs, will eventually lessen or eradicate them. It’s easy for a therapist to think that if you deal with the anxiety or depression or trauma in a person’s background, their ADHD symptoms will no longer be a problem.
It’s not true. ADHD is a processing problem. It affects how you experience and interact with the world, and working through your traumas isn’t going to make it go away. If you’ve been going to therapy for many months or years, and you feel as though you understand yourself a lot better but your biggest problems haven’t changed much if at all, consider that you may have Adult ADHD.
I filled Brenda in on some of this, and then asked her a few more questions.
“Did you always have these problems?”
“I think so. I did well at school, but that’s just because learning and remembering things for tests came easily to me. I had a hard time remembering my homework and handing in papers on time. I almost flunked out of college in my freshman year, but my parents made me sweat it out. I’m glad I did. But I never stopped feeling like I was under the gun all the time. And when a class was one of those lecture types – I hated it! I almost couldn’t stop myself from falling asleep!”
“Are there times when you don’t have these issues?”
Brenda brightened. “When I go camping, I’m usually the most organized person there. I love getting my gear ready and having exactly what I need exactly where I need it.”
“That’s great!” I told her. “Are there other people in your family who have ADHD, or you suspect that they do?”
She made a face. “My brother and my uncle. But they’re train wrecks. That’s why nobody thought I had it. My brother’s never held a job for more than three weeks, and he’s been in jail for DUI. Me, I graduated with a Master’s degree. I was the golden girl.”
For true ADHD, it had to have started in childhood. No one gets it when they’re 30 or 50. But it may have been masked, by high intelligence, or coping mechanisms, or a parent who was constantly managing everything.
Second, it has to be global. ADDers typically have some area or activity in their life that so engages them that they exhibit hardly any ADHD symptoms when doing it. This is very important information, because this may be their true calling! But you can’t be ADHD at work and totally not ADHD at home. If you are, you probably don’t have ADHD; more likely you’re in the wrong line of work.
Finally, since it runs in families and looks to be hereditary, you most likely have at least one other person in your family who also has it, though, as with Brenda, it may show itself as a different type.
Within the next couple of sessions I discussed with Brenda the possibility that she see a physician or psychiatrist for a prescription for stimulant medication. While medication is no panacea, I have found that it helps people with ADHD calm down and focus. Their minds are not as busy, and as one client put it to me, “It turns down the talk show that’s always going on in my head.”
Brenda was reluctant at first, saying that it had never helped her brother. I told her that the medication alone doesn’t fix things, especially if you refuse to look at what you’re doing that causes you problems. She tried it, and it helped her more than she expected.
After that, without ignoring her childhood history or the anxiety and low self-esteem that plagued her, we worked on many little things. We worked on getting a “feel” for time and how to use it. We worked on what her priorities were, month to month and day by day. We worked on understanding the priorities of her job and what her boss did and didn’t want. She started to get praise and compliments at work, including from her boss. Finally, slowly we walked through and worked out every step she needed to take to reach long-held goals, and I helped her not to forget or give up on them.
Her desk and apartment were still a mess, though less of one, but she started feeling connected to and well-liked — even admired — by the people around her. She started to see herself moving toward goals and dreams she had given up on, and she started to feel like she was enjoying and appreciating herself, even when she was alone.
This wasn’t a quick fix. There were many times Brenda felt frustrated with herself, thought she’d never change, and wanted to quit. But in the end she changed the way she saw herself and the way other people saw her. For the first time, she knew where she was going in her life, and had a plan she was following for getting there.