Treating adult ADHD
from the inside out
Brenda’s Story: 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?”
The Right Diagnosis
I filled Brenda in on what ADHD really is; the fact that many people, especially women, have the Inattentive subtype of ADHD; and why many if not most therapists don’t understand and recognize ADHD and don’t offer appropriate treatment for it. Then I 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. I’ve also noticed that people who were extremely athletic as children and young adults, especially in the martial arts, controlled their innate ADHD without realizing it. But when life caused them to stop being so physically active, their ADHD roared in.
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 (ADHD is primarily hereditary and highly heritable), 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.
Brenda’s Treatment
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.
