You Mean I'm Not Lazy, Stupid or Crazy?!: The Classic Self-Help Book for Adults With Attention Deficit Disorder (15 page)

Richard’s mother says he was born with a will of iron and a voice that could shatter glass with a whisper. From his earliest days, he made everyone in the household
dance to the tune of his angry cries. Throughout childhood, he went directly for anything he wanted and shoved aside anybody who got in his way. Now that he’s a forty-three-year-old adult, he seems ruthless and cold as he continues to bulldoze his way over other people’s feelings. He is successful in business but lives in a lonely world. He doesn’t understand why people seem to avoid him.

Richard
really doesn’t get it at all. He’s oblivious of the impact of his forceful nature and is honestly puzzled when others keep him at arm’s length. As he pushes his way through life, he’s aware only of his goals and takes little notice of the people he shoves aside to reach them.

Please remember that the negatives of ADD make up only one dimension
of the disorder. ADDers come in an assortment of packages. There are differences in specific symptoms and in the ways each of us manages these differences. Many of us do an amazingly wonderful job of coping with symptoms of the ADD we never even knew we had!

Lacking an understanding of their deficits, many ADDers feel compelled to spend inordinate time and energy trying to
pass
as normal. This
is a term we’ve borrowed from African-American history. With a long history of discrimination in this country, it isn’t surprising that some lighter-skinned African Americans managed their lives pretending they were white.

In similar fashion, many of us with ADD can pass as normal (whatever that means). We work hard at hiding our differences. We can identify with the adults in this chapter who
have been somewhat successful in their efforts but who have paid dearly for fitting in.

We spend our lives in fear,
feeling like impostors who will be found out at any moment.

A recurring theme throughout the vignettes is the importance of squarely facing one’s behaviors and honestly evaluating them. Many of us, along with the people in our lives, have spent lifetimes wondering why we do the
things we do. We have never considered our behaviors as symptoms and haven’t analyzed our coping strategies as defense mechanisms developed to hide inadequacy. Lacking knowledge about the role ADD plays in our lives, we resign ourselves to the “truth” of the assumptions made about us—we are indeed lazy, stupid or crazy!

If a parent or teacher suspected a problem, she usually attributed it to
poor motivation or a dysfunctional family. Even when a diagnosis of hyperactivity was made in childhood, the prescription was for Ritalin and patience. “Take this pill twice a day, Monday through Friday during the school year, and wait until you outgrow your hyperactivity in adolescence.” Some of us have been waiting a very long time for this miraculous change to occur!

The fact is, many of our
readers have never been evaluated at all. Although there isn’t anything magical about a diagnosis, it is a vital, initial step in changing faulty self-perceptions. Even if you feel fairly certain that you have ADD, you owe it to yourself to have a complete evaluation.

In the next chapter we’ll look at the process of a diagnostic evaluation and share information that can help you make some decisions
about accessing this help. As you may guess, the diagnostic evaluation of ADD adults is less well defined than that of children. So you’ll need to proceed with caution in finding the professional you’ll work with in this important part of your recovery.

Chapter 4
I Know … I Think … I Have ADD: What Do I Do Now?

T
he diagnosis and treatment of a garden-variety illness is fairly straightforward. A throat culture uncovers a strep infection and the patient takes a round of antibiotics and goes on his way. A few days later he feels great. He has come to expect that powerful antibiotics will quickly and easily fix his illness. He views his medical care
as a relatively simple process:

Symptoms—medical tests—diagnosis—treatment—CURE!

The process of uncovering ADD is considerably more complicated. Often, the process never even begins because the symptoms are behavioral, not physical. Many people view behavior as the
cause
, not the
symptom
of disorder. It usually goes something like this:

Behaviors—faulty assumptions—blame—
punishment—POOR PROGNOSIS!

For many if not most of us, the initial discovery of ADD doesn’t come from a professional. It comes from reading an ADDer’s life story that could be our autobiography. It comes from talking with a friend whose description of his ADD sounds remarkably similar to our own behaviors. It comes when our children, who are “chips off the old block,” are diagnosed with ADD.

Adults in support groups talk
of learning about their ADD in all these ways. Most of these adults say they waited a while before seeking professional help to confirm their self-diagnoses. They used this time to read about ADD and to examine their lives to see if the information fit their experiences.

Your Job as a Mental Health Consumer

If you are beginning a similar process of self-discovery, your first responsibility is
to thoroughly educate yourself about this disorder. Part of your self-education should include learning about the professional resources in your community. When you’re ready to proceed with an evaluation, you shouldn’t let your fingers do the walking through the yellow pages of the phone book to find the services you’ll need!

We recommend that you contact the nearest chapter of an ADD support
group. The group can give you leads on ADD-informed professionals in your area. Make sure you ask for names of professionals who are competent in diagnosing and treating adults. Also ask your local organization to put you in touch with other ADD adults who can tell you about their experiences with professionals on the referral list. You may be fortunate to locate an ADD adult support group that can
be an invaluable, informal referral network. For help in locating a group in your area we refer you to the CHADD Web site (chadd.org) and the support group listing in the back of
Delivered from Distraction
, by Edward Hallowell and John Ratey.

Remember that you are the customer and a consumer of mental health services. To be an informed consumer, you need to do your homework before you make your
first appointment. You need to proceed carefully, because many good therapists have little knowledge about ADD.

When you first meet with the mental health professional you have chosen, ask as many questions as you want. If you aren’t comfortable after your initial meeting, don’t hesitate to go on to
the next professional on your list. Your mental health is too important to entrust to someone
you don’t think understands your issues.

After the evaluation is completed, be sure to request a follow-up appointment to discuss the results of your testing. If you don’t specifically ask, the professional may just send a highly technical report to you or your psychiatrist.

Who’s Who

Practitioners from many different fields are qualified to perform diagnostic testing. If you have limited experience
with the mental health profession, you may well find the various titles and professions confusing, including but not limited to:

Ph.D, Psy.D, Ed.D, MSN, MSW, LISC, M.D.

Clinical Psychologist, Neuropsychologist, Cognitive Psychologist, Education Psychologist, Psychiatrist, Mental Health Nurse Practitioner,
Developmental Pediatrician, Licensed Social Worker, Master of Social
Work

The professional
backgrounds listed above can be divided into two main groups, medical and mental health. Any of these professionals are qualified to perform diagnostic testing. The most important question is that of expertise. Is the professional experienced in diagnosing ADD and its comorbid disorders—disorders separate from but frequently coexisting with Attention Deficit Disorder? The various psychologists,
for example, are typically skilled at identifying the specific learning disabilities and dyslexia often present in the individual with ADD.

It may seem odd that developmental pediatrician is included on the list. Interestingly, with extensive experience working with ADD children, the practices of many pediatricians have evolved naturally into treating the parents, many of whom have ADD as well.
The advantage of working with a medical professional is that additional testing can be done should a specific
medical condition be suspected as a contributing factor in an individual’s symptoms. Also, if medication is indicated following an ADD diagnosis, you can continue working with the same person for this part of your treatment.

Consider working with a specialty ADD group practice if one
is available in your area. The benefit is
one-stop shopping
, since both medical and mental health professionals are part of the team.

The Diagnostic Evaluation

There is no medical or psychological “test” that will tell you absolutely that you have ADD. The best diagnostic tool currently available is an experienced professional who takes the time to listen to your story. A diagnosis of ADD is
generally made on the basis of your retrospective history. They will want to know about your ADD symptoms and how they impacted your life in the past and present. For more detailed information about the process of making an ADD diagnosis, we refer you to Chapter 11 of
Delivered from Distraction
.

Tests—aren’t those the things we always failed??

While there is no generally accepted test for ADD, researchers are doing the work that may lead to some useful biological tools for identifying it. Stay tuned for further developments. One medical diagnostic test that seems promising is the QEEG, which measures brain waves. Doctors Hallowell and Ratey, acknowledged ADD experts, have begun to
use this diagnostic tool in their work with ADDers. Another interesting possibility is the SPECT scan, used at this point primarily by ADD pioneer Dr. Daniel Amen. Bear in mind that you are not likely to find these cutting-edge technologies in your backyard.

Of course, ADD doesn’t generally travel alone. ADDers often
also
have learning disabilities and comorbid conditions—that is, other disorders
that may complicate your ADD, such as depression, obsessive-compulsive disorder and other issues. If learning disabilities are suspected, the person in charge of your diagnosis may recommend some neuropsychological tests to be done by a psychologist.

KK:
“It may not matter that the point of these tests is to ‘fail’ them. When I took my neuropsychological tests years ago, I was aware of having
an intense anxiety about going too slowly on the written tests. I tried to beat the clock, even though I was taking the test to get a diagnosis so I could get some
help
! It’s just not that easy to confront your weaknesses head-on.”

Understanding Your Diagnosis

Your follow-up appointment should be a detailed fact-finding mission. You should ask questions about why certain tests were used, what
they measured and how you compared with the normal range for a particular test. When your psychologist explains your results, ask for clarification of terms you don’t understand.

No two ADD people are alike. You should use your follow-up meeting to learn as much as you can about your unique neuropsychological profile. If you leave this meeting armed only with your checklist of deficits, you’ll
have only half the information you need. You must also have a clear understanding of your
unique strengths and the positive compensatory strategies you already use.

You can’t expect to leave this meeting with all the tools you’ll need to manage your ADD. You can expect to leave with specific information about your individual strengths and weaknesses and a framework of treatment options.