You Mean I'm Not Lazy, Stupid or Crazy?!: The Classic Self-Help Book for Adults With Attention Deficit Disorder (47 page)

What Happened Here?

Here is Dave and Kate’s sense of what happened to Dave to cause this seemingly miraculous change in medication response. Initially, Dave was not tuned in to himself enough to realize that he had an adrenaline addiction going. He had little or
no awareness of how his habit patterns and his thoughts contributed to a frantic lifestyle. Fight-or-flight
neurochemicals flooded his body/mind system almost constantly.

The fight-or-flight response was not designated for chronic, heavy use. It works best for dealing with brief, concrete threats, such as revving up to kill a woolly mammoth. When the body’s mechanism for dealing with threats
is overused, its stress response is kicked into overdrive. What Dave originally thought were medication side effects were nothing more than his response to chronic stress. The stimulants did not cause his anxiety, he was just tuning in to his body’s sensations, perhaps for the first time in his life.

By the way, Dave is now an ADD coach and the “meet and greet” person on our Web site—addcoaching.com.
His warmth and caring are a wonderful welcome home for ADDers coming to us for help and direction. Dave made a successful transition from a management job that was a poor fit to the world of self-employment.

Not everyone is like Dave … one size definitely does not fit all ADDults. Many of the clients we have worked with have been unable to meditate or work effectively in coaching until they experienced
the benefits of stimulant medication. In our personal experience with ADD recovery, neither of us did very well with the meditation/mental hygiene part until we were more calm and awake … on stimulants.

Upping the Ante

Recovery is a complex process with a number of passages and stages. One of the stages it is important to mention here is what we call the “up the ante” phase. You get diagnosed
and begin medication, after all those years of living in the fog. At first there is a sense of relief, calm and often delight. Wow, this is what it feels like to be normal. You cruise along for a while, functioning at a higher level than you have in the past. Life seems a lot easier.

If only it stayed that way …

Most of us are not content with the status quo … we start pushing the envelope.
We wonder what we are really capable of now that the ADD is under control. In truth, we have an infinite capacity to grow and change. The sky is the limit—ultimately. We forget (or never knew) that it can’t all happen
now
. So without taking time to monitor the effects of small changes, we start piling more and more stuff on our plates. In short order, we are right back where we started. Remember,
an overload of stress equals more ADD symptoms.

Basically, this chapter has been one long commercial for the benefits of meditation … essentially taking a more meditative approach to life. We are not real big on the hard sell, but we decided to push a little bit more than we normally would because we think it is so important. Correction: We know it is absolutely critical to your recovery.

General Health and ADD

ADD symptoms are only part of the picture. Did you know that your general health is affected by the stress of living with ADD? Four years after our own initial diagnoses, we consulted a physician who had extensive experience treating ADD adults and children. He had worked with thousands of patients by the time we connected with him. It is unfortunate that his research findings have
not been published or widely disseminated, because the implications of his observations are stunning.

This doctor has collected all kinds of data on the effect of ADD treatment on general health issues. He is a primary care physician by background who happened to end up specializing in ADD. He has found that all kinds of general health issues improve or resolve when ADD is effectively treated.
The following is a partial list of the health challenges he has found can improve with ADD treatment:

Hypertension Irritable bowel syndrome Asthma Allergies Arthritis Fibromyalgia Ear infections

It is important to note that the treatment in this case is multi-modal, involving coaching/counseling around lifestyle and self-care, as well as a prescription for meditation. It involves much more than
“sprinkle a little medicine on” and see if that works.

Some of the disorders on the list may make intuitive sense to you. Most of us are now aware of the impact of generalized stress on health. I don’t think any reader who lives with ADD would disagree with us when we state that trying to cope with an unpredictable brain is extremely stressful. Irritable bowel and hypertension, for example, are
known to be stress related. What about allergies and asthma, though? Well, the jury is out on those health issues … scientists are still doing the research to attempt to tease out the complicated interactions of mind and body. What we do know, however, is that the nervous system, endocrine system and immune system are intricately interconnected. It makes sense that a brain somewhat out of whack
would interact with other body systems in a less than optimal fashion. Allergies and asthma are primarily disorders of the immune system.

Kate’s former husband and founder of a large group practice treating ADD states that he also sees improvement, over time, of general health issues with ADD treatment. The most striking improvements, in his experience, are seen with autoimmune disorders. (The
immune system again.) Stress is known to be a major culprit in the cause and severity of autoimmune issues.

The endocrine system is also involved in the ADD + stress equation. In the chapter on women with ADD, we went into a
bit more detail about the impact of falling estrogen levels on ADD symptoms.

Paying for Focus at High Interest Rates

In our stories about Carol and Dave, we talked about
addiction to adrenaline, but we did not go into the physiological reasons for why ADDers might tend to get addicted to adrenaline and how it may lead to health problems.

In the central nervous system, the stress response heightens levels of arousal, alertness and vigilance. It also focuses attention and enhances cognitive processes. In the body, blood pressure increases, as do breathing and heart
rate. Blood sugar is raised and the immune system is suppressed. All of these changes are designed to increase the ability to problem-solve and take action, while temporarily shutting down the functions that we don’t need immediately. When we have adapted to the stressful situation, the brain (and more specifically, the hypothalamus) gets messages to turn down the system … just like a home thermostat.

The HPA Axis:
The human stress response is designed to ready us to deal with the immediate source of stress and then return our brains and bodies to a balanced state. In the brain, the hypothalamus sends action messages to the pituitary, which in turn sends the message “downstream” to the adrenal glands. The job of the hypothalamus is to keep the body on an even keel, while the pituitary is
the master gland of the body, directing the various glands to produce more or less of their particular hormones. The adrenal glands produce the hormones most important to the stress response, including adrenaline and norepinephrine. These hormones communicate both with the central nervous system and the body, producing the changes needed to ready us for action. The hypothalamus-pituitary-adrenal
connection is known in scientific circles as the HPA axis.

You may already have had some “aha’s” while reading this little lecture on the HPA axis and the stress response. Hopefully, it has helped to answer the question of why on earth we ADDers would want to create crises and chaos in our lives. If you trip the stress response circuit, you get arousal, attention, alertness, vigilance … all the
tools you need to complete that project you have procrastinated on right up to the drop-dead line. Cool … sign me up!

Sounds like a pretty nifty strategy at first glance. Our effort to solve the sluggish brain problem with an injection of stress, however, has consequences for the body. Recall what those adrenal hormones do to the body—they raise your heart rate, blood pressure and blood sugar.
They also dampen your immune system. The stress response was not designed to handle constant, chronic stress. It evolved to deal with the needs of our ancestors (150,000 years ago) in a world where change was the exception rather than the rule. The ADD adrenaline junkie is, in effect, paying for focus at high interest rates. Yes, you get a few hours of higher performance, but you pay on the back
end with the impact of stress on your brain and body.

What happens when the stress response system (HPA axis) is overused and abused?

From ADD to Stress to Illness

Research on the mind/body connection and ADD is in its infancy. A number of health professionals who work with ADD have noted and written about the apparent connection between chronic fatigue syndrome (CFS), fibromyalgia (FMS) and
ADD. It has been observed that there is a higher incidence of CFS and FMS among ADD women, but the studies to back up this observation are only just beginning. Other ADD specialists have found that a number of general health problems are more common in their ADD patients, particularly stress-related and autoimmune disorders. These specialists, unfortunately, have not published their data as of this
writing. In a chapter on FMS/CFS in
Gender Issues and AD/HD
, the authors—Kathleen Nadeau and Patricia Quinn—propose a model for explaining how the stress of ADD may lead to physical illness. Bear in mind that a model is not proven fact—it is a working hypothesis, or educated guess, about what might be causing an observed pattern.

Warning … Warning! The next paragraph contains scientific information that may temporarily boggle the ADD brain. If this occurs, discontinue reading that one and skip to the next paragraph.

Many studies indicate that an imbalance of the neurotransmitters dopamine and norepinephrine underlies the symptoms of ADD. There is too much neurotransmitter activity in the brain’s limbic system and not
enough in the frontal lobes. As a result, the frontal lobes don’t have enough fuel to carry out important executive functions, while the limbic system is hyper-reactive. The limbic system is the seat of the emotions. One of its important roles is to evaluate input from the brain/body and the external world. It takes this input, compares it with previous experience and labels it with appropriate
emotional coloration. The resulting information is then sent to the frontal lobes and to the body (via the HPA axis). It is the job of the frontal lobes to provide guidance to the body’s “support ser-vices.” These support services (endocrine, immune and autonomic nervous systems) allow the body to take action.

Here is the “lowdown” on the “ADD to stress to illness” model. While it has not been
“proven” it makes a lot of sense.

The person with ADD encounters a stressor or a problem to be solved. His or her limbic system sends messages “downstream” (to body systems via the HPA axis) to get ready for action. So the heart rate and blood pressure go up, along with the other changes activated in the stress response. The frontal lobes of the brain also get an action message. If you recall,
it is the job of the frontal lobes to provide guidance, to tell the rest of the brain and body
what
exactly they are supposed to do. In the ADD brain, however, the frontal lobes are often caught napping. They don’t respond to the action message and the task goes undone. When nothing much happens, the limbic system keeps sending its request for action and support. It’s as if the limbic system is
shouting, and the HPA axis is overreacting,
while the frontal lobes are still snoozing with the headphones on and don’t hear the shouting.

Of course, it is also emotionally stressful to experience this pattern of sluggish or absent response over and over. When you add the negative self-talk about being dumb or lazy, it piles more stress onto an already overloaded system. There is evidence that
stress can actually cause changes in the way the brain and body function. The HPA axis can “burn out” under a barrage of stress, leading to abnormal functioning and stress-related physical illness. The immune system may also give way under an onslaught of stress, increasing the chance of infections, autoimmune disorders and acquired sensitivities.