Any other grad students with ADHD?

[Rivi]

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[Therapist4Chnge]

*raises hand*

I tried to get through grad school without having to go back on stimulants, but that ended up being a battle of futility. In my prior career I had advanced high enough that I could control my day and how I did things, but in grad school you are at the mercy of your mentor/class schedule/supervisor, etc. I still struggled at times in my prior career off meds (even with having a personal assistant to handle my schedule, a quiet office to do my work, etc), but grad school off meds for me was like trying to study organic chemistry while sitting in the student section of a college football game.

When I decided to go back on stimulants, it was important for me to have all of the recommended paperwork and the support of my prescriber because it took awhile to adjust for the right dosing, etc. It was amazing how different my experience became when I was finally on a stable dose and I could incorporate all of the strategies I built up during my time off meds. Be warned that if you need any kind of accommodation down the road (e.g. EPPP), they will probably require paperwork out the wazoo before they grant them. It took an extra 3+ months of dealing with my state licensing board to sort it all out.

 

[AcronymAllergy]

*raises hand*

I tried to get through grad school without having to go back on stimulants, but that ended up being a battle of futility. In my prior career I had advanced high enough that I could control my day and how I did things, but in grad school you are at the mercy of your mentor/class schedule/supervisor, etc. I still struggled at times in my prior career off meds (even with having a personal assistant to handle my schedule, a quiet office to do my work, etc), but grad school off meds for me was like trying to study organic chemistry while sitting in the student section of a college football game.

When I decided to go back on stimulants, it was important for me to have all of the recommended paperwork and the support of my prescriber because it took awhile to adjust for the right dosing, etc. It was amazing how different my experience became when I was finally on a stable dose and I could incorporate all of the strategies I built up during my time off meds. Be warned that if you need any kind of accommodation down the road (e.g. EPPP), they will probably require paperwork out the wazoo before they grant them. It took an extra 3+ months of dealing with my state licensing board to sort it all out.

I've worked with people in helping them to meet the paperwork demands of some of the "higher-level" standardized tests and professional licensing-related exams (e.g., LSAT, MCAT, Steps, Bar, Praxis), and can definitely attest to this point. I believe we were ultimately successful in nearly every case, but it can take a healthy chunk of time (and serious persistence) to gather together all of the specific materials needed, and I only saw a small portion of said demands.

 

[Psychadelic2012]

Be warned that if you need any kind of accommodation down the road (e.g. EPPP), they will probably require paperwork out the wazoo before they grant them. It took an extra 3+ months of dealing with my state licensing board to sort it all out.

Just curious--what kind of accommodations are you talking about?

 

[AcronymAllergy]

...The biggest problem I have now is the internet. Much too readily available distraction...

You could probably make the argument that the internet has simultaneously been the single biggest boon, and curse, to productivity in the modern age. Possibly even the entirety of humankind (said with only a moderate amount of hyperbole).

I'm horrible with procrastination myself, though, and have found that what you've said regarding breaking tasks into smaller/more manageable "pieces" is absolutely necessary for me. As is scheduling and setting deadlines. Otherwise, I'll quite easily find myself thinking about what I need to, or should, do for an hour or two rather than actually doing any of it.

 

[IT514]

(as a youngster, I frustrated my teachers because I'd re-interpret their assignments into something I found interesting instead of what they assigned)

This made me laugh out loud. I still frustrate almost everyone in my life (advisers, supervisors, wife) with this, but I REALLY struggled with it early on. I have to say though that in life beyond high school, this quality can pay off if used properly.

 

[Therapist4Chnge]

Just curious--what kind of accommodations are you talking about?

For internship....I actually didn't disclose my ADHD until about halfway through, and even then I didn't request accomodations per se, I just wanted them to have an explanation for why I was struggling with certain things. The training staff really cared about providing a great learning experience to the interns, and I didn't want anyone to thing that my inattention, struggle to remember/get to meetings, fidgeting, and a bunch of other things were the result of disinterest or lack of appreciation of their training efforts.

For the EPPP...a quiet room to take the exam and extended time. I went back and forth with even pursuing accomodations because I had made it this far just working harder/smarter than my peers, but I was really struggling to come close to finishing my practice exams in the given time...and that was in a quiet room, at a comfortable time of day for me, etc.

For fellowship...I didn't initially disclose my ADHD, though when I did the faculty pro-actively asked if I wanted to make some tweaks to my day to day work. I never felt comfortable (and still don't), asking for anything 'extra', though I did make some adjustments to the timeframe for submitting notes and a couple other minor things.

 

[Therapist4Chnge]

I was hit with this when I was in 1st grade. Interestingly, psychiatrist said ADHD, psychologist said high IQ/bored.

I never had any accommodations. Took stimulants when I was in 1st grade for about 2 weeks, but parents didn't see the point (performance was fine). I did bomb out of my private elementary school. They got tired of me not doing assignments. Felt bad for my poor mother. On open houses, parents sat at their child's desks. Mine was within arm's reach of the teacher, of course. The school also took away all of my writing implements during class and made me sit on my hands. And I think there were some rules about getting up. I don't remember.

I had the *exact* same experience in grade school. My mother kept a bunch of my old report cards from 1st, 2nd, 3rd grades and the teacher comments included: "T4C is a wonderful child, but he struggles to finish all of his assignments. T4C is a very bright child, but he does not apply himself during the classroom time. T4C is a very inquisitve child, though he struggles to stay on topic." My parents told me years later that one of my teachers admitted to holding her breadth when she called on me because she didn't have any idea what I was going to ask.

My biggest issues were always organization, staying on task (as a youngster, I frustrated my teachers because I'd re-interpret their assignments into something I found interesting instead of what they assigned), and hyperactivity.

I was placed in the honors track and I was still bored out of my mind, so I had to do things to make it entertaining for me. In one of my classes they made us do a simulation of a world economy by assigning us each a country with various goods/services/resources, so I decided to apply game theory to the simulation in an effort to take over the world. I negotiated with each country independantly and ended up controlling all of the ports and enough vital resources to make every country beholden to me. All of the "objectives" we had to agree upon were easily decided because I'd threaten to cut off access to resources if the countries didn't vote in my favor. I considered my victory a blueprint for American Imperialism, but my hug-our-problems-away teacher was furious that I intentionally ruined her simulation. To-ma-to...To-mah-to. 😀

 

[Pragma]

I don't have ADHD (although I bet my boss thinks I do).

But, I have participated in diagnosing ADHD/LD in folks obtaining advanced degrees (i.e., medical school). Documentation is really important, so I would make sure you have updated information on file from your physician and ideally psychiatrist or whoever is in charge of your ADHD medications (in the future).

They also may want testing on file for things like the EPPP and licensure, although perhaps a student who got accomodations could tell you more specifically. They are requiring these things just for undergraduates, so I would imagine some formal evaluation will be needed if you pursue any sort of accomodation.

 

[AcronymAllergy]

I don't have ADHD (although I bet my boss thinks I do).

But, I have participated in diagnosing ADHD/LD in folks obtaining advanced degrees (i.e., medical school). Documentation is really important, so I would make sure you have updated information on file from your physician and ideally psychiatrist or whoever is in charge of your ADHD medications (in the future).

They also may want testing on file for things like the EPPP and licensure, although perhaps a student who got accomodations could tell you more specifically. They are requiring these things just for undergraduates, so I would imagine some formal evaluation will be needed if you pursue any sort of accomodation.

Most of the exams and such will actually explicitly spell out what types and/or actual names of tests they require, yep.

 

[Therapist4Chnge]

Things didn't really click for me until middle school when I was put in the "gifted" program. Then, school was much more fun.

It didn't happen for me until high school, and even then it was towards the end of high school when I did a scholars summer program (I called it "Nerd Camp"). Thanks to Facebook and LinkedIn I've gotten back in touch with 6 people from my cohort, and we all ended up in an academic setting: 3 neuroscience PhDs, 2 MD/PhDs, 1 environmental engineer PhD. I guess we need to keep up that nerd stereotype. 😀

 

[ClinPsychEnthus]

Wow. I have been working with a psychologist/coach and a psychiatrist for this, and was feeling very alone as being a woman in grad school with ADHD. I'm encouraged to see I'm not alone.

I've found that a low dose stimulant, a plan for my days to help me get through assignments, studying etc., organization, and having a lifestyle that supports ADHD management (how I eat, sleep, exercise, etc) all have helped a lot- though I have my up and down days/weeks.

I haven't needed any specific accommodations, though I am working really hard/struggling to get through writing sections of my dissertation now.

 

[ClinPsychEnthus]

oh, and by psychologist/coach, I mean a licensed PhD from an APA accredited program and internship who has developed an expertise in working with adults with ADHD, who agreed to coach me through the skills development and implementation. I really appreciate that she is working with me in such a flexible and helpful way.

 

[deleted176373]

Wow. I have been working with a psychologist/coach and a psychiatrist for this, and was feeling very alone as being a woman in grad school with ADHD. I'm encouraged to see I'm not alone.

I've found that a low dose stimulant, a plan for my days to help me get through assignments, studying etc., organization, and having a lifestyle that supports ADHD management (how I eat, sleep, exercise, etc) all have helped a lot- though I have my up and down days/weeks.

I haven't needed any specific accommodations, though I am working really hard/struggling to get through writing sections of my dissertation now.

I am happy to see that I am not alone either, I have struggled with this all my life and I am finally going to seek treatment now, I have finally hit the wall regarding my lack of focus and organization. How it got missed is unbelievable really. I spent grades 4-6 with my desk anchored to the teachers desk because I was so difficult to keep in my chair and out of "trouble". In a quiet sterile environment I can do great, add distractors and my effort has to shoot way up to concentrate, to be honest, its exhausting. When I am focused, I do extraordinarily well.

We will see what my pcm says about treatment options. My recommendation is to take care of yourself. Self care means addressing any issues you have, including your mental health. Took me a long time to accept that part of my professional responsibility really does include caring for myself.

 

[Therapist4Chnge]

You mean you can't just work harder/longer to overcome it? <--I was stuck on this for a number of years bc I had shown some ability to be off meds and function (if I had control over my job, hours,etc).

Be warned that some providers (GP, FP, some psychiatrists, etc) hold some very biased views about a Dx of ADHD as an adult....even if the person had the Dx as a kid. Depending when they trained, it was often framed as a childhood only issue (bc of early age Dx criteria), so they don't know how to approach an adult case. It took me awhile to find a specialist, but it made all of the difference in the world.

 

[ljpm8224]

The biggest problem I have now is the internet. Much too readily available distraction.

^^ First of all, this guy's entire post was super helpful, so thanks. Second of all, here is what I did to mitigate this problem. It's pretty draconian, but worked well for me. My grades actually improved remarkably once I did this:

- had my boyfriend used software to block EVERY "time waster" internet site I ever used. I don't have any way to turn them on/access them. This included: my skiing forum, facebook, xojane blog, a couple other blogs I loved. I can't access them at all... it just doesn't load. If I reallllly want to check them, I can load them up on my cell phone (Droid) but it's too slow, too small, and too much of a PITA to actually be that engrossing and a time sink for me. One side effect of blocking all my "fun" internet was I defaulted to using SDN as my new time waster, but at least it is helpful/motivational and informative over here even though still some time wasting and general puttering around happens here as well (hello, Lounge!) 😀

Another overall solution that I should use more but don't always have success with is make a daily routine and stick to it.

Oh and one other thing that stuck out in above posts: I also really fall into the "planning trap." I used to spend hours or sometimes even DAYS plotting out what I would do, my schedule, what I'd study, revamping and replanning everything. This was particularly engrossing when I was training 30-40 hours a week for Ironmans, so I'd have three sports- running/swimming/biking and plot out three workouts a day and cross training of yoga and some plyometrics and/or weights. I could fill up sheets of paper writing out and rewriting workouts, structuring my days, just losing myself in this (utterly pointless) planning process. Ultimately, it doesn't even really matter how much you structure a plan, you just have to get out there and start doing it. Just get out the door and put your *ss on the bike, or with school- I stopped plotting crazy study programs and just sit down and open the book.

Before I was dx'd, I think I used to "self medicate" my ADHD with massive amounts of exercise- collegiate level swimming and then marathons, triathlons, ultrarunning. Now, I study and work 60 hours a week so I don't always have time to be doing tons and tons of cardio. Switching to powerlifting- that super heavy output of lots of energy, I can get in and out in an hour and feel completely and happily and utterly exhausted 🙂 was a good time saver. But I do miss tri training sometimes! Just don't have time to give up an entire Saturday anymore to an 80 mile bikeride followed by a 10 mile brick run.

 

[AcronymAllergy]

Exercise is a good point. Exercise has been shown to improve executive functions in some populations already. There are some recently published articles showing positive effects, even acutely, for ADHD symptoms. It certainly affects mood. To that end, along with keeping mentally sharp as I age, and staying pretty 😉, I work out 6 days a week.

How dare you suggest my exercise routine may be improving my judgment and decision making...😀

But yep, the "planning trap" can be just as bad for procrastination as complete avoidance of the task. Like my advisor said back when I was spending hours and hours reading, and absolutely no time writing, during my dissertation prep: "dammit, just sit down and write something." And that's what I started doing. Even if I erased it all the next day, I just started getting things out of my head and into written form.

Also, regarding restricting internet usage, I believe there are programs that you can use to set timers so that you can't access ____.com during the hours of 8a and 9p, for example. Or something like that.

 

[deleted176373]

You mean you can't just work harder/longer to overcome it? <--I was stuck on this for a number of years bc I had shown some ability to be off meds and function (if I had control over my job, hours,etc).

Be warned that some providers (GP, FP, some psychiatrists, etc) hold some very biased views about a Dx of ADHD as an adult....even if the person had the Dx as a kid. Depending when they trained, it was often framed as a childhood only issue (bc of early age Dx criteria), so they don't know how to approach an adult case. It took me awhile to find a specialist, but it made all of the difference in the world.

LOL, of course I can work longer and harder. I would stay at work until late in the night to finish my notes when no one was there and distractions were at a minimum. All sorts of bx interventions, and they help, but the underlying problem remains.

As you are well aware. It's not a complete inability to function but the lack of the ability to concentrate with a "normal" level of effort.

With regard to my pcm, that problem is rather easily resolved. My training faculty can clearly see the struggle, and they are on board with me getting assistance. Having a half dozen experienced psychologists in a major medical center willing to provide collateral information and a free standing psychiatry dept means that should the pcm disagree I can get a second opinion. You'd have to be blind to miss this given all the collateral information from others including my parents and training staff. In this respect I am lucky to be at a major medical center.

 

[paramour]

How dare you suggest my exercise routine may be improving my judgment and decision making...😀

But yep, the "planning trap" can be just as bad for procrastination as complete avoidance of the task. Like my advisor said back when I was spending hours and hours reading, and absolutely no time writing, during my dissertation prep: "dammit, just sit down and write something." And that's what I started doing. Even if I erased it all the next day, I just started getting things out of my head and into written form.

Also, regarding restricting internet usage, I believe there are programs that you can use to set timers so that you can't access ____.com during the hours of 8a and 9p, for example. Or something like that.

Do we have the same dissertation advisor? 😳

 

[AcronymAllergy]

Do we have the same dissertation advisor? 😳

Haha I'm imagining it's probably a line they're taught at dissertation advisor's summer camp, or something like that.

 

[nads1219]

So I thought I would throw in my two cents on this since I wasn't officially diagnosed with ADHD until this week (Im a first year medical student).
I made it through elementary, middle and high school fine. I was also one of those kids that struggled with organization. If I didn't find it interesting I didn't give it any of my time, but the things I loved I excelled in. I was often bored in class and teachers complained to my parents that I was very smart but would never complete my assignments. Busy work was my enemy. I knew the GPA I needed to get into college and was accepted into the state university, which was my school of choice. I had always wanted to be a physician so I knew that some day I would need to get my ass in gear and get better grades... once I got to college 🙂
Once again, I passed college because I could ace an exam with minimal effort, but could not focus enough to organize all the small assignments to get top grades. I coped by exercising and taking extra time to study. Once I got focused I could do well, but very often I would have to sit down 4 or 5 different times before I could settle myself enough and focus long enough to get the assignment done. Because of the light load in college and ample free time, this worked fine and I was accepted to medical school.
Once I got to medical school I no longer had enough free time to manage with my usual coping mechanisms. I was often frustrated by the overwhelming amount of work (like every other medical student in the world) and couldn't keep up with the course load because I would get easily distracted. Compounding the problem was my easy distractibility during lecture. I stopped bringing my laptop to class and took hand written notes and sat in the front. It wasn't adequate. I could focus for 10-15 minutes at a time, but definitely not the 6 straight hours that was expected. I was passing classes, but knew I had the potential to do better... if only I had more time to study (again this is a complaint every medical student has, and I realize that).
I sought the advice of my academic advisor who happens to be a kick ass family practice physician. She knew my grades, my academic weaknesses and I explained my struggles. She gave me several questionnaires to complete and asked how much coffee I drink in a day. When I told her "I drink 4-5 cups, for some reason it calms me down" she responded with "you have classic ADHD".
I was taken by surprise. I always thought ADD was over diagnosed and everyone has trouble focusing on boring topics, right? that's human nature? I was skeptical but agreed to take medication.
After my first week, I am very grateful for the meds. I sat through lectures and was able to pay attention the entire time, which has never happened before in my life.
After being so reluctant to take medications, I am now extremely grateful for them. I feel like they are allowing me to use the brain I have that I couldn't always call on.
I am hoping after the overwhelming first two classroom years of medical school are over I can go back to my usual coping mechanisms for rotations and practice.
for people that need them, especially people with ADD/ ADHD in high volume and pressure situations, I think medication is a god-send when there simply isn't enough time to only depend on other coping mechanisms.

 

[ClinPsychEnthus]

nads1219-

I was very similar in that past coping (which included a tremendous amount of time wasted to accomplish even small tasks) was no longer possible in my current program at school, forcing me to face the issues that came along with my ADHD and go about solving them in more practical, tangible ways. This involves a small amount of medication, using strategies to make work manageable, exercising and doing more lifestyle ADHD management stuff... its just amazing how being busy forced me to accept that my ways of coping were really insufficient.

 

[Neuropsych2be]

The biggest problem I have is that doing detailed stuff is hard. I love writing psych reports and taking data and synthesizing it.I *hate* editing the report, looking for typos or the inadvertent double negative. I also struggle with time management and organization. I always underestimate the amount of time a take will take. In order to cope I always alot myself twice the amount of time I think I should take. Also doing couples therapy or family therapy is abitch because I get too distracted by too much stimuli.

 

[Neuropsych2be]

T4C

Love the story about the simulation. When one of my many plans for planetary dominion come to fruition, I'll put you in charge of something!

 

[BalanceInChaos]

I decided to join this network after reading some other grad student experiences with ADHD. I have had similar experiences to many people who have posted about this topic (thanks for sharing) and it certainly helps to know I'm not the only one in this boat!

I was recently diagnosed with ADHD following the 2nd year of my PhD program in school psychology and even though the diagnosis made sense to me on a lot of levels, it was still really difficult to accept to be true. For a while I thought I must be faking it or something because I couldn't understand how I could get to this point in my life with ADHD. I also work with many children with ADHD and obviously it manifests very differently in children than adults, not to mention gender differences as well. So I was definitely working with a different image of the disorder in my head. As a woman with ADHD, I suffer from extreme inattention and struggle with my organization skills. When I was diagnosed about a year ago, I had originally sought help for anxiety, which I learned was stemming from my inability to focus and complete tasks without major obstacles and stress. It's no surprise that my ADHD began to clinically impact my life when I started all the more independently organized tasks of my program (i.e. qualifying exams and dissertation). Although medication has been helpful, I can certainly say it is not nearly enough to help me manage my symptoms.

I have jumped around therapists to help me organize my life and keep me in check but sadly the hectics of every day life have made it difficult for me to go regularly. Now that summer is here I have been able to make a few regular appointments but I think I need to keep it going into the school year. It's really interesting to me that my stress levels are still pretty high in the summer despite the slower pace, but I guess that's when self-directed time management and organization skills are most needed!

Anyways, I appreciate reading everyone's experiences and even more so the opportunity to be able to share my story with people that may understand. I am curious about how others have dealt with spouse or partner difficulties in managing your ADHD? I got married just a few months before my diagnosis and it's been a challenge to adjust to living with a partner, going to school, and re-learning about myself in the context of my ADHD. I find that my partner has had trouble understanding how this actually impacts my life (especially with the fallacy that people with ADHD don't go far) despite my best intentions to communicate it to him. I would love to hear other people's experiences with this aspect as well. Thank you all again for your perspectives!

 

[ClinPsychEnthus]

Balance-

I'd love to recommend some things that I have found personally helpful.

1. I have been seeing a clinical psychologist who has taken on the role of coach for me, who specializes in working with adult women with ADHD. Her normalizing my experiences has been very helpful for me to not blame myself and get really stuck.

2. Books! The ones I have enjoyed the most have been:

Judith Kolberg & Kathleen Nadeau (2002) ADD-Friendly Ways to Organize Your Life. This book has been super practical and has brought up things that I deal with (one example is choosing an outfit in the morning...) that I had NEVER realized was a part of my ADHD experiences. It also has pointers in it for when working with a coach or organizer could be helpful (certain experiences in certain topic areas, etc.)

Kathleen Nadeau & Patricia Quinn (Eds.) (2002) Understanding Women with AD/HD. This has topic areas for various women's struggles, things that can come up for women in various life stages (i.e. motherhood), and various sections for addressing issues related to significant others and romantic relationships that I have found to be excellent talking points when I work through various aspects of this with my S.O. Excellent book.

3. Give yourself grace. You were able to pull some things off before, sure. Maybe you had less demands on your life then. Maybe age is catching up (I think this one was true for me. I just started needing more sleep...). Whatever the reason, you were never working at peak efficiency, and now you know it. That's empowering, because now you can pursue doing something about it!

4. I'm purposely trying to take my psychologist/coach's advice on making my life work smoother- I'm working less (which is hard with less money) so that I can have more time to work better on school (dissertation, externship...); I'm eating more intentionally/more healthy, I'm working out more and sleeping more (usually the things I cut when I'm losing time from distractions...), I'm taking more limited and intentional breaks, and I'm on a low dose of a med now. Their advice regarding lifestyle changes like these have made a significant difference in my life. Therefore, I'd recommend that you talk to your medical doctor, and see if you can get referrals or even have them work as a team (my coach and prescriber do, and its awesome!) to develop a realistic plan individualized for your realistic life demands and needs, to help you get through this... knowing that getting through dissertation and exams etc. can give you the ADHD management skills you need to also get through other life stages, like early career, childbearing or raising, etc.

Good luck to you! I believe you can do this!!

Feel free to PM me if you want to discuss anything, though I can't guarantee I'll get back very quickly depending on how often I log onto SDN.

 

[compassionate1]

.

 

[Doctor Eliza]

I myself don't have this diagnosis, so I can't speak to any of the specifics of your questions. However, I wanted to let you know about a mental health related board called psychcentral.com (which I think is partnered with SDN in some way) where there are lots of chat boards with people asking and answering questions like yours. You will get a lot of responses there and not run the risk of infringing on SDN 's no medical advice policy.

Also, please see a real psychiatrist and not a PCP. PCP's training in mental health issues is so minimal and I cannot even count the number of clients I have had who had PCP's give them terrible advice on meds. Further, since you are self-diagnosed, a psychiatrist will be able to confirm the dx and discuss in detail treatment options. Also, my sense is psychiatrists are much more aggressive with meds, so if you need them, they won't hold back.

Best,
Dr. E

 

[compassionate1]

I myself don't have this diagnosis, so I can't speak to any of the specifics of your questions. However, I wanted to let you know about a mental health related board called psychcentral.com (which I think is partnered with SDN in some way) where there are lots of chat boards with people asking and answering questions like yours. You will get a lot of responses there and not run the risk of infringing on SDN 's no medical advice policy.

Also, please see a real psychiatrist and not a PCP. PCP's training in mental health issues is so minimal and I cannot even count the number of clients I have had who had PCP's give them terrible advice on meds. Further, since you are self-diagnosed, a psychiatrist will be able to confirm the dx and discuss in detail treatment options. Also, my sense is psychiatrists are much more aggressive with meds, so if you need them, they won't hold back.

Best,
Dr. E

Hello Dr. E.

Thank you for your sound advice.

I will try psychcentral but the mere thought of going on additional site / chat room is already making me tired. One coping mechanism I have learnt to use over the years to deal with my ( self-diagnsed) ADHD is to simplify whenever possible. So owning less things, having fewer memberships, only attending social and community functions which I really deem important etc. I was carefully considering whether my questions border on asking for medical advice prior to posting and would like to clarify and state that this is certainly not my intention! I am interested in hearing about the personal accounts of other individuals in the field who have walked a similar path, with the understanding that every person is unique and what has worked for one may not be the case for another. So I hope that I am still welcome here and please let me know if any of my questions is/are out of scope, I can edit and would still appreciate general feedback about my post. Thanks!

As for your other advice that I see a qualified psychiatrist: The mental health aspect of my health insurance is not that great and I may only be able to see a mediocre psychiatrist which may end up being worse than seeking advice from my PCP who is at least a decent doctor ( although I agree that she may not be an expert on mental health issues and related meds). I did speak to a trusted psychiatrist friend at the clinic where I work and he suggested concerta low dose but of course it is not the same as being properly evaluated. Perhaps I need to do further research to find the right psychiatrist within my insurance network ( paying privately to see someone top-notch in the field is not an option right now).

Still would love to hear others' experiences on or off ADHD meds in PhD/PsyD programs and what coping mechanisms they had cultivated that were helpful to them.

Kind regards,
Compassionate1

 

[compassionate1]

Thanks for your perspective and detailed answers, Rivi!

What do you do when you have to see clients AND take classes on the same day?

I am fine when I teach ( In the "zone", attentive and interactive), I am mostly fine when seeing clients ( unless I find the client's narrative very boring which, thankfully, does not happen often). Most of my difficulty stems from having to get my act together in the morning, and getting ready for activites, when things are not as structured and I need to create my own. My ability to navigate through time and space: time management, finding things that are right there in front of me ( but I do not see them for some reason), not remembering where I parked my car. Also sitting through class has always been an issue, and the older I get, the less patience I seem to have for long lectures. Starting classes in a few weeks...

Thanks again,
Compassionate1

 

[cara susanna]

I would encourage you to seek out a formal diagnosis. As I'm sure you aware, numerous psychological conditions have symptoms that are similar to ADHD.

 

[Therapist4Chnge]

I would encourage you to seek out a formal diagnosis. As I'm sure you aware, numerous psychological conditions have symptoms that are similar to ADHD.

This.

Increased attention while on a stimulant isn't sufficient to confirm a Dx, as psychostimulants typically have this effect on ppl w & w/o ADHD. Because of the complexity of the differential Dx w. commonly occurring Sx's like inattention, it is important to have a solid group of professionals to help sort these things out.

There is also a secondary consideration of outcome response being sufficient reason to use a psychostimulant, but that becomes more of a philosophical argument of treating dysfunction v. Optimizing/maximizing abilities.

 

[compassionate1]

I would encourage you to seek out a formal diagnosis. As I'm sure you aware, numerous psychological conditions have symptoms that are similar to ADHD.

I am wondering if the fact that one knows the criteria may interfere with the process of evaluation and accurate diagnosis as one is more likely to report symptoms they think they may have based on that knowledge ( and I do mean honest reporting; not manipulating the process due to prior knowledge).

Also, your guys made me question myself so I just opened my DSM and checked again: I still meet current criteria for ADHD combined type and I do not meet criteria of any of the differential diagnoses. Never received any formal diagnosis for anything and was never on any medication. But I do not think I am imagining things. Just learned how to compensate really well and hyper-focus but it is taking its toll on me and leaving me drained and unable to function properly in other areas of my life.

 

[compassionate1]

There is also a secondary consideration of outcome response being sufficient reason to use a psychostimulant, but that becomes more of a philosophical argument of treating dysfunction v. Optimizing/maximizing abilities.

This is a very interesting point which certainly merits discussion. Perhaps an even broader point is how does one define dysfunction and the difference between an objective vs subjective perception of impairment. I was present at a talk by DSM 6 task force head Dr. David Kupfer, and he said that indices of severity is becoming a topic of greater focus in DSM-5.

Which is more important : Impairment, perceived impairment or the experience of Distress? ( The example of phobias comes to mind. A person may still meet criteria if they approach the feared object, yet experience excessive distress while doing so. )


Compassionate1

 

[Doctor Eliza]

I do a fair amount of adult ADHD formal assessment. The two things that repeatedly come up as sticking points are the impairment criteria and age of onset. It is possible to have sub-clinical symptoms of inattention that do not require treatment. Additionally, a good number of people I assess have no childhood history. By definition symptoms need to be present in childhood. I think schools are getting better at catching ADHD (and sometimes going overboard). This seems to result in fewer adults in their 20's and 30's being diagnosed for the first time.

It seems like the folks who think they have adult ADHD and don't frequently have anxiety disorders instead.

Not saying that any of this applies to you, just contributing to the discussion.

Best,
Dr. E

 

[AcronymAllergy]

I do a fair amount of adult ADHD formal assessment. The two things that repeatedly come up as sticking points are the impairment criteria and age of onset. It is possible to have sub-clinical symptoms of inattention that do not require treatment. Additionally, a good number of people I assess have no childhood history. By definition symptoms need to be present in childhood. I think schools are getting better at catching ADHD (and sometimes going overboard). This seems to result in fewer adults in their 20's and 30's being diagnosed for the first time.

It seems like the folks who think they have adult ADHD and don't frequently have anxiety disorders instead.

Not saying that any of this applies to you, just contributing to the discussion.

Best,
Dr. E

Agreed. If there isn't any childhood history, based on what we (at least think to) know about its etiology, odds are it's not ADHD; this is why ADHD is conceptualized as a neurodevelopmental disorder. I'm not a fan of the age of onset criteria as it currently exists in the DSM (and data indicates that it isn't a helpful criteria, particularly in adults), but a complete absence of significant symptoms as a child would, in my mind, essentially rule out ADHD.

Although we also need to keep in mind the marked difference between the more traditional ADHD (i.e., that with some history, even if subclinical, of hyperactivity) and what was previously known as ADD without hyperactivity, which has now been (perhaps erroneously) subsumed under the predominantly inattentive type. Thus, the person may not have come to the attention of teachers owing to the lack of disruptive behaviors/hyperactivity, but may have nonetheless been exhibiting the "quieter" symptoms of an inattentive condition.

 

[cara susanna]

I am wondering if the fact that one knows the criteria may interfere with the process of evaluation and accurate diagnosis as one is more likely to report symptoms they think they may have based on that knowledge ( and I do mean honest reporting; not manipulating the process due to prior knowledge).

Also, your guys made me question myself so I just opened my DSM and checked again: I still meet current criteria for ADHD combined type and I do not meet criteria of any of the differential diagnoses. Never received any formal diagnosis for anything and was never on any medication. But I do not think I am imagining things. Just learned how to compensate really well and hyper-focus but it is taking its toll on me and leaving me drained and unable to function properly in other areas of my life.

Most ADHD evals should involve some type of sustained attention task, such as a CPT. Those aren't self-report measures and I would imagine that unless you intentionally try to do poorly on the test, your knowledge regarding ADHD should not impact the validity of your performance.

I find myself constantly questioning ADHD as I conduct more and more ADHD eval testing. Honestly, is it really so pathological that a child forgets his homework, is poorly organized, and can't sit through a full day of school without fidgeting? Would these have even been issues a few centuries ago? Granted, I know that some kids really do have strong hyperactivity and inattention that severely impairs school performance, but a lot of these kids I've been testing who are diagnosed and on ADHD meds don't seem to meet that. I don't even know how well I would do on an uber-boring CPT.

Sorry to go all Szasz on you guys 😉

 

[Therapist4Chnge]

The age criteria is not perfect, but I think it fits the neurological dysfunction theories currently out there. There can be ADHD-like symptoms due to other organic reasons (TBI, substance abuse/dependence, etc), as well as psychiatric reasons (most commonly anxiety and/or OCPD, though other Dx's can fit). I believe there is an over-dx of sub-clinical presentations, but more severe presentations are still much clearer (assuming organic conditions, LDs, and similar factors are controlled for prior to assessment). I saw some borderline cases while working in a school setting, but then I did some research w. mod. to severe Sx's and it was night & day compared to age/ed equiv. peers (elementary school ages).

It gets a bit stickier w. an adult dx bc there tend to be noted differences in presentation btw the most prominant symptoms exhibited by a child & an adult reporting symptoms. Sustained attention tasks can help tease out some of the attentional difficulties common in both age groups, but they are far from conclusive. *edit* Cara..the CPT, TOVA, and similar are brutal for non-clinical populations.

Coping strategies are probably more prevalent w. adults, but there should still be a ceiling effect that can be observed, particularly when considering performance on higher-level/more complex exec. functioning tasks. I think one of the biggest limitations w. assessment of something like ADHD is that the traditional setting for NP assessment provides more implicit and explicit structure than may be typical for the person. If the child or adult can be observed doing school/work tasks, I think the qualitative data would be more compelling. I'd love to get/see an imaging study looking at activation of the neuroanatomical correlate areas, particularly when recruitment for more complex tasks is needed. I'd suspect to see some major differences.

Just my 2 cents...lw. Some edits to clarify and fix some errors.

 

[compassionate1]

I do a fair amount of adult ADHD formal assessment. The two things that repeatedly come up as sticking points are the impairment criteria and age of onset. It is possible to have sub-clinical symptoms of inattention that do not require treatment. Additionally, a good number of people I assess have no childhood history. By definition symptoms need to be present in childhood. I think schools are getting better at catching ADHD (and sometimes going overboard). This seems to result in fewer adults in their 20's and 30's being diagnosed for the first time.

It seems like the folks who think they have adult ADHD and don't frequently have anxiety disorders instead.

Not saying that any of this applies to you, just contributing to the discussion.

Best,
Dr. E

I defentiely had symptoms as a child. In many respects, they were worse than what I experience now as an adult, who has had the chance to develop some coping mechanisms.

As an adult, I know that it is rude to interrupt others, ignore others, not wait my turn etc. So i refrain from 'bad behaviors' much of the time, but the urge is still there! This leads again to the question: Do we judge by objectivity of symptoms or is this a subjective experience? If so, what should be the balance, in all diagnoses, between observable behaviours vs. subjective units / levels of distress?

Re: anxiety dxs, obviously this distinction becomes essential when medication is considered, since ADHD medication would be bad news for someone who is suffering from anxiety instead.

Kind regards,
Compassionate1

 

[Therapist4Chnge]

If this thread is going to stay open, you prob. should delete all of the recent personal info as it feels like you are pulling for med/psych/neuro insight for your own Dx/differential Dx, instead of the more retrospective and academic examples others (myself included) have posted. Jut my 2 cents.

 

[compassionate1]

Most ADHD evals should involve some type of sustained attention task, such as a CPT. Those aren't self-report measures and I would imagine that unless you intentionally try to do poorly on the test, your knowledge regarding ADHD should not impact the validity of your performance.

I find myself constantly questioning ADHD as I conduct more and more ADHD eval testing. Honestly, is it really so pathological that a child forgets his homework, is poorly organized, and can't sit through a full day of school without fidgeting? Would these have even been issues a few centuries ago? Granted, I know that some kids really do have strong hyperactivity and inattention that severely impairs school performance, but a lot of these kids I've been testing who are diagnosed and on ADHD meds don't seem to meet that. I don't even know how well I would do on an uber-boring CPT.

Sorry to go all Szasz on you guys 😉

Thanks for enlightening me about this! Would both psychologists as well as psychiatrists utilize sustained attention tasks for the purpose of diagnosing ADHD? ( I am a MHC, so formal testing was not part of my training).

Compassionate1

 

[compassionate1]

If this thread is going to stay open, you prob. should delete all of the recent personal info as it feels like you are pulling for med/psych/neuro insight for your own Dx/differential Dx, instead of the more retrospective and academic examples others (myself included) have posted. Jut my 2 cents.

OK. This was not my intention ( as above) but point well taken and will do!

Compassionate1

 

[compassionate1]

The age criteria is not perfect, but I think it fits the neurological dysfunction theories currently out there. There can be ADHD-like symptoms due to other organic reasons (TBI, substance abuse/dependence, etc), as well as psychiatric reasons (most commonly anxiety and/or OCPD, though other Dx's can fit). I believe there is an over-dx of sub-clinical presentations, but more severe presentations are still much clearer (assuming organic conditions, LDs, and similar factors are controlled for prior to assessment). I saw some borderline cases while working in a school setting, but then I did some research w. mod. to severe Sx's and it was night & day compared to age/ed equiv. peers (elementary school ages).

It gets a bit stickier w. an adult dx bc there tend to be noted differences in presentation btw the most prominant symptoms exhibited by a child & an adult reporting symptoms. Sustained attention tasks can help tease out some of the attentional difficulties common in both age groups, but they are far from conclusive. *edit* Cara..the CPT, TOVA, and similar are brutal for non-clinical populations.

Coping strategies are probably more prevalent w. adults, but there should still be a ceiling effect that can be observed, particularly when considering performance on higher-level/more complex exec. functioning tasks. I think one of the biggest limitations w. assessment of something like ADHD is that the traditional setting for NP assessment provides more implicit and explicit structure than may be typical for the person. If the child or adult can be observed doing school/work tasks, I think the qualitative data would be more compelling. I'd love to get/see an imaging study looking at activation of the neuroanatomical correlate areas, particularly when recruitment for more complex tasks is needed. I'd suspect to see some major differences.

Just my 2 cents...lw. Some edits to clarify and fix some errors.

"the CPT, TOVA, and similar are brutal for non-clinical populations." Hi, I am curious about this statement. Do you care to expand?

I agree that it is hard to mimic real life situations in test conditions and compare it with a person's regular level of functioning. Neurological / imaging testing should be very illuminating and I suspect we might see a greater focus on this in DSM 6 or 7.

Compassionate1

 

[cara susanna]

Thanks for enlightening me about this! Would both psychologists as well as psychiatrists utilize sustained attention tasks for the purpose of diagnosing ADHD? ( I am a MHC, so formal testing was not part of my training).

Compassionate1

Psychologists are probably more likely to use sustained attention tasks, from my experience. Psychiatrists and other MDs will often refer people to psychologists for ADHD testing.

 

[Therapist4Chnge]

"the CPT, TOVA, and similar are brutal for non-clinical populations." Hi, I am curious about this statement. Do you care to expand?

They are examples of tasks that require a person to keep focused on a task for a long time. Those types of assessments can take awhile, so even a regular person will get really bored. Some tests are interesting to give...those kind of tests are not (outside of the data they can produce, which tends to be useful).

 

[compassionate1]

Cara Susanna & Therapist4change:

Thanks for explaining!

Compassionate1

 

[Pragma]

I'd love to get/see an imaging study looking at activation of the neuroanatomical correlate areas, particularly when recruitment for more complex tasks is needed. I'd suspect to see some major differences.

It is certainly an interesting adult diagnosis, and adult ADHD evals were common on my postdoc.

A few years ago I saw a presentation where they followed a cohort of children with ADHD and age-matched controls (I think) with functional neuroimaging all the way to adulthood. my understanding was that activation patterns normalized after late adolescence more often than not. Not sure if the data were published or not.

That said, obviously Barkley's work suggests 1/20 adults has ADHD. What I find interesting is how people make decisions about diagnosing it. I had some adult cases where I was really on the fence, as there was some data that could support either a diagnosis or no diagnosis. In some clinics, just saying you are disorganized, distractible, and procrastinate will get you a diagnosis.

It is also a difficult thing to diagnoses via treatment in adults. I know several psychiatrists who do it (i.e., let them take the medications and if it seems to help them, then it must be ADHD). Complicating that is the fact that a stimulant medication would also benefit someone without ADHD.

All that said, there are great habit change/workstyle books out there. I often recommend some of the books mentioned earlier in this thread to people even there is no ADHD diagnosis...because they are good recommendations!

 

[compassionate1]

Hi everyone,

Here is my update:

After seeing a neurologist who specializes in ADHD, I still have my doubts regarding the validity of the diagnostic process and its current methods. i took a computerized sustained attention evaluation task and had done fairly well. Yet, the doctor said that I may have just learned how to compensate and that I still lost attention frequently, just learned how to go right back on track. He put me on a law dose stimulant. This is day #3 and I am not liking the side effects, plus it seemed to work for the first day for a couple of hours, which was great as I was sitting in class and taking notes for the first time in many years! But day 2 and 3 were different: no observable benefits and still some concerning side effects. I reported to the doctor and he was not alarmed and said to keep on it for at least a week. I don't know. I may just have to go back to working longer and harder...naturally, which is disappointing as I was hoping for a positive change in my life, especially at school.

I find that the most difficult for me currently is being able to do independent study/research as I need to structure it on my own but struggle to decide which readings to do and then complete the ones I chose. Any tips on how to do well in an independent study course when having trouble with time management and organization?

Thanks,
Compassionate1

 

[deleted176373]

I'll provide a bit of an update myself:

My story is a little different than the story above, as I knew for YEARS that I was truly ADHD, and smart enough to get away with it most of the time... including in graduate school. I avoided treatment to avoid the label and the stigma. That said, I was beginning to hit the limit of my abilities during my internship and it was becoming a serious problem.

Treatment actually had a number of positive effects and no side effects that I found objectionable. My writing and organization has improved. My frustration tolerance also has increased markedly (i.e. less likely to get annoyed with traffic or delays). I have been able to sleep much better since starting treatment, which really surprised me... I could take a full dose of my stimulant medication late and still fall asleep quickly (far more quickly than I did before).

Therapy with stimulant medication certainly is not for everyone. I suspect that those who don't need this treatment might find the effects of daily stimulant use difficult. For instance, I know some people have reported difficulties with sleep, mood, or feeling jittery on stimulant medications.

Compassionate1, keep working with your doctor. Finding the right dosage with some medications is not as straight forward it might seem. Metabolism and drug half life play a big role in this. I have my medication split across the day because it won't last long enough otherwise for proper coverage.

Mark

 

[compassionate1]

Thank you, Mark. I am glad that medication works for you!
I had the most side effects on the first day. second and third day, they were all gone, minus the chest pressure / pain which persisted. I e-mailed my doctor and he is not concerned which should reassure me, given the fact that I reported my experience in writing, and he would be responsible if something went wrong. But it is still *my* health and my life...

I also read a lot of accounts online from individuals ( many of whom are in school and/or in demanding professions) who stated that stimulants had lost their effects altogether after about a year, or required the addition of further stimulants in the PM hours, just to get through the day. Since PhD takes a number of years to complete, it would be unfortunate for a medication to lose its effectiveness just when you might need it the most. I am wondering if all those of you who shared you are on low dose stimulants have had any such experiences where it stopped working after some time.

I guess very few things are simple in life...Taking PhD level statistics while trying on a new med is not fun! sigh.

Compassionate1