About an Adult ADHD Diagnosis: Who to Tell, & What to Say, & How to Tell, & When to Say, & Should I Say It At All?

This coming Tuesday afternoon I'll be attending the second of three appointments at the ADHD clinic.

The first one of course was where I spent about four hours meeting with a psychiatrist and then a pychometrist answering a boat-load of questions. I started off writing a series of psychological measures, everything from depression and anxiety tests to ADHD symptom tests and a psychiatric, medical, family, and historical questionnaires. I ended off the session participating in a computer test that appeared to measure my attention. I had to hit the space bar a lot when certain stimuli appeared in front of me. Despite my best efforts, I hit the space bar when I wasn't supposed to several times. It is hard to pay attention for a long time, says I.

At the end of the appointment, they gave me a blank paper test - one very similar to one I had written measuring symptom severity and life function measures, to give to someone close to me who knows me well. So I gave it to my wife who filled it in that very night. While ADHDers often can be very intuitive and perceptive of others (due to the multiple channels of attention to which they are unintentionally paying mind), sometimes they're not always the best judge of their own ADHD behaviours. It is useful to compare the views of someone close to you, along with your own, to strengthen and validate the observations.

So this coming Wednesday, I'll meet with a clinical psychologist. I don't know what the agenda will be. And the third meeting, still to be scheduled, will probably be a consultation where they review the results of the tests, provide some sort of diagnostic instruction, and hopefully recommend a course of treatment. The course of treatment might be counseling and/or medication, or a long stint in a rubber room, with my very own straitjacket. I'll ask for mine in green, my favourite colour.

All of this takes place during at time when I am discovering new perspectives with myself, and working towards getting a diagnosis and treatment. This will affect me. But it will also affect my friends and family and people I know in various arenas of life.

It begs the questions: who, what, how, when, or even should I let them know?

I crossed a big hurdle yesterday when I went out to my hometown. My wife, me and my little boy dropped by my parents' house to say hello. And I ended up going out for a long walk with little boy and my mum. We walked through the town pushing the little boy while he slept in his stroller through grassy parks and down by the lake, chatting and looking at the new spring growth, the birds and the animals, and the lake. The air was cool and the sun was warm.

All the while my mum and I chatted. I spoke most of the time. She had asked when my next appointment would be, as I'd previously let her know a bit about what was going on with me. So I told her a little about the first meeting, and she asked about what sort of questions they ask.

"Maybe before I answer that, I could go into a bit about what all this ADHD stuff is all about, and then I could better describe the questions if you don't mind me going into some detail", I offered. I wasn't sure how she'd react, and I wanted to gauge whether she felt comfortable talking about it.

She wanted to hear, so I spent the next hour chatting with her about it. She asked me questions, I told her about what I'd read and learned. About the neurobiological basis of ADHD. The fact that it was relatively unknown in adults until recently. The genetic heritability (0.8), and what that means. The inconsistent attention, the impulsivity, the hyperactivity, the daydreaming and zoning out. The different criteria and diagnostic subtypes. The morphological differences that are believed to exist in the various parts of the brain. I spoke about the difference between the white matter, the corpus collosum, and the crenellations of grey matter in the pre-frontal cortex, and the executive functions that are impaired. I also dove a bit into the circuitry and the neurotransmitters, the receptors, and how stimulants like Ritalin are believed to work - comparing them a little to SSRIs in depression. The various parts of the brain that relate to the governance, maintenance and control of attention, and how it is surmised that in ADHD folks, there are neurophysiological differences. I spoke about specific symptoms and of comorbidities of anxiety and depression, and how they related to what scientists know about ADHD. I talked about specific behaviours I've observed in myself, others have observed in me, and she tossed in a few authentic and very interesting observations as well.

Happily I could tell she was synthesizing all of this information. She'd felt bad initially when I told her, she related, because she wondered how she could have known, and why she didn't pick up on this when I was younger. But I reassured her, explaining that really most of the symptoms of ADHD are within the normal range of people, but just amplified to a large degree. It's not like I was hallucinating, or having seizures or something that obvious. Plus people didn't know much about it when I was a kid. ADHD blends into the background of the crowd, I said. I spoke about my historical and school and interpersonal and vocational experiences. I spoke about my emotional and personal experiences. I spoke about the turmoil, and sense of multiple channels being on at all times, the distraction, the failures, and the searching for something that made sense to describe it all.

And along the walk, a chipmunk appeared, or a new spring bird. And I was naturally drawn to them and interrupted the conversation. That's the nature boy side of me. I was completely thrown off my game though when a loud motorcycle began revving its engines near the stroller where my baby slept. When we were approaching a noisy leaf blower. Even when we saw people sitting on the sidewalk. I had to push hard to keep my focus on the conversation. I guess I allowed myself to pause and allow myself to get lost for a minute or two.

I spoke about how attention can be sustained with an ADHD person when that subject or experience is perceived to be very interesting, and yet how it is lost in repetitive, boring tasks, or when something else interrupts or suddenly appears. How when emergencies happen, I'm calm and able to focus on the big picture and will end up directing traffic (in the case of a streetcar/pedestrian accident I witnessed a few years ago), or carrying someone out of a crashed car, up a mountain slope (back in high school, after having been in the accident itself while sitting in the passenger seat) to safety, to more everyday excitement that takes place at my workplace when computer systems are down or faulty and something needs to be done quickly. To some degree ADHD contributes to my successes and unique approaches. And of course contributes to my failures and struggles and interpersonal difficulties.

The signal to noise ratio metaphor is especially compelling to me. When my ADHD (as yet undiagnosed of course) is full-on, I find it hard to isolate a clear signal in the noise taking place around me. I either need to (when I'm at work for example) close my door, or go for a walk, or close my eyes, or shake my leg anxiously when it gets really noisy around me. Or if I'm in a mall, and holding a conversation with someone - I fight to maintain my attention to the conversation. I must look like I'm in tertiary stage syphilis, with a rigid grin on my face, eyes unblinking and unbelievable tension affecting my neck and jerking bodily movements.

I exaggerate a teeny tiny bit, but you get the drift.

I also spoke about the beneficial aspects of an ADHD's person's experience - the ability to sensitively read body language, gestures, environmental signals and various channels of information, above and beyond the merely spoken words in a conversation, that non-ADHDers might not notice. The tendency of ADHD people to have varied interests, various hobbies, and - in my case - a broad range of intellectual interests.

Sometimes that's good. Sometimes that's bad. In novel situations and meetings it can be somewhat useful to watch body language, but in routine business meetings it is probably best to focus on mostly what is being spoken. If you're in a casual or even a dangerous situation, it is useful to have your ADHD multi-channel wits about you. I can bring to bear my knowledge of many arenas of interest onto problems and 'think outside of the box', coming up with novel and non-linear solutions to problems. I have three active blogs and one coming online shortly, a story I have been trying to write over the past few years. Maybe that'll be one of my new projects if I can focus on it!

I went on and on (as I am prone to do). And my mum listened. She remembered comments from teachers and letters she'd written me when she was at her last wits with me in my teens and early twenties.

By the end of the walk, I think we were both feeling better. My heart rate was slower; the nervous buzzing in my hands had left. My mum was inquisitive, relaxed, curious and seemed to be thinking a fair bit. We talked a little about who in the family might also have it. But that's another post.

So that went well. But once I'm through the diagnosis and the start of treatment, who else do I tell? I'll tell a couple of my close friends, and a business colleague I'm close with. My wife knows and hopefully she'll see improvements and changes in my behaviours, and attain new insight along with me about this ADHD stuff.

My little boy is at the stage that he knows the difference between his milk bottle and his breakfast pablum and between his various bath toys, but I'll need to wait for a few years to tell him. I won't need to tell the dog. He wouldn't care either way; he wags his tail no matter what - I can always rely on the dog.

At this point, other than what I've said above, I'll probably keep it mostly private - on a 'need to know' basis, unless I really trust a person. Oh, except with all of you readers... :-) Because many folks either don't 'believe' in ADHD, or understand what it is - and I totally get that, and many people have taboos about crazybrainstuff. In that they figure it's all crazybrainstuff.

Well, that's all for today.

Cheers,

Mungo

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