ADHD & AS - the first 4 months
ADHD, Asperger's Syndrome and me today
It is now 4 months since I received my ADHD diagnosis and slightly under 2 since I had my Asperger’s diagnosis formalised. In this blog I am going to explore the initial impact of my diagnoses on my day-to-day existence, the effect of ADHD medication, and the changes that I have made in my personal and working life.
First and foremost, I must make the point that both diagnoses have been hugely positive for me, quite literally life changing. They have given me an understanding of what makes me tick, and why I am different to the perceived norm. It is powerful stuff, the sense of liberation that comes with understanding why I don’t conform to neurotypical standards and that it’s hard wired into me is immense.
I am now able to evaluate my own behaviours and rein back on some of the ‘masking’ that I have developed and practiced since an early age. I can’t explain how tiring masking has been, I only realised it myself as a result of cutting back on it, trying to stop that endless of process of trying to think through every word or action, second-guessing every interaction before, during and after the event. It’s not a licence to do and say as I please, I’m not sure that society will develop far enough in my lifetime to deal with the raw me in huge doses, but it allows me to find a better balance between my natural instincts and thoughts and the wider world around me. It gives me a growing degree of confidence that I have a place and purpose, and that there are many others around me with the same conditions, so I am not alone.
Attention Deficit Hyperactivity Disorder.... or is it?
Attention Deficit Hyperactivity Disorder, despite its wording, is not about having a deficit in attention, rather a deficit in the ability to focus it. The need for instant gratification to make up for a deficient dopamine circuit means that I have been unable to focus my attention as I can’t engage with the idea that there will be a dopamine driven happy reward at the end of a task, and that there is seldom anything to gain from doing a task just to complete it. That’s why people with ADHD are messy buggers generally, there’s no discernible benefit for us to doing the washing up or tidying our room, so we go on Amazon and buy stuff instead, because hitting ‘buy now’ does give us a little buzz. This is a simplistic view of a mental process that is called executive function.
Treatment of ADHD typically involves a 3-pronged approach:
- Medication – stimulants are used. They help the user to concentrate better, and it can make them less impulsive and calmer
- Behavioural Therapies – including Cognitive Behavioural Therapy (CBT) are used to process through a diagnosis and the mental health issues that may come from it
- Coaching – to develop coping strategies to help the ADHD brain to manage the environment around them
I do not feel that counselling is a priority as I had worked through the issues of feeling different to the world around me 3 or 4 years ago when I was diagnosed with PTSD, and in effect all that my ADHD diagnosis has done is to give those issues a definitive root cause. That is not to say that I don’t think counselling is important, if I had not already gone through an intensive process to shake loose some of the issues, I would need that help right now as I am pretty sure I would be angry about my late diagnosis.
Coaching will come at some point soon, there are just a few too many things going on in my life now to give it the focus that it needs. I will be very picky about coaching when I do engage with it though, looking for someone who either has ADHD and AS, or lots of experience in working with people who do.
Medication, however, is a different matter. I have now worked through the process of finding the right drug and the correct dose with my psychiatrist (the titration process) and I am in the process of being signed over to the day-to-day care of my own GP for prescribing purposes. What does this mean? I’ll soon be paying normal NHS prescribing charges instead of the £140 every 28 days that I have paid so far. That’ll cover some coaching costs eventually!
ADHD medication and its impact on me
ADHD medications are typically stimulants. The drug that I take is called Lisdexamfetamine and its job is to stimulate certain parts of my brain to:
- Improve concentration
- Focus attention
- Reduce impulsive behaviour
The impact has been huge, the fact that I can even write this blog is testament to that. I take my pill at 06:30 every weekday morning, 07:30 on the weekends and in 15-20 minutes my focus kicks in.
My productivity at work has increased to levels that I have never experienced before. I can zone in on a task and give it my attention from start to finish. Equally if I must break away from a task for some reason, I am able to focus back in on it again and pick up where I left off. I am retaining information far more readily, accessing it easily, and seeing the linkage between things in ways that I have not been able to before. Pre-drug me was a last-minute rush kind of person, leaving many things until the absolute last minute then doing them in a hurry, making mistakes and not checking my work before submitting it. Now I am in the headspace where I get work done in a timelier manner and with more attention.
Away from work I am far more productive too. There are less of those projects that I start but don’t finish (I’m even going back to some old, abandoned ones and finishing them off), more jobs get done around the house, though I’m honest enough to say that I still don’t do my share of the housework yet, and I am far more likely to evaluate purchases and ask myself if I really need them, resulting in far fewer amazon boxes arriving in the house.
The main downsides are twofold.
- I can’t switch the hyperfocus off (more on this below)
- Insomnia. If I am strict with myself and stick to a decent bedtime routine I can minimize this, though my 50-odd year old bladder doesn’t always help, but if I don’t respect this schedule then I quickly pass a point of no return and a bad night follows. This is something that will be high on my list of things to address when I engage with ADHD coaching.
Asperger's
It is clear to me that the ADHD medication has altered the balance between the 2 conditions, reducing the ADHD to something of a strong nuisance factor and leading to the Asperger’s Syndrome coming to the fore and starting to dominate. Understanding the traits of Asperger’s and how they manifest in me is an ongoing process and will be the key to managing this new balance, but current life events make it feel like I have a long way to go.
I’ve got a lot going on at the moment, and it’s definitely ‘stress testing’ my ability to manage life with AS. The primary issue is the health of my mam, who at the time of writing this is in hospital having suffered the latest in a series of strokes and TIAs that have stripped her of her independence and seen her rendered immobile, blind and ravaged by both Alzheimer’s and Vascular Dementia. This decline has gone into overdrive in the last 9 months, taking her from independent living but with a memory like a sieve, to where we are today.
Where this impacts me, other than the obvious emotional side, is in its affect on my routine. It turns out that I function best when I can plan my time and set a few goals. Since my diagnoses I have been working on all sorts of daily planners and job lists, paying a lot more attention to getting stuff done and feeling some sort of reward when I get to tick things off my to do list. That might sound like normal life to a lot of you, but to me it’s quite alien, and I’ve discovered that if I don’t stick to doing this I become quite agitated! My employer has been really helpful with this, giving me the space to plan out my days with some clear breaks scheduled in, all while continuing to work from home (as I have done since the start of the Covid pandemic, some 2.5 years ago now). This helps me to keep focussed on work, but keeps me from continually disappearing down a hyperfocussed rabbit hole. On weekdays I start work by 07:30 then use the extra time that gives me to take more breaks; a 1/2 hour break mid morning, an hour at lunch and 1/2 hour break again in the afternoon to get on with some of my own personal plans. By doing this I get to the end of the working day having found some compromise between work and life, achieving things in both, and that helps to keep my mind balanced. At the weekends I keep the early and late routines in place and create myself a list of stuff to do as this helps me manage the impact of the stimulant drugs. If I don’t follow this then I end up getting my butt kicked by insomnia and I’m no use for a couple of days after that.
Where problems arise, for example with the situation with my mam, is that I don’t respond well to being knocked off course. My ability to deal with interruptions is patchy, whether that be something as banal as my wifi playing up, or something more impactful such as dropping everything and going to stay in Birmingham for a few days to keep an eye on mam. If I’ve made a plan, or if I know I have things that need to be done, I don’t deal very well with being disrupted. If I am in the middle of a task and something goes wrong with it, that’s a different matter, problem solving is one of the great benefits of the increased focus that I now have, but disruptions outside of my focus can make me lose my rag.
This dynamic comes with a load of guilt that I need to work through. It feels selfish to be grumpy about disruptions, especially when they involve a very poorly 82 year old, but at no point have I seen anything to suggest that AS is logical, it’s just the way I am wired, and I clearly have more work to do to at least try and cope better in these situations.
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Brilliant writing and analysis, Ed. Well done