An ADDitude reader recently wrote: “I was diagnosed in my early thirties with inattentive ADHD. Not being able to successfully manage the condition has got me looking for helpful tips to manage my daily life, as well as medication advice. I have steered clear of medication because I was misdiagnosed in my late teens as having bipolar disorder. I was prescribed Depakote, which led to my gaining 40 pounds and becoming a zombie.
“I was misdiagnosed again in my mid-twenties as having depression. I was prescribed Celexa for a year, which curbed my anxiety but did little to diminish my ADHD symptoms. These misdiagnoses contribute to my fear of medication. Not until I finished college, later in life, did I get a proper diagnosis of ADHD.
“I am now in graduate school and cannot concentrate. I spend too much time online trying to distract myself from not being able to concentrate. I would love some tips for inattentive ADHD, as well as some medication guidance.”
I admire your persistence and determination. Despite your challenging experiences with misdiagnosis and medication, you are still looking for answers. As your story shows, the path to an accurate ADHD diagnosis and effective treatment is neither straight nor narrow.
ADHD is an umbrella term for ADHD Hyperactive-Impulsive Presentation, ADHD Inattentive Presentation, and ADHD Combined Inattentive, Hyperactive-Impulsive Presentation. The Inattentive presentation of ADHD, like yours, is frequently missed, or misdiagnosed, due to a lack of commonly recognized ADHD symptoms, like hyperactivity and impulsivity.
Your misdiagnoses are, unfortunately, common. Because there is no medical test to detect ADHD, it is a diagnosis of exclusion — determined by eliminating other possible reasons for the symptoms. The elimination process is based on your history of symptoms, an examination to rule out physical causes of the symptoms, or through a variety of tests to assess for key challenges.
The Changing Nature of ADHD
ADHD is developmental in nature, meaning that the condition looks different at different ages. Symptoms of hyperactivity may become less obvious as someone grows older. Many teens and adults appear calmer, but they feel restless and distracted inside. The Inattentive presentation usually lasts from childhood to adulthood, and includes ongoing executive function challenges, such as forgetfulness, disorganization, and problems in concentrating. It is common that, over time, and with a longer history of symptom identification, a professional can properly diagnose ADHD and rule out common co-existing mental health disorders, like bipolar disorder, depression, and anxiety.
A missed diagnosis is disappointing to the patient, and, in your own case, it has resulted in fear and mistrust of medical treatment.
Now that you have received a proper diagnosis, it is understandable that you are hesitant to use medication as a sole treatment for ADHD. You are looking for treatments that will complement medication. ADHD medication is effective in reducing the symptoms of attention deficit, but it is not a standalone treatment. It works best with other treatment approaches, such as talk therapy, coaching, behavior modification, and educating yourself about the condition.
Questions for Your Prescriber
The FDA has approved a handful of medications to treat ADHD. Experiencing positive benefits of ADHD meds requires that you have the three “rights”: the right medication, the right dose, and the right timing. When looking for a prescriber you trust, I recommend asking him or her the following questions:
> What type of medication is this? Stimulant or non-stimulant?
> How does this medication work in my brain? How does it help my ADHD?
> What negative side effects are normal with this medication?
> What health monitoring checks need to be done, if any?
> Are there any side effects that would warrant my calling you, or to stop taking this medication?
> How will I know if this medication is working? What differences will I notice?
> When do I take this medication? Does it matter if I take it in the morning or at night?
> Do I need to take this medication every day?
> If I want to stop taking this medication, how do I do that?
> Do I take this medication with or without food? Does it matter?
> How long will this medication take to start working?
> How long do the effects of this medication last after I take it?
> What is the plan for following up and adjusting the dose of this medication?
Finding it hard to initiate or stay with an unpleasant or uninteresting task is a common challenge for people with ADHD. In an attempt to get our brains engaged, many people with ADHD are distracted by more interesting activities.
Beginning a task involves more than just getting started doing it. It requires executive functions affected by ADHD, such as prioritization, organization, planning, and time awareness. As “global thinkers,” many ADHDers are overwhelmed at the “getting started” stage. Global thinkers focus on the big picture and don’t see the details. When faced with a big project, you must define the goal you want to achieve, gather all the information, and break down the task into smaller pieces that can be accomplished over time, based on priorities, due dates, and so on. This process is difficult for people with ADHD.
Here are some suggestions for how to get started:
> Ask yourself about the goal you are trying to achieve. Specifically identifying your outcome will help you get a handle on starting the task. Is the goal to write a two-page paper? Read three chapters of your textbook? Prepare for a test? Knowing the specific outcome helps to narrow your focus.
> Break the total task into different pieces. If the goal of the task is to read your textbook, break this larger outcome into “read Chapter 1, read Chapter 2, and then Chapter 3.” These are smaller, more doable tasks.
> Estimate how long each smaller task will take. People with ADHD often overestimate or underestimate how long something will take to complete. In order to compensate for this, double how long you think it will take to complete something. Any time left is a bonus!
> Tackle the pieces of the task in smaller increments of time — say, working 15 to 30 minutes at a time, followed by a short break. Experiment with various time intervals to find out which works best for you.
> Ask yourself when your brain is most productive. Make sure you schedule your more difficult tasks for these times.
> Be aware of what distracts you and minimize it. If you notice that checking e-mails is constantly taking you away from the task at hand, plan to check e-mail only for a certain length of time at certain intervals.
> Experiment with using background noise to help focus on less interesting tasks. A particular kind of music or conversation in the background helps some people focus on a task by providing stimulation that their brain craves. Working in public places, such as coffee shops, provides a sort of “variety” that helps us stay engaged.
It’s an exciting time in your life. You have finally got an accurate ADHD diagnosis, and you are willing to address your challenges head-on — anything is possible.