Mike's Guide to ADHD for the Short-Attention-Spanned

Look! A link to a doc! Mike's Guide to ADHD for the Short-Attention-Spanned

Impromptu Morphology Overview--Powerful Dyslexia Intervention and Vital Language Arts Reform Content

 

Making Math Less Repellant

A lot of students experience math as something teachers say is process-oriented, but the students' actual experience is that it is product oriented. The concerns are, in order of importance: Am I done? Am I right?  And often "am I right?" is a distant 2nd in importance. For the adults, the primary concern is "have I learned the skill?" Until the students and adults have found common ground by explicitly discussing these different lenses, everyone tends to be a little frustrated and feel like the other's behavior is inexplicable/unreasonable. The adults have to realize that the students' assumptions are reasonable, as is their approach, and, especially in middle school, students will need to feel some agency in the process of changing their approach to work. "Show your work" feels like "clean your room," unless the student feels like they are in a collaborative learning relationship with their teacher, and can understand that showing the teacher their thinking is their part of that collaboration. We adults also have to realize that the assertion that we are collaborating for the student's good is highly dubious, on the surface: we offer them more choice or less choice in any given situation, but the very fact that it is ours to offer is entirely worthy of resentment and suspicion from anyone trying to assert autonomy: they have to go to this school; they have to work with this teacher; they have to do this work... but I, this willing participant in this oppressive institutional setting, swear I'm here to help! I worry more about the students who don't push back.

A guiding principle of my work is that I cannot build motivation in an area where students feel more unsuccessful than successful. They simply have to feel successful much more than 50 percent of the time, or any normal person will prefer other activities. Teaching students to notice and celebrate micro-successes is a key life skill. 

In math, specifically, the primary foe, or at least, the starting place, is differentiating between challenges with conceptual understanding vs challenges with accuracy. Many students experience math as a "right or wrong" zone (setting aside the above insight that "done or not-done" may be far more important to the student who sees schoolwork in general as a barrier to freedom/autonomy), and whether they make a "careless error" (accuracy) or a conceptual/procedural error that reflects a developing understanding or skill, they simply feel wrong, which is demotivating (and also MOTIVATES rushing, because it feels bad and so we want to be out of it sooner). Kids need to know that conceptual errors are a part of learning (blah blah blah...but, no, really! (ok prove it)), and 

if their calculations were accurate, then a "wrong" answer is actually right in two ways: their calculation skills are strong, and they are closing in on the correct procedure/understanding by filtering out what doesn't work, and (hopefully) why. For those of us who have carried the right/wrong framework into adulthood ourselves, asserting this for a student can come off as disingenuous (a deeply middle-schooler-repellent thing, and also super common and obvious to students), but we need to do the (emotional?) work to truly see that it isn't! We are not pretending a wrong answer is right! We are parsing the genuine rightness, and thereby modeling the process-oriented mode of math-learning in a genuine way. 

If their calculations were inaccurate, but their conceptual understanding is strong, they are right in the most important way: they have met the primary learning goal of the lesson! Plus, congratulations: you have entered the realm of the adults! You ask what does this learning have to do with real life aka when will I ever use this? Well, accuracy is the most straight-forward and disappointingly simple problem to solve, and millions of adults' jobs depend upon their ability to be accurate in areas where they 100% understand the conceptual framework and the stakes, but a mispunched key on a calculator, typo on a spreadsheet, or ambitious use of mental-math can make them wrong in a truly consequential way. So what do we do? We use inverse operations, we re-enter the data in the opposite order, we get another set of eye-balls onto the work... And most importantly, getting back to math class, I believe, in the context of right/wrong, done/not-done, this kind of "checking your work" sounds just like "showing your work" (aka clean your room, check your email, eat your vegetables....), but in the context of "wow, you have such a great conceptual understanding on every single one of these problems, so you can tear through them at light-speed! So cool. Let's figure out how to boost the accuracy piece so you don't get fired :P" or "Man, your calculations are PERFECT! I'm so jealous! It looks like you don't know that you have to multiply by the reciprocal yet, though. But with calculation skills like that, you'll be rockin' these next time around...!" it becomes a conversation about making a good thing better.

 

BTW I dropped that "careless error" thing in without addressing it. I think that term is SUPER judgy. Careless errors don't feel careless; kids are putting in the effort they know how to put in. Well, at least, ADHD kids like me are. And the voices that tell us our best efforts are insufficient become the internalized voices that lead us to blame ourselves and even hate ourselves for not doing things we know we should, don't know why we don't, but in fact can't, at least until we learn or are taught how. For some of us, avoiding the careless errors takes MUCH more "care" than conceptual errors ever will. I guess I think that when we say "careless errors" we are erroneously (carelessly?!) projecting the ease we would have avoiding such errors onto a kid, and I just don't think we actually know how easy or hard that is for that kid, and asserting that it is a lack of care is just mean, because it shows them we assume they made the choice not to take care. It's disrespectful. And this builds distance between us and our students, which is the opposite of what we need, if the work of teaching and learning is ever going to feel collaborative to the students.

Math Journals for Students Who Can't Remember Math

There are a lot of students who seem to be unable to retain math procedures in spite of herculean efforts to do so. In particular, some people on the autism spectrum can seem to have a wholly divergent comprehension and mental "filing" system, making connections that other students don't make, and finding the associations which enable other students to retain their learning completely ineffective or incomprehensible. I'd love to hear from anyone who has a deeper understanding of what is happening for these students! In the meantime, my pragmatic-tutor mode has led me to rely on creating math journals with such students, and advocating for their use in all math work, including assessments!

It can take some careful conversation with some math teachers, but eventually most can understand: this student can work endlessly to comprehend and complete various math skills exercises and activities—perhaps several times as much practice as the average peer who retains the skills mentally—and it just does not stick, in much the way that spellings do not stick for dyslexic students, so they have to re-spell almost every word, each time they write it, even on the same page. The parallel breaks down with math, in that a student cannot usually "sound out" the procedure for a math problem the way one can sound out a word. So what would an adult do in a professional situation in which the requirements to produce work outstripped the capacity of their memory? Write down the things they need to remember! Thus, this student has created a journal of math procedures. This is in no way an "easier" way to do math: they have worked harder than the vast majority of peers just trying to retain all this math mentally before realizing a journal was necessary, and then they had to meticulously re-learn the procedures yet again and write them down in an organized manner that could be used as a reference. And of course, the journal does not contain answers, it contains procedures, and therefore still requires the critical thinking needed to choose the procedure, and the attention to accurate application and calculation required to answer the specific problem presented to them. Thus, for this student, it is appropriate and fair for them to use the journal for all math work, including assessments. In fact, it would be unfair for them to be deprived of it.

We put one problem type per page, with a heading at the top that uses words the student will recognize when it counts. Similarly, we don't worry particularly about neatness, but we simply employ the journal later, and if it is not useful because it is not legible, we fix it. 

I recommend using a small, loose-leaf binder, so that the student can alphabetize the pages for easy access. Ultimately, though, we have to use what the student is comfortable with and agreeable to using... or they won't use it anyway!

ADHD and Procrastination in Middle School — Broken Promises to Self and Others

So, there's this rut we ADHD kids get into, that parents and teachers often don't seem to be able to understand. Term after term: assignments get missed; work quality decreases or stays the same while peers' work keeps improving; "attitude" devolves toward defiance or indifference or both. The level of executive functioning required for success keeps increasing, but the skills to manage developmental delays in executive functioning  are not being taught, or they are not being taught at the micro-chunked level that we would need in order to embrace, retain, and employ them. As it stands, the increasing cognitive load and workload force us to ignore "extra" assignments—like using a planner well, or keeping a binder organized with labelled dividers—in order to feel like we have a chance in hell of successfully completing actual coursework. Organizational requirements in middle school feel like the coast guard yelling down at you as you bob in the bay to comb your hair so you look nice while you drown.



Thus, around the middle of the term, and toward the end, alarms are raised. Emails and calls go home about missing assignments and poor work quality. At best, there's a wack-a-mole quality to mid-term grades, with, say, a D in science last term raised to a B this term, but now math is a D, and English is a C-. Any statistician would see that pattern and assert that there is a shortage of resources in this system: one area cannot improve without a descent in another area. Yet, we often blame the student... for trying to do what we said!—we freaked out about science last semester, and science improved! It's pretty reasonable for the student to ask "What do you want from me?!" at that point...

But I still haven't gotten to the rut I mentioned.



The tragic disconnect between such students and the adults around them seems to be this: by the middle of 7th grade, every term has had this freak out in the middle, when everyone starts pointing fingers at the student and bemoaning the ascendant calamity. The student generally does the best they can, scrambles and lunges, under intense pressure, and (between that and the grade inflation of most independent schools or the low-low-bar in most public schools—the former to support statistics that prove the school is giving families the success they are paying for, and the latter to support statistics that prove the school is successfully educating a vast diversity of learners) emerges with a report card that no one loves, but that doesn't feel tragic to the student. So why all this brouhaha every term? It always comes out OK; I dip, then I rise. Why you yellin'?



Parents and teachers are at wits end, because their entreaties seem to have no effect. Students say, and genuinely mean, "I will do better!" and they usually do! But nowhere near better enough. 



Neither party seems to realize the facts of the situation. 



The student does not understand that the mid-term slump is a hole out of which they will soon not be able to dig—somewhere between 8th and 12th grades, that last-minute burst of energy will not pull them back into the passing zone. They also do not understand that the actual learning they are doing, especially in math, is increasingly foundational to future work, so passing without learning is another set-up for a future crash-and-burn. 



Thus, it is important for parents to understand that it is a developmentally inappropriate expectation for almost ANY teenager to be motivated to change a behavior based upon a future possible negative outcome. They are wired for immediate positive reinforcement, and future positive reinforcement only when it is very compelling. Dire warnings based upon the experience of others do not feel salient, and this is quadruply so in teens with ADHD.

Our teens are hard-wired for a severe case of something akin to what psychologists call "optimism bias."  Simply put, positive reinforcement is MUCH more effective than negative reinforcement. An expected reward seems to remain present in the mind much more effectively during the day, when choices count, than a dreaded punishment, which may only actually come to mind when they are actually suffering it, and, worse, the thoughts may be more resentment than reflection... and this resentment often inspires more rebellious instincts than any desire to do what one is told! In fact, the desire to change behavior might actually be inhibited, because that means admitting defeat and giving the oppressor what they want.



Most parents do not understand that the myriad iterations of "I meant to do that" and "I don't care about this" and "that teacher is a jerk" do not represent students willfully avoiding work they do not want to do, but choosing an ego-saving assertion of choice in a matter where they probably have little to no actual choice at all. What appears to be a poor choice or defiance is actually more usefully perceived as a symptom of ADHD. What's more, developmentally, any middle schooler is desperate to put aside childish things. The honest answer as to why a student with ADHD didn't do the work is probably deeply humiliating, and therefore may not even be consciously accessible: either "I don't know" or "I can't, even when I try." Students mean it when they promise; it feels do-able; people around them are doing it; they will just work harder! And it doesn't happen. Of course, they then say they didn't want to do it in the first place.



If students can only pull themselves together at the end of the semester when the terrible outcome finally feels immediate enough, it is not just because they finally "get it" but may be because their brain is literally not stimulated enough to muster the actual focus needed to produce the work until they are at risk of immediate dire consequences. Abstract notions of future suffering don't fire up the neurons in the necessary way to keep the student on task... so they put off the impossible until it is possible. 



Intrinsic motivation is great—best kind, first choice! But, so far, there are only two solutions I know of when ADHD is the primary barrier to school achievement for a bright student: sitting with the student to redirect them, repeatedly, for the entire, or almost entire, course of a carefully laid out work plan, or providing profoundly compelling positive extrinsic motivation. Either one of these can provide an experience of success that can build momentum for future positive change.





Otherwise, we are left hoping that the student will somehow come to understand themself, and adapt, naturally. The best hope for this probably comes from, at least, describing this whole dynamic to them, to see if it resonates.


The following is an admittedly somewhat-frantic email I recently sent to a former student, who has already heard all of the above, who is still firmly entrenched in the cycle above, and who had just sent me a "good intentions" email after their parent insisted they contact me. Any tutor will tell you, this email is too long for a student with ADHD, and many others... unless that person is at a tipping point, genuinely hoping for change, and maybe kind of feeling like the jig is up:

Hey ____!

Good to hear. The key question is: how? How will you do those things? 

A lot of students decide to change a behavior (or to start a new behavior), and making the decision is all they do, and nothing changes.
"I'm just gonna do better"
or
"I won't turn anything in late"...
these good intentions rarely add up to change unless actual actions are taken AT THE TIME THE DECISION IS MADE to support those changes. 

The Friday check-ups with teachers are the best part of this plan. Nice! :)

• Are they actually scheduled? 
• Have you set up any kind of reminder (phone alarm? calendar notification?) to make sure you get to them? 

Please do these things right away, if not! 

Teachers have very limited resources (time being the most important resource), so please please make sure you show up (even online), and I'm telling you right now, if you don't give yourself reminderS (plural), you probably won't.

The problem for most of us is, the behavior change idea is a big decision: I WILL DO THIS instead of THAT. 

Yet the actual actions involved in that decision are tiny, and there are hundreds of them each week, even each day: Every hour, you will be at a crossroads, and each little decision will not feel important, but it IS: 

• Play the video game now and get work done later? No big deal. 
• Meet with the teacher today or tomorrow? Tomorrow is fine. 
• Do my work completely and well, now, or fix it up later? I'll fix it up later...actually, who cares, maybe I'll do the next one better....teachers like to see improvement, anyway...

ALL OF THOSE RESPONSES IN THE MOMENT ARE LIES WE TELL OURSELVES AND THEY ADD UP TO NO CHANGE IN BEHAVIOR and NO CHANGE IN OUTCOMES. 

I apologize for yelling; it's because I am talking to you and also myself. I have suffered so much humiliation in my life because I could not understand this thing I'm trying to describe to you. I want better for you!

So, please, take action now to remind yourself throughout your day that you need to turn toward getting work done, and done well, first, and away from all other things except family responsibilities and genuine self-care. BTW if you use family responsibilities and genuine self-care disingenuously, as an excuse, I fear I'm useless to you.

Do these things:

• Put on a bracelet, a watch, a rubber band or something else you will see over and over during the day, to remind you to think "Am I doing the most important thing right now?" and, if the answer is no, do the right thing, right away.
• When you learn to ignore the bracelet, or rubber band or whatever, get a new one that looks different, put it on the other wrist, or something else to refresh the reminder.
• Put a post-it or a note on the TV, on the game controller, on the computer--lots of people make a reminder their desktop background--and anywhere else that you tend to go to relax or avoid schoolwork. It can be blank or it can say "FIRST THINGS FIRST" or whatever you need to hear.
• If you look at that post-it or note, and say to yourself, "I have been working; I need a break!" take a DIFFERENT kind of break that doesn't seduce you like those things do. Take a walk; play with a pet; make something; get a snack... AND whatever you do, consider setting a timer and putting it somewhere you will have to walk to to turn it off. A phone in the pocket is too easy to quiet quickly. 
• If you look at that post-it or note and say to yourself, "I hardly have any work; I can do it in like ten minutes!" then prove that to yourself by doing it right away. 
• If you look at that post-it or note and say to yourself, "Who cares. Stupid notes. I'm throwing that away..." just don't do that today. Throw it away next time. This time, double check if you have work to do, and do it right away. Right now, you only have to worry about this one time. Next time, you can get fed up and do whatever. This moment is just about doing the right thing one more time, even if it feels pointless or unimportant, or like someone else's stupid idea of what you should do.
• REAL TALK: Procrastination is not a time-management problem; it is about dealing with feelings! You can google it. If we are honest with ourselves, when we avoid important work moment by moment, it is always because the work causes emotional pain: "I don't actually know how to do this." "I can't do this well even if I want to." "I don't even know what I'm supposed to do and that is embarrassing because I'm supposed to know" ... or WHATEVER. We who procrastinate have to learn to face the truth about these feelings, and ask for help from people who will not judge us, and who know what we need to know. We have to find those people and make the most of those relationships. YOU are in charge of deciding who those people are. I am volunteering to be such a person, reachable by email or text, but it is up to you to decide if you want me in that role, sometimes, always, once-in-a-great-while, or never.....

Wishing you the very best of success, and hoping to hear from you again, ____!

Mike

Using White Text to Study

Please Read the Report Before You Meet the Kid (Things Helpers Need to Know)

So, why is there ever resistance to reading about a new student’s learning profile before meeting them? A teacher may say, “I like to get to know students first without any preconceived notions” or a parent may say, “Would you like the report? I realize you may want to draw your own conclusions first and I respect that...” In the parent’s case, I think it is just a wise marker of respect, signaling a certain deference to the professionalism of the teacher. Yet, because of what is at stake here, I hope more parents will find other ways to do that. And I definitely hope that excellent teachers will reflect upon the fact that 

• Their very excellence and professionalism is what protects them and their students from any sort of “bias,” or “prejudgment”—any negative narrowing of the lens through which a student is perceived—as a result of reading a neuropsychological assessment, or pass-up notes from colleagues. 

• There have surely been other excellent teachers all along each student’s journey, and those teachers’ reactions to a struggling student as they have gotten to know them are mentally paired with the student’s self-concept as much as the reactions of less-experienced teachers. That is, if school has been primarily a place of struggle and failure, if we react to the student even in subtle ways that they have seen before--ways that even skilled, kind teachers have reacted--we are still reinforcing the student’s sense that this year will be just like last year and the year before... Basically, what could be an opportunity to signal a genuine new beginning has unnecessarily become just the opposite. 

As a learning specialist once upon a time, it was a key part of my job to try and ensure that all agreed-upon accommodations for students were in place “from day one.” This, to me, should be the very minimum we do to pave the way for student success. I’m asking reflective teachers to help us do much better than that.

For many students, school is a relentless ramping-up of the pace of assaults upon their self-esteem. Whether it is a challenge with reading, writing, math, processing, retention, production, behavior, or any combination of these, as academic demands increase in volume and complexity, experiences of inadequacy, helplessness, different-ness, hopelessness, and failure increase as well. A kind peer can be a beacon of hope in a sea of despair; a kind teacher who can systematically prove to a student their worthiness, their unique strengths, and the sheer normalcy and manageability of their challenges, can be a fortified life raft in that sea, perhaps even delivering the student all the way to a shore they've never known.

In those first days of school, working with a teacher who likes to give everyone a “clean slate,” the student who is an outlier in one or more areas is probably clinging to the tiniest desperate hope that this class will be different, that this teacher will be different, that they themself will be different. Thus, they can be incredibly sensitive to moments that confirm the dreaded status quo. A teacher deprived of the foreknowledge of challenge areas for that student may just have a benign pause, a little moment of mental processing when they first notice a student struggling: the student might take in anything from a few extra blinks, to a friendly “oh, this is tough, huh?” or just a quick subtle surprised look. Of course these are incredibly minor compared to destructive accusations of laziness or lack of effort the student may have received in the past. In fact, the sheer weight of the student’s awareness that nearly all of their peers perform with ease particular tasks that are so hard for them likely far outstrips the familiar microhurts of the teacher’s tiny moments of recognition.

Yet, the teacher has the opportunity to explicitly send messages from day one that run counter to all the evidence of hopelessness the student sees around them. In spite of accommodations which are, of course, given without fanfare, from day one—in the same way that a student might be gently reminded to put on their glasses—there will still be moments of struggle, and these are much more emotionally fraught for a student with learning differences than they are for a peer. By knowing the exact contour of that student’s challenge, at least as far as it is understood up to that point, the teacher can not only avoid the moment of concern or surprise which deflates the child, but can immediately signal a genuinely hopeful new start.

When the child struggles and looks for a reaction, the informed teacher seamlessly redirects the student’s attention to a genuine strength that the student has revealed in their effort, and immediately presents an alternate approach to the task, not as a crutch or an easy way out, but as a logical next step in helping the student manifest the aforementioned strength in the completion of the task. When this is done reflexively and repeatedly, the teacher is not only signaling a possible new stage of growth and joy as a learner in this new classroom for that student, but also modeling a key ingredient of the kind of grit and resilience that almost any student needs to learn to survive. 

Rather than hitting a wall and thinking “See? This always happens. I’m dumb. It’s hopeless...,” we learn to think “Oh! A wall! Of course I hit a wall; I’m trying to do hard things. That’s an important part of school and learning! So where’s the loose brick? Is there a side door or a low spot? Is there something useful to do to the left, right, or behind me, so I can come back later feeling stronger? Can I get a boost from somebody or offer a boost so maybe they’ll help me with one later? Do I have wings I keep forgetting about?...”

My firm belief is that previewing what others have noticed about our new students won’t make us blind to the special perspective and insights which our singular new relationship with that student will bring. We are not a collection of binary switches processing an assembly line of clones, a few of which are stamped defective and thereby assigned to the reject pile. We bring our whole selves to the work, and the students are kind of forced to bring their whole selves to school, try as they might to hide in plain sight. Let’s have all the tools and scaffolds we can at the ready for our most vulnerable students, from the first moment we see them; that way we can save some of the mental bandwidth we might use to figure out the basic contours of their learning style, and instead apply it to being ace strengths-detectives, relentlessly reminding each student of their unique awesomeness, while demonstrating the fine art of resilience and grit, and how one forthrightly gets what one needs from the various institutions we all must navigate.

ADHD + Medicine from the Inside (TMI Digression 2)

I was diagnosed with ADHD just before my 50th birthday. I was a little shocked at first, and even more so when medication was recommended soon thereafter.

Six months later, the honeymoon is over, medication-wise, but I cannot deny that my life has changed in wonderful ways. I still bounce between grief over half-a-century of unnecessary self-loathing, judgment, and shame, and tremendous gratitude that the page seems to have turned, at last. I am also grateful that the things I managed to learn, as an adult, to survive and thrive with undiagnosed ADHD, have made me so valuable to my students, who are getting something I did not get, and the healing in that for me is impossible to overstate.

My students’ experience with ADHD medicine has always been hard to glean--I’m either told it “helps” or not told anything at all--just as their individual experiences of ADHD itself are pretty inscrutable. It is very difficult for them to describe, because they know no other way of being: it is the water they swim in. It has also been, I now know, the water that I swim in. But I think I might be more able to describe the contrast, in my own life. It has clearly impacted my personal interactions, as well as approaches to tasks, and productivity in general, in pretty profound ways, explained hereafter.

The primary difference between my experience and what I thought my students were experiencing--and what educators are often told they are experiencing--is that my distractibility is primarily internal. That is, external distractions do make it harder to focus, sometimes intensely so, but this really doesn’t touch on the key debilitating and emotionally crushing piece, which is that often I could not tell my brain what to think about. Productive focus has always meant that a huge, invisible mental effort was dedicated solely to batting away intrusive thoughts, and when the executive part of my brain doing that got tired and took a breath for a second, the intrusive thoughts¹ immediately pounced and filled that exposed bandwidth with associations and worries and musings, until something environmental or internal randomly happened to redirect me to the task at hand. When I’ve asked students about this, they generally identify with the experience.

So, what follows is my before and after experience with medicine. After several months trying a few different combinations, I have been on the same regimen for about three months now. I say “the honeymoon is over” because it is clearly up to me to make the most of what the medication gives me. I can still fall into compulsive behavior; I still have emotional ups and downs; I still struggle to eat right and exercise. The medicine gives me precious, new executive control of my own mind--I can aim it where I want, keep it there, and utilize far more bandwidth for the area of focus than I have ever known. This is a revelation. But it is also ALL the medicine does for me. Which is, actually, a good thing, in the long run. Lastly, I need to say that this is a snapshot of today--it may continue to change for better or worse, and if you are reading this after March 2019, you might check for updates!

Right now, today, much has changed:

Interactions

I noted in the previous blog post how shocking it was to be able to listen to folks’ entire verbal contributions in meetings, without associations from things they say constantly carrying me away into my thoughts without asking my permission. Now, a rising mental association is simply an opportunity to reflect, not a slippery slope into oblivion, and to my amazement I can reflect with focus, while maintaining focus on what is being said, simultaneously, because I have so much more mental bandwidth to work with now. It is like switching from trying to function while running through a dastardly funhouse to doing it while moseying through a quiet meadow.

I have long considered myself an introvert, and I think that is true, but not nearly so much as I had thought. The accumulated anxiety from years of randomly not hearing what people say, or not remembering key details that I did hear, because they went in and out of my head so quickly that nothing stuck, has made me interaction-avoidant. The message people get is often that I don’t care enough to listen, or to note, things they say, and it is off-putting. I’m sure I have seemed self-involved, uncaring, disinterested, or worse, at times when I actually felt the polar opposite of these. In fact, the anxiety that grows around this dynamic makes it self-perpetuating and self-reinforcing.

The flip side is the hyperfocus that comes with really caring, which makes me notice and remark upon details and subtleties of the conversation and environment that the other person whom I care about so much may not have noticed at all, and I can sound super-nerdy, quirky or random, and when I see that familiar bemused expression on their face, I retreat. These are things that echo in my adulthood more than they are actually present--I have learned to be me and be OK, for the most part--but I think the cumulative experience has shaped me a great deal. Very early in my experience with medicine, I began to find social situations less overwhelming, and less worrisome. I seemed to have the bandwidth to calibrate my interactions casually to the people around me, and I was no longer so afraid of missing what people said, and being off-putting in that way. I care a lot about people, and now that doesn’t express itself in hyperfocus or anxiety as much as a genuine happiness to see and interact with them. We meet in the meadow instead of the funhouse.





I have had the same umbrella for this entire rainy season. That has never, ever happened before. It is a bigger deal than it sounds.

Sequential Tasks

In the mornings I make breakfast and lunches for my two daughters, as well as myself, get them up, and dressed, and try to exercise and finish up whatever dishes need to be done. A year ago, I had learned that this took me 60 minutes to do without exercise and dishes, 90-120 minutes with. I would decide how ambitious to make each morning based upon how much time I managed to give myself by waking up early enough. Once in the kitchen, that room became the boundary that kept me on task. Whatever direction I looked, there was something to do within this set of tasks, and I did whatever I saw until I was done. This meant I was doing everything at once, darting across the kitchen countless times, and opening and closing cabinets as well as the refrigerator and freezer over and over again. If anyone tried to talk to me I would probably forget what I was doing, be unable to restart where I had stopped, and fall behind schedule incrementally. This meant that anyone saying anything more than good morning to me would be greeted with a sigh at best, exasperated frustration at worst. That is not a nice greeting, but it is very hard to maintain a cheery demeanor when being productive always feels like juggling fine china. I am grateful that Emily has endured me for a decade.

Now, I can actually do these things one after another. I open the fridge and take out all the things I need, and I put back things all at once at the end. If I have time, I do dishes, then lunches, then breakfasts, then wake up the girls and instead of running away to finish the chores, I can actually visit with the girls while supporting them to stay on task (which is strangely hard for them...) on many mornings. These things take about half the time that they used to, and rather than juggling china mentally, it is like hiking up a familiar trail; if I get stopped it is obvious where to go when I start again, and though there is exertion, there is usually not much stress.

On my way out the door in the morning, not only am I able to think through whether or not I have everything for my day, but I remember to do that. Of course, remembering was not really the problem before as much as simply having either no ability to muster an idea of the day ahead and the necessary supplies for that day, or not being able to spare the considerable time it would take to do so. I think we sometimes remind kids to “think through” what they need, not realizing that remembering to do so doesn’t mean it is something they can actually do.

Productivity

As addictive as screens and video games seem to be for so many, I think people like me probably experience an additional layer of compulsion. This has been greatly reduced for me, if not stripped away, by the medicine. My primary compulsion of this sort–my Fortnite, if you will–is pinball. For years, I have known where all the machines are near any workplace, school, or other place I regularly spent time.

The interactive, high-speed, kinetic nature of the game, combined with the patterns of shots that one strategizes while playing, make for an immersive in-the-moment diversion that completely removes me from other cares and concerns. By contrast, the electrified tightrope of perpetual mental exertion to focus, produce, navigate, and interact in the world of work and people is desperately tiring and simply doesn’t turn off by itself. In the past, I am embarrassed to admit, I have regularly driven 45 minutes in order to play pinball for 15 minutes during an hour break. There was a desperation to it; the moment my hands moved to the flipper buttons, the relief was palpable... Simply put, I don’t need that the way I did before. I find myself with a 90 minute break and I start instinctively to pack up to go play, but then realize I’d rather get some in-depth analytical work done for a client. Making that choice used to mean enduring that tightrope for hours longer. Now, it means, getting that work done, and feeling the satisfaction of a job well done, before maybe taking a little walk and continuing my work day refreshed.

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New Challenges

There are times, now, when I find myself wondering if the medicine is still working, because I am already so accustomed to it. But I have a built in reminder system–all I need to do is miss a good night’s sleep, and its effects are greatly reduced. I’m reintroduced to the Mike I knew for five decades, who works so very hard to muster hyperfocus when he needs to get things done,² and who has learned myriad self-supports to function (relatively) effectively in the world, and I am again grateful for the medicine’s support.

When I first started the current medicine, I had no appetite until the end of the day, and struggled not to overeat in the evenings after starving all day. But I adjusted, and then my appetite actually returned, for good and ill.

I am bone-tired at the end of the day, and it is sometimes sad that my family gets that version of me, while the world gets a much sharper one. But in the past caffeine did the very same thing, frankly, just much more acutely and erratically, with far less benefit (nowadays I drink about 3-4oz in the morning, and that’s all—it’s pretty clear I was self-medicating with caffeine all my life). The good news is that I now have the resources to notice and act on this, to learn to bring my whole self into my day, and then into my home as well. It was just too much before.


All of these things may change, of course, and I may have to go back to an unmedicated version of myself in the long run, but at least I will be armed with the knowledge of what efficient cognition can be like; perhaps I will learn to meditate after all, knowing better the benefits I am after.

And I do hope that many others, too, who may not yet realize what is possible for them, because their struggles are the water they swim in, will find the tools to step out of the storm, out of the funhouse, out of the swamp, out of the pit, and into a place of calm and light, of clarity and joy.

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1. Anyone who meditates probably recognizes the “intrusive thoughts” idea, and I do believe meditation is likely very helpful–I have really tried it, repeatedly, and will surely do so again. I also think that people without ADHD who assert that meditation is “the answer” are a little like healthy people who prescribe positive thinking for the terminally ill. Frankly, I am excited to try meditation again, with medication, because it feels like it may actually be possible for the first time.

With or without medication or meditation, as a wise colleague reminded me back in December, best practices for overcoming ADHD will be integrated approaches, using combined methods to combat a complex problem: things like therapy, direct instruction, nutrition/exercise, medication, meditation, etc. Not one, but many.

2. It is clear that the incredibly attentive, nuanced work about which I care so much– one-on-one academic help for students –has been an ideal, naturally-occurring hyper-focus environment for me, for years. I’m assessing, planning, translating, observing, communicating, suggesting, inviting, calibrating, and improvising moment-to-moment, and it feels like my most perfect niche, as a human and a professional