Narratives of Introversion with ADHD

Narratives of Introverts with ADD/ADHD Vraniak, Swenson, Rasmussen, DRAFT: January 1, 2015 Schmelzer & Rowney

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Narratives of Introverts with ADD/ADHD (75 pp)

by Damian Vraniak, PhD Great Lakes Mental Health Center with Allison Swenson St. Mary’s University of Minnesota Ben Rasmussen Harvard University William Schmelzer, PhD Psychologist, Hayward, WI Janet Rowney Hayward Community Public Schools Draft Version 10: January 2015


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Abstract I am in my small office with the parents of a fourth grade girl. This is the 40th

referral this year concerning questions of ADHD/ADD for children or adults and the 20th that also involved introversion at the same time. The mother is on the couch, where her daughter first played with a basket of puppets easily accessible next to the couch. The step-‐father has moved from the stool by the desk to the couch, when I offered the daughter a box of magnetic lego-‐like construction items to play with. After playing with the construction kit and nicely putting all the pieces back, I offered to let her draw on the white board, which is close to my chair. I am talking to the parents about their child, watching the child draw a series of three different drawings, while I intermittently make positive comments about her drawing and take photos of them with my cell phone camera, then showing her each photo. During my conversation with the parents, as time goes on, they become increasingly surprised at how calmly focused their child is drawing and comment that she has never stayed so composed and so long at any activity before. Before the end of the hour-‐long initial consultation I give them copies of the materials in this article, which describes the ‘Rule of Three’ and other concepts that begin to explain how their daughter spent the whole time so composed and working so nicely.

Simply put, this very bright, high energy, highly sensitive child who

frequently shifts focus was offered three activities that increasingly moved her energy output from gross motor to fine motor (‘whole body’ to ‘hand-‐eye’), then from psychomotor to psychological, and, finally, to a relatively healthy balance between outflow and inflow of energy. At the end of the session the child was quickly cycling through three different activities in a smooth way – making her drawing, interacting with me, and listening to me talk to her parents – in a seamless process I have called circuit learning or circuit performing, where an individual rotates in continuous fashion among three, and only three, activities until each and all of the activities is completed or comes to satisfactory closure.

This article, revised after 300 views from professionals and regular people in

50 countries, describes a newly identified sub-‐group of children and adults who have high energy output and frequently shift attention (ADHD),

are highly sensitive and open to highly detailed input (introverted), who are often misdiagnosed as depressed or bipolar, and are often

mis-‐medicated, as in the unfortunate case of actor Robin Williams. The challenges of the tension and turbulence occurring for an individual with both high outflow and high inflow of energy, where the outflow shifts and elicits significant negative external response from others, and the inflow is quite detailed, eliciting a significant emotional and mental response-‐load internally, is often excruciating and exhausting, leading to ‘going out’ adventures that are often frustrating and unsatisfying, coupled with ‘coming in’ collapses that cause significant disappointment and despair. External disapproval linked with internal disappointment is a confusing mixture that I have mapped differently and developed some simple and effective approaches to remedy, using new language and new approaches, described herein.


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A brief review of the literature suggests that there has not been focus upon an important group of individuals who display symptoms of ADD/ADHD – those who may also be quite introverted. Short bio-‐sketches, individual interviews, and a group conversation with 2 male and 2 female persons (2 professionals and 2 university students), who indicate they are introverted with diagnoses of ADD/ADHD, provide material for a narrative analysis of the dynamics of this combination of psychological features, particularly in terms of critical junctures in paths of compensation and adaptation to the challenges presented by ill-‐fitted contexts and unfortunate responses by others typically experienced by those with ADD/ADHD. Sections:

1. Description of ADD/ADHD 2. Description of Introversion 3. Individual Bio-‐sketches and Semi-‐structured Interviews (x4) 4. Interviews with significant others 5. Summary of group participant conversation 6. Key features and dynamics of introversion with ADD/ADHD 7. Commentary, Conclusions and Recommendations 8. Important Supplemental Materials 9. Extensive Bibliography


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The Challenges Among Introverts Diagnosed With ADHD Introduction “People always ask me “what is it like to have ADHD?” and, for the most part, answers vary given the day or work load for that week. Overall, I tend to experience it as a room full of different size balls that never stop moving and occasionally the lights turn on and off. For a moment, picture yourself in a brightly colored room. As you stand in this room you have tasks that are represented by the different shaped balls where the bigger ones are the most important, and the smaller ones least important. As you bend down to pick up a medium sized ball, the entire bunch explodes and balls start to bounce off the walls in an uncontrollable fashion. You keep trying to grab and place all the balls into the mesh gym bag that represents completed tasks. But, as you gather all these tasks most tend to get away or fall from your arms or just do not seem to fit as you run endlessly around getting tired, until the lights shut off then turn on once again. By the end of your time in the room you look inside your bag of completed tasks and nothing is in there; you realize that you started so many things and completed none. For me, ADHD is a lot like that.” (Biosketch/Interview #1: young adult, ADHD, introvert; 2013) Much is known about the extrovert who also is diagnosed with attention-deficit/ hyperactivity disorder, or ADHD, and their need for stimulation and experience of chaos. However, little is known about those introverted individuals who also are diagnosed with ADHD and how they function on emotional, cognitive, and behavioral levels. Attention-Deficit/Hyperactivity Disorder Description & Course Into Adulthood Typically, the symptom-presentation of ADHD in adults may include: trouble focusing; restlessness; impulsivity; difficulty in completing tasks; disorganization; low frustration tolerance; mood swings that are frequent; hot temper; trouble coping with stress; and unstable relationships. Individuals with ADHD have a difficulty prioritizing and focusing on everyday tasks, leading to an array of challenges day after day. Originally Attention Deficit Hyperactivity Disorder (ADHD) was considered a childhood disorder that faded over time or was “outgrown” (Simon, et al, 2009; Mayo Staff 2013, web). However, over the past 20 years researchers have established that its features persist into adulthood. The recent updating of criteria in the fifth edition Diagnostic and Statistical Manual of the American Psychiatric Association (DSM-V) reflects this newer understanding (APA Fact Sheet 2013). While the criteria remain the same, the previous scheme for aggregating symptoms into clusters (inattention, impulsivity and hyperactivity) has been revised by viewing impulsivity and hyperactivity as related features in the same cluster.

The majority of children with the disorder continue to display symptoms throughout adolescence and into adulthood (Weyandt & DuPaul, 2013). As many as 69%


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may meet criteria for ODD as children and/or adults. (Reimherr et al 2013). Clinical presentation often changes in adulthood. In children, the impulsivity/hyperactivity cluster is often more prominent, while with adults the overactivity tends to lessen and be superceded by problems in living associated with inattention and impulse control. Male: female occurrence ratios vary widely from about 3:2 to as much as 10:1, depending on a variety of factors, such as age, developmental stage and population samples. Twin concordance studies show heritability of about 76% (Chang et al, 2013). Neuro-imaging studies have reported structural and functional brain abnormalities in patients with ADHD, which involve a variety of pathways, the inter-relationships in relationship to the symptom picture and individual traitwise variations remain to be understood.

Approximately 70% of adult patients with attention-deficit/hyperactivity disorder (ADHD) have at least one co-morbid disorder, rating impairment specifically attributable to ADHD is a hard task; yet there is evidence to suggest that the negative life events experienced by these patients are associated to the severity of ADHD independently from co-morbid psychiatric disorders. (Garcia et al 2012) ADHD is associated with higher levels of dysfunction and maladjustment including academic underachievement, relationship problems, un/under-employment, psychiatric comorbity (bimodal: substance use, antisocial behavior; anxiety, depression), legal problems and divorce. (Fleming and McMahon, 2013) ADHD can also be a predictor for smoking and alcoholism and stimulant treatment in childhood offers some protective effect against drug abuse and alcoholism in adolescence. (Koumoula 2012). Adults with ADHD are at increased risk for depressive disorders, but little is known about the potential cognitive and behavioral mechanisms of risk that could shape treatment. There is some indication that cognitive-behavioral avoidance is more strongly related to meeting diagnostic criteria for a depressive disorder than dysfunctional attitudes, for instance. (Knouse, et al., 2013). Adult persons with ADHD have difficulty mediating negative thoughts and modulating the negative emotions; cognitive-behavioral therapy (CBT) for adults is efficacious when targeting negative automatic thoughts -which share a relationship with ADHD even after accounting for the confounding role of depression. (Mitchell, et al, 2013)

The results suggest issues in social perception, in that adults with ADHD focus on too many cues in social interactions, especially invalid ones; but, adults with ADHD taking stimulant medications increase use of salient cues, but also of distracting cues – and, compared to controls, women with ADHD pay more attention to social cues, while men with ADHD pay less attention to them. (Peterson & Grahe, 2012)

There is an extremely limited amount of research that looks at the identity development for adults with disabilities, particularly those who identify with a hidden diagnosis of Attention Deficit/Hyperactivity Disorder (Schott, 2013).

Adult coping with the condition may evolve through stages (1) suffering from lack of self-confidence, accompanied by functional difficulties, stress, and guilt feelings; (2) second stage (begins post-diagnosis beginning to believe in one’s ability to lead meaningful and more manageable lives; (3) realization/belief that traits as persons with ADHD helped to cope better than others unaffected by this syndrome. Under some


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conditions, those who have an ADHD diagnosis seem able to defeat unnecessary negative emotions and self-blame. (Fleishman & Fleishman, 2012)

Specific Cognitive, Memory And Executive Features

Meta-analysis shows a growing literature providing evidence of ADHD-related dysfunction in multiple neuronal systems involved in higher-level cognitive functions but also in sensorimotor processes, including the visual system, and in the default network. This meta-analytic evidence extends early models of ADHD pathophysiology that were focused on prefrontal-striatal circuits. (Cortese, et al, 2012). Cognitive deficits persist into adulthood. (Doenert, et al, 2013)

There has been study of the unique contributions of central executive (CE) and storage/rehearsal processes to working memory (WM) deficits in adults with ADHD. Adults with ADHD exhibited significant deficits across both phonological and visuospatial working memory modalities. Further, performance worsened as set-size demands increased. Overall, the CE and PH storage/rehearsal processes of adults with ADHD were both significantly impaired relative to those of the healthy control adults; however, the magnitude of the CE effect size was much smaller compared to previous studies of children with the disorder. Collectively, results provide support for a lifelong trajectory of WM deficits in ADHD. (Alderson, et al, 2013)

Other findings showed that adults with ADHD have inefficient attention, interference control and set-shifting functions, which may be revealed on neuropsychological tests that require greater cognitive demand. Given the finding that interference control deficit exists across the lifespan in people with ADHD, it has been suggested that interference control-associated functional weakness may be a core deficit for ADHD. (Pazvantoqlu, et al 2012)

Within the last decade, working memory (WM) has garnered increased interest as a potential core deficit of attention-deficit/hyperactivity disorder (ADHD). Meta-analytic review findings indicate that WM deficits persist into adulthood (Alderson, Kasper, et al, 2013) and other studies indicate that demand features contribute (Ko, et al, 2013). These include processing capacity bottlenecks in the human brain; one such may be a dissociation between working memory and response selection capacities, (Roberts, et al, 2012)

ADHD is often associated with difficulties in planning and time management – especially with systematic biases in habitual time orientation which may contribute to functional problems in ADHD. (Corelli & Wyberg 2012). ADHD have specific difficulties with set-shifting as measured by the CWIT, difficulties that probably also reflect problems related to executive function in their daily life. (Halleland et al 2012).


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Affective Features

“There is an ongoing discussion whether symptoms of emotional dysregulation should be added to the conceptualization of ADHD in order to describe the psychopathology of ADHD more precisely, at least in adult patients. Symptoms of emotional dysregulation are well defined and seem to be distinct factors of the psychopathology of adult ADHD. Assessment of this psychopathological dimension has shown sufficient reliability and validity. Empirical studies have confirmed a high prevalence of this psychopathological feature in adults with ADHD that compares to the frequency of the ADHD core symptoms, inattention, hyperactivity and impulsivity. Evidence is given that emotional dysregulation has an independent effect on social problems associated with ADHD in adult life. Moreover, pharmacological and psychotherapeutic interventions help to ameliorate emotional dysregulation together with symptoms of inattention and hyperactivity/impulsivity. Thus, there is growing evidence that emotional dysregulation might be recognized as a core feature of ADHD.” (Citation needed.) Scholarly dialogue continues as to whether symptoms of emotional dysregulation should be core to the conceptualization of ADHD, at least in adult patients, because that dysregulation has an independent effect on social problems associated with ADHD (Retz, et al 2012).

Intersection of Symptoms, Features With Temperament

There is very little systematic investigation of how key temperament variables interface with and mutually interact in affecting the expression of ADHD in a lifetime course. Database searches revealed no examination of introversion-extroversion, per se. There has been some examination under the five-factor model, and related formulations, but these are fairly recent and tend to be associated with Impulsivity and Activity, and inversely with Agreeableness (e.g. Nigg et al, 2004)

The literature pertaining to study of ADHD is vast and reveals a variety of approaches to understanding the condition, ranging from the biological to the characterlogical, single- to multiple-pathways models, and debate over categorical versus dimensional means of characterization (Gomez, et al, 2012). Although data indicate that symptoms of ADHD can be identified across cultures, neuro-imaging data shows ADHD to be a polymorphous label. Stemming from these conditions, there have been increasing efforts to integrate the multitudinous, disparate findings on basic energy, personality factors, and environmental factors affecting development (Cloniger, 1993). Attention to whether symptoms are best described in dimensional terms as extremes of ordinary personality features has increased in recent years. Miller, et al (2008) argued the possibility that ADHD and personality/temperament are the same constructs viewed through different theoretical lenses (see also Gomez, 2009). However, we observe an apparent bifurcation in the literature that seems to have gone unnoticed and for which a simple framing may do much to advance the cause of addressing these issues: There is a large body of research on externalizing aspects of and associated with ADHD; this includes findings that identify impulse-control, conduct and


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antisocial behavior issues, risky-behavior-proneness, substance use and over-representation of ADHD in prison populations (citation). However, especially in the accumulating research on adults with ADHD, there is also a body of information pointing to high co-morbidity with anxiety and depression. Drawing on theory of Vraniak (2009), we propose that all individuals’ challenges in living can be understood through a comparatively simple heuristic describing relative physical, emotional and mental energies, the individual’s temperamental tendencies for management/utilization/expression of those energies and the iterative shaping of development over time depending on contextual goodness-of-fit to individual developmental needs. We propose that this apparent bimodality of distribution in the expression of ADHD can be understood differently by explicit attention to the introvert/extrovert temperament dimension, a factor which has proven one of the most robust descriptors in personality and its development. In particular, while much is known about the extrovert who also is diagnosed with ADHD and their need for stimulation (or controlled chaos), almost no inquiry has been done into how those having introverted temperaments and diagnosed with ADHD function on an emotional, cognitive, and behavioral levels. Our belief is that these individuals comprise the greater majority of persons with ADHD who also demonstrate anxiety, depression, and certain interpersonal problems, whereas those more preponderantly on the extroverted pole tend to comprise the population segments with more characteristically oppositional, antisocial and conduct-related issues in living. There is a well-established literature on the differences between ends of the introversion-extraversion temperament dimension; why this construct has not been applied to the examination of diagnostic labels like ADHD is unclear. It appears to provide a simple and direct way of meaningfully partitioning and organizing extant knowledge that otherwise appears conflicting. This would also have significant implications for clinical recognition of different presentations within the population of those who may be diagnosable with the condition, and or the many clinical, (mal-)adaptive and personality co-morbidities that may arise from mis-/non-diagnosis. The purpose of this paper is to present occasion for our field to consider this alternative means of viewing the manifestation of ADHD – and variations in individuals’ means of adapting and coping by interweaving some review of the literature with first-person case narratives and a collective mapping of similarities/differences in its course over time.

Treatment

Diagnosis. There is still significant debate about symptom thresholds, heterogeneity v unitary entity and how to conceputualize the factors that yield impairment. Some data have been interpreted as providing a compelling basis for lowering the symptom threshold of hyperactivity-impulsivity for adults in the DSM-5. (e.g. Solanto et al 2012). EEG evidence supports the notion that ADHD is a


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heterogeneous disorder (Leichti, et al, 2013).

Complicating the differential diagnostic picture, symptoms like problems with attention, concentration, irritability and organization overlap with a host of psychiatric and behavioral constellations. For instance, many people with ADHD are known to have sensitivity to light and therefore have proneness to circadian rhythm disturbances; the literature is only beginning to highlight the reciprocal links between ADHD symptoms, sleep and diurnal preference. (Voinescu et al, 2012). Symptoms are under-reported for both inattentive and hyperactive-impulsive clusters, indicating that adults with ADHD tend to under-estimate their own ADHD-related impairments.(Manor et al 2012)

Medication. Stimulant medications long been used to treat ADHD, yet their action is still not understood. (Urban, et al., 2013) Newer classes of non-stimulant medications are also in use, as are antidepressants, atypical antidepressants.

Skills training. It has been suggested that working memory training programs are effective both as treatments for attention-deficit/hyperactivity disorder (ADHD) and other cognitive disorders in children and as a tool to improve cognitive ability and scholastic attainment in typically developing children and adults. Meta-analyses indicated programs yield reliable short-term improvements in working memory skills, which for verbal working memory, were not sustained at follow-up, whereas for visuospatial working memory, some evidence suggested that such effects might be maintained. Importantly, there was no convincing evidence of the generalization of working memory training to other skills (nonverbal and verbal ability, inhibitory processes in attention, word decoding, and arithmetic). (Citation needed)

Therapy. Recent randomized controlled trials indicate that cognitive-behavioral therapy (CBT) for adults with attention-deficit/hyperactivity disorder (ADHD) is an efficacious treatment. Findings provide an empirical basis for adult ADHD CBT to target negative automatic thoughts, which share a relationship with ADHD even after accounting for the confounding role of depression. Modification of negative automatic thoughts may be a mechanism of change in adult ADHD CBT and should be considered in future research. (Mitchell, et al, 2013)

Adults with attention-deficit/hyperactivity disorder (ADHD) experience significant difficulties with time management, organization, and planning, which medication alone cannot remediate. Some findings suggest that stress management training is a valuable component for the treatment of ADHD in adults. (Langer, etal 2013), others indicate that specifically tailored to targeting executive dysfunction are key (Solanto, et al, 2011).


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Introversion

Typically, most individuals think of introversion as shyness accompanied by the need to be alone or the loving comfort of being separated from the pack. But, we must not say “introversion is shyness” due to the fact that it is not the case at all. Introverts tend to choose the seclusion life, whereas shy people tend not to exactly choose this lifestyle. Being alone, or in a small interpersonal group, is a great advantage for introverts as it gives them time to think things over, process new ideas from the day, and also to avoid over stimulation that would likely cause a mental, or even physical, collapse.

Having a sensitive nature about themselves, introverts feel more than most. Their keen sense of detail, high standards, and worst case tendency thought process make for a very sensitive being. Unlike their thick skinned extroverted friends, they get caught up in every remark or become consumed of negative emotions if anything becomes less than what they expected it to be. With such a sensitive nature, they are often over-stimulated by high energy and exhaust easily from it.

Introverts do enjoy socializing, however not as long as an extrovert would care to. Introverts tend to dig deep into one subject and stay there until it’s completely finished and then go on to the next. Asking an introvert three different questions will overstimulate cognitive functions and cause the individual to freeze which results in delayed answers, or no answer at all (mostly because introverts like to process one question and answer it deeply and meaningfully). When it comes to introverts it’s always a rule of 1: 1 person, question, answer, project, group, schedule, day, and one’s alone time. Unlike their extrovert counterpart, introverts are very perceptive and pay close attention to detail which in turn takes them time to process and reflect upon. If you do not give introverts time to think it will ultimately provoke fear and anxiety as they feel rushed and helpless resulting in incomplete tasks or conversations.

As much as introverts like to socialize in small increments with few people, they highly enjoy their down time. It is crucial for a introvert to be alone with his or her own thoughts to debrief and decompress what high energy they just endured. Because introverts are such deep thinkers and take time processing they tend to build a useful long-term memory bank, which is very helpful when it comes to recalling information from months or even years back. Down time is not just for thinking alone, it’s also about recharging their internal battery and balancing within themselves and without.

To others, this solitary balancing within and without can look a lot like depression - which is quite the opposite. Due to the fact that they are highly focused and attentive individuals they tend to come off quiet, sensitive, cautious, helpless, and as someone with low energy levels - but that is just who they are. Just because they like their alone time and tend to be the quiet one at the party does not mean they are not ‘happy’. They key to happiness for individuals is through their down time and catching up on thoughts while doing something purposeful or creative, or just being alone.


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Bio-sketches and Interviews: Four Participants Bio-sketch: Participant #1 I was always the kid in class who could never manage to stay still, let alone be quite for two seconds. Fidgeting was a common occurrence that my teachers and even my parents realized were abnormal compared to others in the class. That is when I went to the doctor and was tested for ADHD; I was in 3rd grade. After receiving my chart-topping scores I was diagnosed ADHD and from then on it has been a struggle in finding ways to work with my disorder, and also which medication was right for me. I am now 21 years old still working on finding what works for me. I spent years trying different medication, and also years forgoing medication in its entirety making myself and teaching myself how to pay attention. To make things even worse, I always thought of myself as a flaming extrovert who was always ready for the next adventure. As a psychology major you read about these personality traits and self-diagnose yourself in the best light possible. Now, after spending my summer interning at a mental health clinic, I have come to find that I am truly an introvert. Shocking, but I must admit defeat for I do not want to undergo psychosis later on. More interesting however, is the friction that my introverted self and my ADHD carry between them. I have always struggled in school, even now. The mood swings, anxiety, stress, and frustration have gotten progressively worse since freshmen year of high school. But, I have taught myself skills in working with my disorder, along with medication, that make everyday life a little more manageable. I also come to find that being introverted helps in my positive outcomes in that it pulls me away from people and has me working alone and aids in the completion of tasks. Would I much rather work with a person or two? Yes, but I have learned that if I do that frequently I tend to wipe myself out far faster than being alone. As much as my hyper side would love to socialize and jump from subject to subject I am dominated by my introversion in that I can only take a little bit of stimulation before I desperately want to go home and crawl in bed. It is an everlasting pull between the two sides that so desperately want opposite outcomes. Burnout is a common occurrence with me, and I feel like it happens unpronounced and sudden. This is the negative side of my wonderful concoction. Introverts tend to lose steam, and then rest and they are ready to go. Not me. I find that I have so much hyper energy in me that when I let it out for a second my introverted self loses all control and just lets my hyper activity and wandering attention take over until I run out of fuel. After this happens it takes me almost a full weekend of just laying around, doing nothing, to bring myself to a full charge. But, when I take my medication to control my ADHD symptoms I do not experience burnout as fast, and I tend to not experience those moments of ADHD takeover and introvert recovery. Balancing these two traits that I have come to acquire, from my wonderful genetic code, has been somewhat...simple. I have always been in a sport or two, or running around with my neighbors or friends. I have also found peace in creating art with my hands - especially art that is easily broken. For me stained glass and mosaics were my


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releases in high school. I won many awards for my pieces and have had the opportunity to showcase them to the public. But, the only place I have totally felt ‘whole’ or ‘me’ has been hockey or the rink in general. Hockey for me brought all the pieces together from the fast pace high energy intense physicality nature of it all, to the need of team play but also individual skill and balance. Now that I have retired my jersey I still find my better self on the ice. I am fortunate enough that I go to a university that keeps the rink doors open and nets set everyday so I can lace up and be by myself shooting hundreds of pucks for hours until I lose an edge (a very Minnesota thing to do - I know). I think it is the immense amount of chaos that brings me to the rink, and also the risk of every move you make. You have to be constantly thinking about every single thing you do out there and that is what my ADHD craves the most, as well the non-stop movement hockey lives for. I know it’s such a cliche - but hockey (or skating in general) is my drug of choice. If you have ever heard the edge of your skates dig into the fresh ice or the sound of the puck hitting the crossbar as a failed attempt to go upper right - you would understand the peace and tranquility I submerge myself in every chance I get to become the person I know myself to be. Overall, I am improving daily. Declaring myself an introvert was my shinning moment in realizing how I can better work with my ADHD in school, and life in general. For me, every day shines light on a new discovery. It may come in the form of good or bad, positive or negative, but it helps shape the person I want to become tomorrow. And I strive everyday to be better than I was today. Interview: Participant #1

1. What characterizes ADD/ADHD for you, in your own words?

For me, ADHD s characterized by the constant need to do something or anything. I always need to be moving. I can start a task but it starts to get boring really fast so I keep switching tasks until I have a handful of half-completed tasks that never seem to get finished in adequate time. Fidgeting is by far my worst enemy when it comes to ADHD, also anger and frustration and then the anxiety that follow or provokes it. Also constantly being one step behind or disorganized is heavily present. Also, low self-esteem is negatively correlated with my anxiety that may come on due to incomplete tasks or just being behind.

2. What are the most difficult challenges ADD/ADHD brings?

For me the most difficult challenges are staying still, controlling my roaming sporadic thoughts, completing tasks, and school work in general.

3. How do you manage your symptoms of ADD/ADHD?

I take medication, but I have also taught myself to take breaks every 20 mins to shift my focus and be a little hyperactive for 5 minutes or so and then go back and get down to business. I also spent a good chuck of my childhood and adolescent life refusing


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medication because of the side effects and taught myself to catch myself zoning out or being inattentive and to narrow my focus, by high school that was a little harder todo.

4. Do you know what your basic temperament is? How does that temperament interact with issues surrounding ADD/ADHD?

Introversion. The interaction between the who is somewhat of a disaster. One minute I’m up the other I’m down. Being introverted I always want to be alone or with a few other people at most, but my ADHD wants me to be around massive crowds and be this social butterfly. So for me it’s hard to balance which side I should attend to. Most times my hyper active inattentive self wins and then, typically, I crash hard and burn out suddenly to the extent it takes me days to recharge or even want to get out of bed and the thought of interacting with anyone sickens me. I also think this combo really heightens my anger/frustration/stress/anxiety and result in mood swings that are very apparent. Also low SE is very much part of my everyday life in that I feel down and out about everything and how I can never fully complete a task or I forget things when it comes to homework and I find I never have time to read over any of my writings or correct any mistakes I make - it’s very frustrating.

5. How do you find common ground between your introversion and ADD/ADHD?

Medication for my ADHD helps in balancing the two. I make myself work alone, for the most part, and that is usually when I get the most done. I also limit myself on how much socialization I get. Being a college student you are surrounded by people constantly so I tend to stick to my own. I’m not a loner by any means, I still have fun - just in small increments. I also make time to exorcise daily for at least an hour, but usually two hours. Working out helps in releasing all that built up hyperactive energy that I keep from letting out during the day so by the time I go to bed at night I am completely exhausted and ready to recharge of the day to come.

6. What has been your experience with medications?

I was diagnosed ADHD in 3rd grade and medication started the day after. I tried everything under the sun and hated all the side effects. I also didn’t like the fact that I had to go to the nurses office during lunch to take my pill, fortunately my classmates never teased me about it. In middle school I stopped medication all together and that is when I taught myself how to pay attention and catch myself wandering off. But that lasted only a couple years and then I went back on meds in high school, which was nice because by then they came out with Adderall XR so I only had to take one pill a day - but the side effects were intolerable. I was nauseous all the time and my body shook uncontrollable, but I was able to pay attention - soon after I stopped taking it and went on Buproperon or Wellbutron how ever you spell it. It was mostly for the depression I was experiencing, or what they thought was depression. Doctors hold me that after awhile it would work as an ADHD stimulant - it didn’t. So I went back on Adderall and was still on the antidepressants - which was a horrible experience. They actually canceled each other out and almost made me more depressed and almost suicidal - so I stopped that pretty fast. I was off of meds for a while thereafter, but now I take 30mg Adderall in the two tablet


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form that works way better than anything I have tried yet. The shakes and nausea are still there just not as bad as before.

7. Have you ever used other substances (e.g. alcohol, marijuana, other drugs) that has affected your functioning?

I started drinking in high school, not heavily just occasionally. When my first year of college hit I think I drank every night of the week, not enough to make me drunk just a little buzzed. I think I used alcohol as a way of making up excuses for my academics and as a way to feel comfortable socializing so that I don’t get annoyed by everyone.

10. Have you made any lifestyle changes like diet, exercise, etc. that you been/not been helpful?

My transition from high school to college made it extremely hard to adjust to my fluctuating energy outputs. In high school I was a 3 and 2 sport athlete playing hockey all 4 years then track, softball, and volleyball so I was constantly moving and I found that the fast pasted sports were the best for my other all functioning. When I went off to college I participated in track for my first year then quit because it was boring. So I took to working out which has really helped. My diet has mostly stayed the same, I may eat a little better now than I did in the past. The college scene has really effected my life in a negative way in that I am always over stimulated and around people and can never find time to have alone time. I find myself burning out way faster now then I ever did, and it takes me a long time to gather myself and recharge.

11. How has your high energy level and distractibility affected your interpersonal relationships?

Interpersonal relationships are fine and dandy for the most part. Being introverted I tend to only have a few close friends and like to keep it that way. I love meeting new people but it just gets too tiring. I do have a bad habit of losing friends. When I see one thing that bugs me or annoys me about them it gets so heightened and soon everything that person does I hate and it makes me cringe. Over time those people become “dead to me” to the point that I forget they are even there. It’s a horrible habit of mine and when it happens it makes me an angry person, I do have anger issues on top of it so that doesn’t help. When it comes to my family, I can be very explosive. If someone says something I don’t like or does something not the way I wanted it I get so frustrated and then I start getting angry and explode. It has gotten much better since I was younger but for some reason when anything goes wrong or someone bothers me it never goes over well with me.

12. Have you found particularly kinds of partnering with others to be helpful in coping with ADD/ADHD?

Yes. I have partnered a lot in my life. I think I use it as some for of security blanket that I can go to when I’m lost or need reassurance. My boyfriend helps a lot in telling me to relax especially when he knows I’m starting to get angry. My close friends


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also know when I am having one of my ‘days’ and point it out which really helps me turn around or they leave me alone when they know I’m recharging.

13. Have you had any difficulties reading, writing or communicating in various ways with regards to ADD/ADHD?

Reading is fine if it is not a text book. If I’m reading a text book for class it may take me days to get through a page or two and actually understand it, so I tend to take lots of notes to the point where I’m practically re-writing the book out. Communicating is really hard for me. Even on my meds my brain is still a scattered puzzle and my thoughts run at a million miles an hour. With that I tend to mumble A LOT. It’s actually really bad. When I take my meds it’s a little better but it’s still there. I can’t talk on the phone to save my life because I just from subject to subject or just tune the conversation out completely and look out the window or pick at my nails - it is one of my biggest challenges. 12) What has been the one most significant challenge in coping with ADD/ADHD? Balancing between my ADHD and my introversion. It’s an everyday battle. 13) What has been the one most significant help in coping with ADD/ADHD? Exorcise and medication, and also just knowing how to work with both my introversion and ADHD. 14) Do you have any other insights or comments you would like to share after you look at this set of boxes that are a working map of key words relating to these issues? Not at this time.


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1) What characterizes ADD/ADHD for you, in your own words?

For me, ADHD s characterized by the constant need to do something or anything. I always need to be moving. I can start a task but it starts to get boring really fast so I keep switching tasks until I have a handful of half-completed tasks that never seem to get finished in adequate time. Fidgeting is by far my worst enemy when it comes to ADHD, also anger and frustration and then the anxiety that follow or provokes it. Also constantly being one step behind or disorganized is heavily present. Also, low self-esteem is negatively correlated with my anxiety that may come on due to incomplete tasks or just being behind.

2) What are the most difficult challenges ADD/ADHD brings?

For me the most difficult challenges are staying still, controlling my roaming sporadic thoughts, completing tasks, and school work in general.

3) How do you manage your symptoms of ADD/ADHD?

I take medication, but I have also taught myself to take breaks every 20 mins to shift my focus and be a little hyperactive for 5 minutes or so and then go back and get down to business. I also spent a good chuck of my childhood and adolescent life refusing medication because of the side effects and taught myself to catch myself zoning out or being inattentive and to narrow my focus, by high school that was a little harder todo.

4) Do you know what your basic temperament is? How does that temperament interact with issues surrounding ADD/ADHD?

Introversion. The interaction between the who is somewhat of a disaster. One minute I’m up the other I’m down. Being introverted I always want to be alone or with a few other people at most, but my ADHD wants me to be around massive crowds and be this social butterfly. So for me it’s hard to balance which side I should attend to. Most times my hyper active inattentive self wins and then, typically, I crash hard and burn out suddenly to the extent it takes me days to recharge or even want to get out of bed and the thought of interacting with anyone sickens me. I also think this combo really heightens my anger/frustration/stress/anxiety and result in mood swings that are very apparent. Also low SE is very much part of my everyday life in that I feel down and out about everything and how I can never fully complete a task or I forget things when it comes to homework and I find I never have time to read over any of my writings or correct any mistakes I make - it’s very frustrating.

5) How do you find common ground between your introversion and ADD/ADHD?

Medication for my ADHD helps in balancing the two. I make myself work alone, for the most part, and that is usually when I get the most done. I also limit myself on how much socialization I get. Being a college student you are surrounded by people constantly so I tend to stick to my own. I’m not a loner by any means, I still have fun - just in small increments. I also make time to exorcise daily for at least an hour, but usually two hours. Working out helps in releasing all that built up hyperactive energy that I keep from


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letting out during the day so by the time I go to bed at night I am completely exhausted and ready to recharge of the day to come.

6) What has been your experience with medications?

I was diagnosed ADHD in 3rd grade and medication started the day after. I tried everything under the sun and hated all the side effects. I also didn’t like the fact that I had to go to the nurses office during lunch to take my pill, fortunately my classmates never teased me about it. In middle school I stopped medication all together and that is when I taught myself how to pay attention and catch myself wandering off. But that lasted only a couple years and then I went back on meds in high school, which was nice because by then they came out with Adderall XR so I only had to take one pill a day - but the side effects were intolerable. I was nauseous all the time and my body shook uncontrollable, but I was able to pay attention - soon after I stopped taking it and went on Buproperon or Wellbutron how ever you spell it. It was mostly for the depression I was experiencing, or what they thought was depression. Doctors hold me that after awhile it would work as an ADHD stimulant - it didn’t. So I went back on Adderall and was still on the antidepressants - which was a horrible experience. They actually canceled each other out and almost made me more depressed and almost suicidal - so I stopped that pretty fast. I was off of meds for a while thereafter, but now I take 30mg Adderall in the two tablet form that works way better than anything I have tried yet. The shakes and nausea are still there just not as bad as before.

7) Have you ever used other substances (e.g. alcohol, marijuana, other drugs) that has affected your functioning?

I started drinking in high school, not heavily just occasionally. When my first year of college hit I think I drank every night of the week, not enough to make me drunk just a little buzzed. I think I used alcohol as a way of making up excuses for my academics and as a way to feel comfortable socializing so that I don’t get annoyed by everyone. End of my first year I smoked pot occasionally and found that it really calmed me down and made me feel better about myself and that everything was going to be alight, but like most things that got boring real fast. Then came my cigaret use and still is present to this day. I found that being on my medication for my ADHD smoking really helped combat the side effects my meds had on me in an extremely wonderful way that I know is bad for me but helps so much. It’s not like I’m a pack a day smoker...I only would smoke one a day - maybe two depending on the stress level or anxiety of a given day. And sometimes I can go a week with out needing one. If I have learned one thing it’s mixing Adderall with alcohol is never good.

8) Have you made any lifestyle changes like diet, exercise, etc. that you been/not been helpful?

My transition from high school to college made it extremely hard to adjust to my fluctuating energy outputs. In high school I was a 3 and 2 sport athlete playing hockey all 4 years then track, softball, and volleyball so I was constantly moving and I found that the fast pasted sports were the best for my other all functioning. When I went off to


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college I participated in track for my first year then quit because it was boring. So I took to working out which has really helped. My diet has mostly stayed the same, I may eat a little better now than I did in the past. The college scene has really effected my life in a negative way in that I am always over stimulated and around people and can never find time to have alone time. I find myself burning out way faster now then I ever did, and it takes me a long time to gather myself and recharge.

9) How has your high energy level and distractibility affected your interpersonal relationships?

Interpersonal relationships are fine and dandy for the most part. Being introverted I tend to only have a few close friends and like to keep it that way. I love meeting new people but it just gets too tiring. I do have a bad habit of losing friends. When I see one thing that bugs me or annoys me about them it gets so heightened and soon everything that person does I hate and it makes me cringe. Over time those people become “dead to me” to the point that I forget they are even there. It’s a horrible habit of mine and when it happens it makes me an angry person, I do have anger issues on top of it so that doesn’t help. When it comes to my family, I can be very explosive. If someone says something I don’t like or does something not the way I wanted it I get so frustrated and then I start getting angry and explode. It has gotten much better since I was younger but for some reason when anything goes wrong or someone bothers me it never goes over well with me.

10) Have you found particularly kinds of partnering with others to be helpful in coping with ADD/ADHD?

Yes. I have partnered a lot in my life. I think I use it as some for of security blanket that I can go to when I’m lost or need reassurance. My boyfriend helps a lot in telling me to relax especially when he knows I’m starting to get angry. My close friends also know when I am having one of my ‘days’ and point it out which really helps me turn around or they leave me alone when they know I’m recharging.

11) Have you had any difficulties reading, writing or communicating in various ways with regards to ADD/ADHD?

Reading is fine if it is not a text book. If I’m reading a text book for class it may take me days to get through a page or two and actually understand it, so I tend to take lots of notes to the point where I’m practically re-writing the book out. Communicating is really hard for me. Even on my meds my brain is still a scattered puzzle and my thoughts run at a million miles an hour. With that I tend to mumble A LOT. It’s actually really bad. When I take my meds it’s a little better but it’s still there. I can’t talk on the phone to save my life because I just from subject to subject or just tune the conversation out completely and look out the window or pick at my nails - it is one of my biggest challenges.

12) What has been the one most significant challenge in coping with ADD/ADHD?

Balancing between my ADHD and my introversion. It’s an everyday battle.


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13) What has been the one most significant help in coping with ADD/ADHD?

Exercise and medication, and also just knowing how to work with both my introversion and ADHD.

14) Do you have any other insights or comments you would like to share after you look at this set of boxes that are a working map of key words relating to these issues?

Not at this time.

Bio-sketch: Participant #2

I have always seen myself as an introvert, but many people seemed to see me an extrovert. Those who have known me best have described me as having a lot of contradictory characteristics: Tender, empathetic, but also often quick-to-anger. Gentle, soulful; intense, hard. Clear, analytic; obtuse, thoughtless. Intuitive, brilliant, insightful; absent-minded, disorganized, oblivious. And so on. I did not know I had ADHD until I was around 32 years old, and a part of me still does not believe it, in a manner of speaking. Even though it has been well over a decade since, I am still, on one hand, working on recognizing its implications and where I hold out denial about its significance, and on the other, sorting out my priorities about how to harness the gifted aspects that go with the combination of introverted and ADHD features.

I am ‘fortunate’ in regards to the ADHD, because it seems to be mild in the scheme of things, with distractibility being the most prominent feature. As a tyke, I was busy; I climbed things, was awake a lot, asked a lot of questions, got into things. But, I usually did not do ‘bad’ things, didn’t “act-out,” as school and service personnel so often say. I was always considered a very bright boy, and the introvert aspect was evident in a preference for reading, building/inventing things and drawing; so, much of the energy went there. Also, I spent a lot of time outside. I did do risky things sometimes, where the ADHD aspect would show – ‘escaping’ a sitter by climbing out the window headfirst at about four; climbing pine trees to jump out and roll down the branches; and later, things like mini-biking and wind-surfing. I almost never got hurt or in trouble doing these things, and I think that is because of being bright enough to have some foresight, combined with the introvert tendency to take only calculated risks. I am also ‘unfortunate’ with regard to the ADHD, because it went unrecognized, and a major result of this is that many of its symptoms, implications and resulting habit-patterns have been experienced as syntonic – part of ‘me’ – and therefore not experienced as a ‘problem’. I think this is because the aspects of introverted temperament, high intellect and good home context combined to start me off in a good direction as a child. But, because I didn’t present as a behavior problem and was able to achieve in school, no one really took a closer look after the first one: Well before school years, my parents asked our pediatrician if I might be hyperactive. “Normal overactive”, they were told. Benadryl was suggested to slow me down, but it yielded a paradoxical increase in activity. No other diagnostic or treatment efforts


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occurred until much later. My mom used to get us to play a game she called, “going on magic carpet ride”, which was really an activity that today we would call autogenic relaxation training with guided imagery. Pretty on the mark, and way ahead of the times, given what we now know about the value of relaxation training for ADHD kids.

Throughout the school years, I got good grades in school, was in the top of my

class, got high scores on standardized tests, and liked to read and learn. I did sports like baseball and soccer, socialized and had a best friend. The only concern that was raised about attention came in eighth grade when one of my teachers caught me out for daydreaming in class. This only happened once. Looking back, I know that I chronically drew pictures in class, read other books or/and balanced on the hind legs of my chair; but, because I was quiet and got good grades, these did not draw attention. In small groups of peers, I was often in a leadership-like position; I was senior patrol leader in the Scouts, became an Eagle Scout, and was managing editor of the school paper, for instance. I got medals for oration (audiences were usually just judges and a few participants) but was generally averse to having group attention focused on me, and avoided ‘performance’ where possible. In high school, I really didn’t have to work at getting grades or staying out of trouble. I did however, try out a variety of moderate-risk activities like dirt-bikes and windsurfing, but never smoked or did drugs. I lettered in track and cross-country, taking the athletic code for those more seriously than most. I dated, but did not do premarital sex. College was essentially the same. I graduated with honors, but in hindsight, I often did papers on the day or night before. Still able to get the grades, there was no press to change my style, and putting things off until ‘necessary’ became a pattern that worked. I usually scheduled morning classes, had good attendance and did homework in the afternoon/evening. I was physically active for at least an hour nearly every day, sometimes two or more hours, whether playing lacrosse or training.

Graduate school was where I can see ADHD features were catching up with me. Study and work patterns were pretty much the same. Exercise however, started to drop out of the picture. Even so, school was the only thing I was doing and I came up with ways to streamline perceived ‘busywork’ (e.g. doctoral dissertation library work was lessened by using some of my student loan to buy a new thing called a ‘lap-top computer’ – which meant I could carry it around in the library typing in citations and references, formatted automatically). I was still ‘skating’ though: where classmates began studying for comprehensive exams three months early in groups, I studied alone, intermittently, for three weeks, then set the curve.

In all those settings, I had only myself to account for, and was able to meet expectations within contexts that provided flexible but firm structure.

In graduate school I married a wonderful woman who is still the love of my life after more than a quarter-century together, and four children later. With the benefit of hindsight, I can see that the combination of having a family (i.e. others I care about who depend on me) and moving into career life was a significant change in external circumstance that changed my psychological context.


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After graduate school, my first work was in a small, rural, mental health business. In terms of context-to-individual goodness of fit, there were some aspects that matched up well and some that did not. Having a set schedule and an agency secretary were good. A supervision relationship that I had no hand in selecting, and offices in two locations, were not. The supervision caused me to nearly leave the profession and the doubts created there still haunt me today sometimes. There were a couple of areas where unrecognized ADHD features contributed to problems with performance (organization) and interactions (missing cues or misinterpreting communications, e.g.). In hindsight, I see there was a tendency to speak my mind in a way that contributed to some of my rejection/failure experiences; this still happens in varying ways/degrees now.

I often have trouble keeping up on relationships, or I talk too much or say the

wrong things in those that I do maintain. I tend not to readily recall things that are not immediately at hand, and so have trouble remembering-so-as-to-do. It has required a lot of gimmicks and reminders to compensate and has still taxed the patience and goodwill of people around me a lot over the years. I have tried all kinds of systems for this. I have also tried a range of different medications; most have not affected the needed areas and the effects have disappeared within a week or two, leaving only side effects and no increase in main effect with increased dose.

In the day-to-day over the past 15-20 years I have had persistent and increasing feelings of discouragement and under-achievement, stemming from numerous failure experiences. Most of these seem to stem from difficulties integrating long-term projects with my work and family life – especially because I have trouble making work fit into time. There have been many of these projects, the time being huge and largely unpaid, and I have added them on over the top of a private practice and amidst family life and volunteering. For many years, I would cut corners on sleep to try to keep up, but this is one of the worst things I can do because it reduces concentration and loosens up the emotions. The projects have all been very worthy, but I have seldom been able to be as prepared and timely as would be best, and there have many times where I have dropped the ball or done damage to process or relationships around me; my relationship with a senior colleague of many years has been taxed more than once, to be sure. I tried dropping some of the community and volunteer activities, but it turned out, those were areas where I was able to contribute in my way, without a lot of extra time involved, so dropping them only took away an area where I felt good.

It has taken me a very long time to understand how it is that I tick, and how I have

tried to fit things in to my life that don’t work with that, or for which my makeup is not optimal. The occasion of this article prompted a lot of reflection – a process that was quite devastating for several a few months.

I realize now that I have not situated myself well for the combination of strengths

and challenges that I have. Recognizing these has taken a long time, and remains a work in progress. Being able to construct or situate myself in a well-fitted context is another order beyond this.


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A good “innie”, I am sensitive and deeply loyal; I regard my marriage and family as my vocation in life, above and beyond my job, work or career. A strong sense of spiritual life and values usually has far more influence in how I make decisions than do pragmatics. I feel things a lot – and much more so than when I was younger, because I have more insight on life, more I care about (love), and much more at stake. I am devoted and determined, and have a good work ethic; but, I am not very motivated by personal gain (financial or other), so people have a hard time figuring me out. Often I will give to others or commit to something with no thought of gain or cost to me; I just look at whether it is good in principle. Also on the innie side, I am detail-oriented, meticulous and very failure-averse. I realize now that it takes me much longer to process how I feel about things than I used to think it did, and that when I fail to take the needed time, my decision-making is not as good as I need. When things go badly, I reflect, self-analyze and run the risk of curling into depressing self-criticism and pessimism. I have had major depression at least once, and get caught in small depressive swirls fairly frequently (it’s hard not when you experience the thing that disables you as internal and stable).

On the ADHD side, I can leap before I really look and have often committed to

good causes without foreseeing what it will take and making a searching assessment of whether I can fully honor the commitment. I have failed in this more than I care to admit. Then, once engaged, I have run into my range of perennial pitfalls with inefficiency and disorganization. Among these, distraction is the biggest stumbling block. At first, it looked to me like it was just that, if I was working on one thing, other competing stimuli (sounds, movement, thoughts) would interfere. While this can be true, there is a subtler aspect as well: It is hardest to resist distraction by things with emotional valences attached (especially negative valences), and it is especially problematic when there are a lot of them.

I have chronic trouble remembering-so-as-to do, so I often forget to do things that

are important to me, in the timeframes that are best/required/promised. This has cost me a lot over the years, and in a lot of painful ways – financially, reputationally and in relationships. I spend most workdays with a vague, gnawing dread, sure that I have missed something (and it regularly turns out that I have). This basic anxiety is about aversion to failure and is the dark-side ADHD and introversion interacting. Each feeds the other: anxiety grabs the attention and disrupts productivity, requiring extra work to go back and recover; the loss of efficiency evokes ideas about being behind and fears of falling more behind. The introvert in me has a hard time dismissing failure, and creates a bias of vigilance for it. When there are a lot of things in the works that are important to me, I get more apprehensive that I will fail and then have a harder time checking stray thoughts about what I may have missed, or am not getting done. The stress-response runs in the body and I end each day feeling exhausted. When I am stressed, I don’t sleep well and when I have felt behind, I have often worked in the wee hours in order to have family time while the kids are home and awake. The over-striving, anxiety and sleep disturbance/loss make a recursive loop that increases problems with over-focusing, decreases the frequency of adaptive behaviors like exercise, increases functional fixedness (reduces cognitive flexibility) and decreases self-awareness. I often struggle harder and harder, well past the point of diminishing returns. Noticing when to stop and


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re-set is a constant challenge. Most often, I have gone until I have made a mistake that has damaged progress in an important project or relationship – more often by omission (failing to meet a deadline, e.g.), but also by outright errors. Sometimes I just get sick because I’ve pushed my stress-response and immune systems too far. A result of the numerous failure experiences is a loss of confidence that predisposes anxiety and the whole over-striving loop all over again. Another is a tendency to narrow the field of things going on and avoid overwhelm, then I withdraw.

One part is processing style: My mind tends to a patterns that I think of as

“simultaneous divergent-convergent”; this means that I seem to co-process a couple of channels at the same time, incorporating a wider field of concepts and information as I go. When this goes really well, I get a brilliant, intuitive result that I can readily explain (or can just do and don’t have to explain); more often lately though, I continue to add complexity/detail until I bog down and have trouble sorting, then communicating the most essential parts. This style may or may not overlap with ADHD features, but because of the complexity that occurs, if I do get interrupted of distracted, I can quickly lose track of what is in the mental buffer, again having to reconstruct. (A common derailment is when I suddenly remember something else I was supposed to get done.) This pattern happens quite a lot on writing projects, especially at the keyboard. I find that I do much better speaking, so wherever I can, I dictate.

Adjacent to these is what I think of as my relationship to time. It took me a long

time to realize how I orient to time. On one hand, the introvert’s sensitive-reflective side tells me time is the one resource I cannot renew, so I am not willing to give too much of it to ‘lower-order’ priorities. This belief interacts with my belief as a helping professional that, while it is important for me to help others’ and their families, if I neglect my own, I lack credibility. There is another belief I have about family life as my more primary call. So, for instance, there is only so much time I am willing to give to things like work and career while children are at home; I will provide enough materially, but it is more important to me to provide my time; when they no longer show need of my that, I may reallocate some of it for other things.

The other side of my orientation to time is more ADHD-related: When I am

super-focused on something, I often have no sense of time or outside context whatsoever. I think of this as a self-monitoring or –awareness problem. If I am at peak ‘flow’, super-focus enhances my performance. Often though, it means being too-detail-absorbed, losing the big-picture, losing track of time, and running overtime with one task, to have it push aside other things I know I needed to do.

For years, because I was unable to see these through a non-syntonic lens, I did not

notice them and instead noticed what was easier to see – all the things other people were doing. Then there would be thoughts and feelings about that; others have often seemed to experience my talk about those things as irrelevant, secondary, misplaced or even distortional or manipulative. My innie tilt to be with few/no people is reinforced there.


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After fifteen years, I’ve also had more on my plate, and more cares. The trouble with fitting work into time is that it adds management layers constantly, because things get pushed up on the next to-do item, I fall behind, then feel anxiety and stress. My response to this is to try harder; I work more hours to keep up, drink more coffee and try to eke by on less sleep, thinking it will only be for a short while. It never is. The overstriving, anxiety and sleep disturbance/loss make a recursive loop that increases problems with overfocus, decreases the frequency of adaptive behaviors like exercise, increases functional fixedness (decrement in cognitive flexibility) and decreases self awareness. This only became visible to me with years of hindsight, and by degrees in recent years. The changes mentioned further reduce efficiency and I often struggle harder and harder, well past the point of diminishing returns. Most often, I go until I make a mistake that damages progress in an important project or relationship – more often by omission (failing to meet a deadline, e.g.), but also by outt right errors. Sometimes I just get sick because I’ve pushed my stress-response system to far. A result of the numerous failure experiences is a loss of confidence that predisposes anxiety and the whole overstriving loop.

Much of my life, people near me have reflected to me that I seem a contradiction

to them: Quiet and like to be alone, but take risks like windsurfing a storm front or free-climbing a quarry. Tender, empathetic, but also often quick-to-anger. Gentle, soulful; hard, judging. Clear, analytic; obtuse, thoughtless. Intuitive, brilliant, insightful; absent-minded, disorganized, oblivious. I have always experienced myself as more introverted, while most of my casual acquaintances would say outgoing extrovert. About ten years ago, I began asking myself what happens when we cross the introverted temperament with the high energy that goes with ADHD, permuting different temperament dimensions with different constellations of energies on the physical, emotional and mental domains. Looking at contradictions began to make some sense. I kept pretty quiet because my nearest colleagues and friends really didn’t buy the innie thing for me. And many still don’t, quite, I think.

One of the most useful formulations on the condition, for me, was that of Russell Barkley, to the effect that it in not so much a disorder of attention, per se, nor of hyperactivity, but rather a disorder of self-monitoring and -–control. The self-monitoring part stuck for me. I find aA chief challenge is self-monitoring – noticing when I’m not functioning well, so as to do something about it. Adults with ADHD are notoriously blind to their own deficits – which only makes sense because it is very hard to see and pattern something one doesn’t notice. The emotional sensitization that goes with the introverted temperament often tows the attention towards things one does notice – but these are usually things others are doing. Then there are new thoughts and feelings, that others may see as irrelevant, secondary, misplaced or even distortional or manipulative.

I have learned that I need people nearby whom I trust and who can mirror my functioning to me through timely prompts and feedback about when I am going off-trail. There has not be a shortage of those who will say things like, “Why would you even do that?!” post facto, after I already know I’ve erred and am feeling bad. Often when I’m


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not functioning well and am on the exhaustion and over-striving downslide, I’ll know I am doing poorly, and may even try to ‘down-shift’ to a cognitively less-demanding or simpler task (which will also go poorly), but I am still inexplicably unable to just stop, recover and reorganize myself, until something goes patently wrong. Once the pause happens, I feel scared, humiliated, frustrated, stupid and hopeless, because I did it again and maybe I won’t be able to change that.

The supportive aspect of having people nearby who can provide mater-of-fact

feedback at the very earliest moments of disorganization, distraction or over-absorption cannot be underscored. I really want to be productive and not unduly trouble those around me, so I am more than willing to take feedback early and often. But, it is also true that I need and depend on that feedback from others. Perhaps the single most helpful person in learning this was an administrative assistant of mine who had raised a child with ADHD; she had a really good knack of being immediate and direct, and I really trusted her ability to nudge be back in a way that I could not do myself. Having her help in office matters was worth over what it cost in wages. When she retired, a lot of things took a turn for me, because I had foreseen but not really grasped the need to replace her support before the fact.

It takes quite a bit of time to come to terms with the need for that help – that it is

pretty much a continuous need - and that I am not, therefore, as self-contained/-sufficient as I supposed or wish. I think these are probably true for many with ADHD. And maybe others too.

It is a long, slow process trying to break lifelong habits and instill new ones, when the previous set had been firmed up over 32 or more years. Sometimes I question whether I have taken the right path. Humility is good, but I wonder how long the humiliation that leads to it will keep going. My best supports are the successes I experience in the things of most importance to me, my marriage, my children and family, my volunteer contributions to youth and community, my work. These enable me to counter the too-frequent bad self-talk with reality-based good stuff. Knowing that I have done these things well despite flopping along in other areas of my life, give me hope that if I can get it together, I can do something really good again.


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Interview: Participant #2 1. What characterizes ADD/ADHD for you, in your own words?

What makes ADHD debilitating often for me is the constant disruption that it presents to train of thought, sequences of behavior and the like. It undoes the things I try to put in place to compensate for it, because it makes it hard to establish habits and easy to derail them. Everything is effortful because I always have to be vigilant for the mistakes I know I am bound to make.


It feels like my biggest enemy is time and I think the problems with attention are the larger part of that. Mine often shifts when it shouldn’t – usually drawn by a sound or something I see moving, sometimes a thought or idea. Other times, my attention is exclusive, hyper-focused; but, in those periods, I often have no awareness of the passage of time. Depending on how focused my mind is versus the complexity of the task or project, the hyper-focus can be very productive to very inefficient. Daily, I lose time to a host of inefficiencies. Especially problematic is that I forget things often; remembering-so-as-to-do is hard, so I depend on a lot of external reminders. If I get interrupted, I often lose much of the train of thought I had going or get derailed from completing steps to pin it in place, so I am constantly reconstructing what I just lost because the phone rang or someone came in, or what have you.


It has taken me years to recognize that nutrition and diet make a difference for me. I can especially feel sags in omega-3’s and I can feel the benefit of trace minerals through supplements. It’s a subtle factor, with about a 3-day offset, but it makes a difference that I can see clearly now.

Managing or decreasing levels of stress is important on both the general and moment-to-moment levels. Tai Chi is probably the most beneficial single exercise regimen I have been on, though physical activity in general helps improve performance. Having the help of a secretary of office manager also is priceless in keeping me organized, reframing things and keeping me on track.


Yes, introvert. This tendency means I am comfortable with solitary activity and often prefer it, and that when I get stressed, I’ll likely withdrawn into contemplation rather than spring into action. It creates a pattern that seems inexplicable to some people, seeming opposites, because the ADHD keeps me moving and noticing things while what I otherwise want is to be left alone and delve into one thing.



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Most of the places where these two sets of tendencies meld well are outdoors. One activity where they meet is during bow hunting season. Whether still-hunting, stalking or sitting, the slowness satisfies my need for quiet (introvert characteristic), and the slower I go, the more I find novel events and chains of events going on around me (ADHD). Another area is when I am outside with small groups like scout patrol or a few other hikers; because I’m sensitive to my surround and am always noticing things, I have a good eye for the weather and seldom get lost – which are both beneficial. I’m willing to tolerate the risk of high adventure (ADHD) but do a good job of preparing and keeping self and others safe and aware (innie).


I tried three different medications in the past to help with my ADHD symptoms. My experience was that they seemed to help a lot in the first few days, but my body quickly adjusted, and the main effect wore off within a week while side effects became a problem. Increase doses led to increased side effects that outweighed the main effects. The stimulant-class meds, for instance, gave me volatile irritability when I was coming off at the end of the day, which created problems in marital and family relationships. Coffee has been a primary fallback.


No. I did drink socially in college, for fun with friends; never missed class or work because of it though, nor experienced adverse consequences beyond a headache the next morning occasionally. Never tried drugs; never smoked.

2. Have you made any lifestyle changes like diet, exercise, etc. that have been/not been helpful?

I do better when I go to bed earlier and get up earlier, and sleep well. I do poorly with sleep disturbance or disruption. My eyes are sensitive to light, even closed; the digital clock would wake me when it would get to a time like 12:38 or 4:45, when most of the digital bars are lit, so once I got a sleep mask, I enjoyed a huge improvement in sleep quality – which makes a big difference in mental sharpness and focus during the day. When I stay on a morning routine that includes some prayer, some Tai Chi and some time to do some thing enjoyable, I do better. If my sleep becomes troubled however, these often get sacrificed and I have a hard time getting back on routine. Dietary factors also make a difference for me: boosting omega-3’s helps a lot; eating protein in the morning seems to help, but this may reflect sensitivity to a flatter glycemic curve more than a direct effect on functioning.



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Working I constantly is failing to finish things, run out of time, and feel discouraged from under-achievement - so that interferes with relationships. With my family I am torn between adequate sleep or spending time with them, and a lot of it has to do with incomplete tasks at work that spill into family time. This waterfall of or cycle also leads to feelings of discouragement from underachieving at work and then at home in that I don’t get to spend as much time with my family that I would hope to. (interpersonal relationships at work? Might want to add)I very often feel like I misstep in relationships, especially by talking too much, or saying some thing I shouldn’t have, or saying it in a clumsy way. When stimulated by interesting ideas in conversation, I often keep talking, interrupt or finish people’s sentences for them. Failing to remember to do things, losing track of time and missing a deadline or being late for a meeting, often impact my relationships badly as well. The main way high energy affects my relationships seems to be that people perceive a lot of intensity in me, even when my responses are subdued.

4. Have you found particular kinds of partnering with others to be helpful in coping with ADD/ADHD?

Yes. Partnering with my wife has been the best in coping with his ADD/HD in that she helps balance me. Also, partnering with my assistant when I had her was very helpful also in that she keep me on track. Partnering with my colleague has proven to be helpful. The main kinds of partnering that I have found helpful are when another person can prompt me when I get off-track, but can also help me secure time without disruptions. Interactions that prompt prioritizing of tasks help too. Partnering that reflects and refracts how I am doing, feeling and thinking, is usually helpful, but often comes after a period of poor performance, so I experience it as unpleasant initially. Longer-term experience with this tells me that it helps me see myself and be more intentional in my development and maturation, but I still often dread it because it usually starts from something negative. I would not say I am good at seeking this kind of partnering; maybe if I was more regular and proactive with it, I would experience it as moving from a secure place into addressing an area of challenge, rather than feeling like moving through humiliation to better.


The question is a compound one. On one hand it seems to ask about learning-disability type issues; to that I say no. On the other, it seems to ask if ADHD affects how well/often I communicate. To that I would have to say that yes, it does affect whether and how I communicate. Often when I am too-absorbed with things, or feeling stressed (“going too fast”), I will forget to communicate, or just not communicate because of being to inwardly-absorbed or in my own world of trying to perform well. Alternatively, I may not read all of the addressees on the email, may send without the attachment or the like. I may miss cues or not hear all of what is said. My tendency to think divergently can get me in trouble in writing tasks because I conceptualize too many ideas and have a hard time concisely writing one train of thought; I write, edit, edit the edits and re-edit, which takes a long time and usually leaves me displeased with the product besides.


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6. What has been the one most significant challenge in coping with ADD/ADHD?

Awareness. Acceptance. It is hard to cope with something one doesn’t necessarily see. It is hard to see something I don’t want to have. It is hard to accept something that derails things and thereby makes everything feel effortful, vigilant, unrelenting. From the innie perspective, it’s a challenge of maintaining morale and motivation in the face of something that probably will not get better.. When I do start a habit or task it then all of a sudden it just stops - it is a constant underachieving cycle that lead to feelings of discouragement. 13) What has been the one most significant help in coping with ADD/ADHD? I would have to say my wife – having her unconditional love and positive regard makes it possible and desirable to face where I feel small, incomplete, damaged or hopeless. She reminds me of successes and things that she values in me. She helps me to regain a more circumspect view when I get over-focused on things that seem like failure. After her, my former secretary who was good at being direct and unflapped. 14) Do you have any other insights or comments you would like to share after you look at this set of boxes that are a working map of key words relating to these issues? Fourteen questions about a heavy topic is a lot; and answering them on the fly, without forethought is unpleasant. It’s a reasonably good map though, based on what I feel and experience. It gets me thinking that I usually just try to survive the context I’m in, instead of shaping it.


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Bio-sketch: Participant #3

When I was asked to write a brief description of myself, my brain went into fast forward. (“Brief? I can’t do ‘brief’! And if I say …. maybe someone would think ……… or think ……….. so I really should say it in a different way. And what about the time when …………., but that would take 3000 words just to explain ……”) It is like being asked to look into a mirror and describe yourself. I am not looking into a single mirror. I am trapped in a hall of mirrors seeing infinite distortions of myself. I am an only child. When I was quite young, I recognized that I wasn’t functioning the way other kids my age were. I was overly sensitive and took everything in. I knew I had problems socially. My thoughts jumped all over the place and I had difficulty expressing all that I was thinking. I blamed all my problems on being an only child. I thought that having siblings would fix me. I had an active imagination and could go “inside myself” easily. Part of me knew that I would always have to take responsibility for my own entertainment and I could do that well. I wasn’t a social outcaste, but I was definitely on the fringe. My best friend was the most popular person in my grade. If she and I had a fight, everyone would side with her. If I was absent or wasn’t at an event for some reason, I don’t think anyone would have noticed that I was missing. I felt invisible. I have always had problems completing tasks. Needing to do something perfectly was a significant issue when I was younger. (I took two years of drafting in high school; at times, things got really bad and it took a long time for me to complete projects with many ripped off my drafting board, crumpled up, and thrown against the wall.) Perfection can still be an issue, although I pick and choose what is important to fuss over (sometimes). I also can’t pick up a task where I left off; I have to start over from the beginning. For example, if I am cleaning my kitchen counters, I start on the left side. So the left side of my counter might get cleaned twenty times before I ever get to the right hand side. Some people say that it gives them a sense if accomplishment when they write a list of “to-do” items and then cross things off as they are completed. When I write a “to-do” list and finish something, I rewrite the list. I am often judged because of the way I approach a task, but I’ve learned to care about others’ opinions less than I used to. In terms of relationships, I often form bonds with domineering extroverts that work fine for a while and then fall apart in a big way. On the positive side, I work on a tall ship during the summer. A lot of the relationships that I have developed sailing are really good. I think it is because we live together 24/7 and working as a team is a necessity. On my boat, I’ve found the “family” for which I’ve always been searching. In several cases, young “bad boys” (crew members in their 20s and early 30s - young enough to be my son - who, for example, have outstanding arrest warrants, were in “BD”


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classes in school, etc…) specifically seek me out as a friend. Outside of sailing, my few close friends are introverts and they “get it”. Besides sailing, physical activity is something that helps me cope. The main “safe place” for me is on stage. Immersing myself in a character and being in front of an audience is where I feel like I can really be me. I wouldn’t change who I am. I have many gifts – noticing what others don’t, combining ideas and concepts in fresh ways, sometimes being able to distill all the information into a succinct thought. Because I have had to always work to fit in, I think have more compassion for struggles that everyone experiences. Can I be done now?

Interview: Participant #3

1. what characterizes ADD/ADHD for you, in your own words?

For me ADD/HD is the inability to stick with a task/complete them. Constantly jumping from thought to thought or activity to activity. Also, having trouble meeting others expectations about the way something should be done. Energy swings (mood swings) are also a common characteristic for me especially when I was younger in which I was very explosive (angered or frustrated).


Finishing tasks is one of the most difficult challenges along with frustration/anger, communicating with others, or anything with a deadline attached.


Exercise is a big thing in managing my symptoms whether it is mentally stimulating or physical. With that I participates in Tall Ships and sail with a crew. Sailing is awesome in managing my symptoms in that I am part of a team, I am given one role at a time and that task I am given must be completed for the ship to sail properly. With sailing I am able to maintain a high amount of focus for a given task, and in the end when it’s all complete I can stand back for a moment and see the beauty in it all. I also rock climb, which is another sport that requires a lot of concentration, but also shifting my focus from one thing to another as I scale a rock wall.

I am also really good at catching myself when I am off track. Being a teacher I think it helps in making me realize and recognize when I need to kick it in gear. Another great way I manage my symptoms is taking responsibility when things do not go the way they were planed.



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I am an introvert. With that I gather information and processes, but need response time from others. That also brings about the issue with scattered thoughts, so sometimes it takes me longer to organize the information coming in, sometimes not. I tend to avoid phone calls, and would rather do things over email. When I am with others and many conversations are going on at once it is quite draining for me. If I experience so much of this high energy throughout the day I will then feel drained once again, and with that I experience burnout often. With that burnout I know I needs my alone time to recharge for the next day of high energy and communications with others.


Sailing is a huge part in helping me find balance between both introversion and ADD/HD. I also find that being a teacher helps, but often gets sidetracked by the kids or lesson plan.


I have no history of using medication.


none

2. Have you made any lifestyle changes like diet, exercise, etc. that you been/not been helpful?

Finding time for things that bring me to a neutral state (sailing, rock climbing). With that I finds that exercise is necessary for me to balance within.


Very few interpersonal relationships, but the ones I do have are strong they just live in a different state. With that I tend to keep to myself, but does find a bond with my sailing crew. When I have been in relationships I have been very subservient, others have always been dominating.

4. Have you found particularly kinds of partnering with others to be helpful in coping with ADD/ADHD?

Sailing crew is very much helpful with coping, and when I have gone through hard times I did find that partnering did help in one way or another. When I rock climb I have a partner, because without that person I would fall - but that partner is very toxic.


Reading I do fine with. When it comes to writing I would rather not have anything to do with it other than my love for fiction novels, I would love to write one someday. Managing documentation is a problem, too much effort - not interesting. Communication is poor. I try to avoid phone calls. I am currently the one responsible for planning a trip


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and I do not even know who’s going, who’s driving, what time and where. I am just hoping that things will just “happen” to work out without my doing anything 12) What has been the one most significant challenge in coping with ADD/ADHD? Trouble being taken seriously by others 13) What has been the one most significant help in coping with ADD/ADHD? Realizing and taking responsibility and also catching myself when I notices I am off track or distracted 14) Do you have any other insights or comments you would like to share after you look at this set of boxes that are a working map of key words relating to these issues? None *Notes by Interviewer* Brought up how her cognition, affect, and behavior transitions from the classroom, to her life outside work and play, and then to her activities that she participates in. Found it interesting that in her normal everyday life at home she has what I call “organized chaos” in that her house is not exactly tidy. Then when she shifts to school life, her classroom is kinda unorganized also but she will point out a place that is organized and clean (and feel pretty good about it). Then when it comes to her exorcise/activities (that she deemed necessary) it’s the opposite. I think sailing has a huge helping hand in balancing her two energies out to produce something that is amazing (catching wind and flying over the water). On the ship she has a bond with the crew, has a task to do that must be completed, and completes the task and moves on to the next. I find that because sailing requires one thing at a time she can maintain her focus (and on something she enjoys doing) and finish something. In life and at school she has so much going on, inside (mentally) and outside (physically) that distraction and incompletion of tasks occur quite frequently, or they are done just in time or on the date due. This sometimes then leads to her frustration and anxiety, and on top of it introverts are sensitive individuals so in a sense it heightens these emotions - as far as I see it. We also brought up the idea of going shopping, which I never thought about before. Looking at the idea of shopping, whether along or with others, is quite an overstimulating environment. For her it’s an in and out experience - I go get what I need and then I leave - and for me I really enjoy going to the mall and walking around and looking at things and keeping to myself. Really cool to see similarities and differences in those who are introverted and ADHD.


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Bio-sketch: Participant #4 I was not diagnosed with ADD/ADHD until winter of my freshman year of college. I had always suspected that I had it but didn’t have enough problems or serious enough problems that I felt I needed to address it before then. I also know it runs in families and my brother was diagnosed with it which gave me more suspicion. To sum up how I have always been when my doctor was questioning me about it to see if I did have it he came to the subject of sitting still for long periods of time such as in a meeting or film for football. Without even asking whether I did have problems with that (which I did) he said “Yeah you’ve always been kinda energetic and fidgety.” So needless to say it was very apparent that in that area I was always affected by it.

When I was younger I was always running off by myself to explore or build things or just tinker. It started with outlets that allowed me to do this is in an “acceptable” setting such as gifted/talented program competitions for elementary school in which you would be given a list of items to use to build a contraption that must complete a given set of tasks under its own power. With friends we would always run off into the hills and hike around and find interesting places to hang out or see. Then as I got older video games and other things helped fill the part of my life that needed constant stimulation but without getting over stimulated. When I got old enough I was allowed to buy airsoft guns, which are like BB guns that fire plastic BB’s bigger than a metal BB but smaller than paintballs. As I bought smaller cheaper spring powered guns I would take them apart and combine other pieces and make adjustments to make them better, satisfying my need to tinker as well as gather my energy, often doing so in the comfort, quiet and peace of our downstairs shop as life continued on at a fast, shallow, and extroverted pace of my mother upstairs.

I was tall and lanky when younger but slowly grew into my frame, both growing up and filling in my skinny frame. Sports were always a constant in my life, whether it was after school soccer, basketball, or my mainstay hockey. I was always able to adjust to the fast pace environments and read the plays and situations and process many details because of my ADD and introversion. This helped me be “me” but in a more socially acceptable environment. I was very bright as a child, but often would zone out and then when I came back to Earth minutes later missing much of a lesson or example I would then be able to figure out how to do what I needed to do to compensate for my distraction. But even as a child I always knew that I learned better through doing than simply watching or listening. Visual lessons were always much easier because if I zoned out I could simply put the pieces together and catch back up to where the teacher was at because of my intelligence.

As I got older I continued this pattern of tinkering, exploring and sports. I was becoming quite the student and athlete. But I started to notice as I got into more advanced classes such as calculus, or in situations that I could not compensate for my ADD such as football practice or football camps, where in all seriousness thousands of dollars were on the line for me as I was working to garner


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scholarships. I would find myself missing directions during football and zoning out of class for 10 to 15 minutes at a time and then barely scraping by after hurriedly teaching myself the lesson out of the book that was constantly missing key points that it seemed only the teacher possessed and doled out as he pleased. However as I struggled in traditional style classrooms, the shop classes that I was taking were a welcome escape from the constant pressure to try and force myself to pay excruciatingly close attention, or at least it seemed that way.

I often struggle with timing, either in quantitative matters such as being on time for many things or in more qualitative matters such as relationships or friendships, often taking what seemed like “too long” to process things and make a decision. I was trying to force my introverted, ADD self into the lower-‐mobility, extroverted world and obviously, as painstaking, painful, and useless this was, until I learned more about myself and the traits I possessed I suffered through it. After the help of a very close counselor/mentor, I have slowly begun to accept these traits that I possess. I’ve been able to dissect my situation more and realize why I do what I do, and to work with who I am, rather than trying to fit myself to my environment, but rather melding my world to fit me.

With ADD and introversion as two major traits of my being, I often noticed deeper details in many things, and as people with ADD often do, say these things out loud, very often at the disdain of my audience. Most people do not wish to delve deep than the surface and highly dislike when you cause them to think deeper than they usually do or realize an obvious truth that seems to be somehow eluding them like a parade through a library. As I have come to learn people with ADD often don’t filter their words how most people are “socially prescribed” to do. I have found this true in my life that I have often been called “tactless” or “too straightforward”. I am at times labeled an “asshole” or “a dick”, implying I lack empathy towards others or simply wish to metaphorically rain on their parade. This is simply not the case. A short interview with a coworker led me to realize that many times, often involving alcohol, I say things that are not very welcome or are considered harsh, but are not lies or any other fanciful notions. I realized that while I do not wish to make anyone’s life hell, or rain on them, I do feel constricted and constrained by my lack of ability to string together thoughts into a longer plan and thus often am at the mercy of others’ “flow”. This leads to a feeling of a lack of control, and thus when I am finally able to maintain my own flow, I feel very defensive and often aggressive to anyone trying to constrict or disrupt my organic flow. As I moved forwards I continue to realize and accept the benefits, contradictions, and challenges that having ADD and being a sensitive introvert entail. I continue to mature and move towards a more graceful state of being, especially in regards to these two traits that make up so much of who I’ve been, who I am, and continue to shape who I will be. I am putting more effort into growing as a person and growing into being a man and a human being. Everyday I’m learning to “do” less (pretending and forcing my shape of peg into the wrong whole that is the extrovert dominated world) and just “be me” more. The best way I feel I can leave you with an idea about how knowing more about my own ADD and Introversion,


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and how they interact and affect me, and how this knowledge helps me find peace, I can only think of a quote, “the smart man knows the world, the wise man knows himself.” Interview: Participant #4 1 What characterizes ADD/ADHD for you, in your own words?

I tend to look at it not as a disorder, but as a set of traits that are unique to me and I tend to see it as a gift and a curse. Organization proves to be difficult, and also beginning and completing tasks.


The most difficult challenge is being on time, and being prepared for things.


Medication helps manage my ADD/HD symptoms in that it helps break things down and gives me the ability to focus on one thing at a time, or the one thing that is to be done in that moment.


Introvert. It’s about being “In yourself and lost and in yourself” mixed in with thinking from thought to thought and wanting to be active and moving.

How do you find common ground between your introversion and ADD/ADHD?

I have come to know that if I were to go out one day and be around people (high energy stimulation) I would have to spend the next day to himself to recharge. And also, if I knew I was going to be around a large group of people or be in a high energy situation then I would take a nap before going out. Football also was a mediator between my introversion and ADD/HD. You have the physicality of it all, but also the racing of thoughts from one play to another, and then the individuality of being the only person in your position and it’s your job to make the right move.


I was diagnosed ADHD in the winter of 2011 and have been on Adderoll XR 60mg since. Since being on the medication I as noticed a difference in my ability to pay attention and complete things, but then again I have days where the medication may not even seem to kick in and I just “exist”



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That has affected my functioning? No. I am in college so I tend to drink socially. I have noticed hat nicotine helps a lot with, or works well when I’m on my medication. 2. Have you made any lifestyle changes like diet, exercise, etc. that you been/not

been helpful? Transiting from high school to college was difficult. I was a smart kid in high school and if I zoned out in class I was quick to teach myself how to do something or what needed to be done to catch up. College is different, but the meds help with keeping me focused during school. Also, I can no longer play football now due to a major career ending concussion. I went out for track and that was fun. I have always been a very active person, so finding new outlets is going to have to occur. Also, I moved out of my parents house which was very helpful. My mom is a definite extrovert so she doesn’t really get me and is always on my case, so being away and alone is helpful. 3. How has your high energy level and distractibility affected your interpersonal

relationships? I have a knack of being blunt and stating my opinions, so some people are put off by that. Other than that my interpersonal relationship are okay for the most part. 4. Have you found particularly kinds of partnering with others to be helpful in

coping with ADD/ADHD? Working with someone has proved to be helpful for me. But, I go to a very individualistic university where everyone is out fending for themselves so it’s hard to find someone who will sit down and work on something with me. 5. Have you had any difficulties reading, writing or communicating in various

ways with regards to ADD/ADHD? Reading has been difficult due to my career ending concussion from football in the recent years. Writing brings no difficulties and I feel I am proficient at it. When it comes to communication I much prefer to talk to anyone in person, if it is an important matter I will call them if meeting them in person is out of the question, other wise texting works well. When it comes to socializing it’s good and bad. I tend to speak my mind so people call me a “dick” or “ass” but that is just how I am. 12) What has been the one most significant challenge in coping with ADD/ADHD? School. 13) What has been the one most significant help in coping with ADD/ADHD?


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One of the most significant helps is being in a situation that requires the set of traits I have, or the strengths that I brings to the table. 14) Do you have any other insights or comments you would like to share after you look at this set of boxes that are a working map of key words relating to these issues?


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Summary of Group Participant Conversation

Challenges

Each of the four innie-‐ADHD participants described their individual experience with ADHD in its key implications/challenges.

As expected, all participants described difficulties with attention, concentration, and switching mental sets; high level of detail-‐orientation/-‐processing, tendency to either super-‐focus or get distracted often and difficulty sustaining performance over long periods/projects. All related degrees of difficulty with staying organized. All described chronic feelings of failure, underachievement relative to intellect, and chronic and sometimes intense feelings of discouragement/depression or/and anxiety. All experienced frequent irritability/ anger and frustration as well – both at others and self. All described emotional sensitivity in general and sensitivity to others, but also related feelings of too-‐often making social missteps or unwittingly damaging relationships at one time or another – either through commission (not “using the filter” in conversation, v. failing to follow-‐thorough on something important. Correspondingly, all related periods of obliviousness to inter-‐personal or environmental cues/surroundings. All disclosed degrees of feeling like social outsiders for these reasons. But, for similar reasons, all have some avoidance of relationships too. All expressed feeling that the socio-‐institutional contexts of their living leave little room for being authentic (as-‐I-‐am), and instead require the donning of an assumed persona that attempts to identify with and meet perceived expectations and demands -‐ but which is experienced as incongruent in greater or lesser degree.

Similarities and Differences By Gender. Both women had higher degrees of acceptance of diagnosis and difficulty than the men. The men were more likely to overtly express or exhibit contrarian attitudes towards systems/authority, the women more acceptance of the status of things. Though all endorsed relative difficulties with certain kinds of social perception, the men were reportedly more likely than the women to notice and focus attributions for perceived failure or difficulty on external events/factors. They may tend to act more on the environment and thereby experience more outwardly-‐directed frustrational attribution.

Similarities and Differences by Age. The two young people both disclosed other substance use alternating with or in addition to the prescriptions, including nicotine, caffeine and alcohol. Both also ascribed to “acting” in relationship to others, as well as utilizing their introvert sensitivity to “play” or manipulate others deliberately. Comments from the older participants indicated relative absence of deliberate effects here but more awareness of subtle attributional errors that color thinking, feeling and acting over time.


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The older adults did not endorse substance use, nor prescription medication use. The older male had tried prescription medications, but found that main effects briefly outweighed side effects, then the converse, which yielded discontinuation of the medications. Both older adults endorsed use of caffeine.

Similarities and Differences by Age-‐at-‐Diagnosis. The younger participants were diagnosed at younger ages and showed differential rising to the challenges, by gender. The younger woman related earlier utilization of professional services, and more-‐frequent use of intentional compensatory strategies, but also more doubt about individual coping and positive future. The younger male endorsed having the condition, but also endorsed lowest use of adaptive compensations, and highest use of compensations likely to be costly or maladaptive. The older male was diagnosed latest in life, did utilize some professional services, but related not being at the same level of acceptance as the two women. All described greater or lesser degrees of grief-‐like processing associated with diagnosis. Compensations The group discussed their adaptations and compensations: Similarities and Differences By Gender. Both women had higher degrees of acceptance of diagnosis and difficulty than the men, which is viewed as a key step in intentional compensation. The women appeared to have rather better individual adaptations (perhaps because of different socialization to interpersonal relationships) and to have found adequate institutional context niches they could tolerate. The men tended towards less engagement with confidants -‐ less depth or very low frequency, whereas both women had two or more supportive others to whom they regularly turn for unconditional support and regard.

Although most adaptive in daily techniques, the younger woman also voiced highest frequency of utterance about anxiety, depression and probabilities of negative future outcomes, and to have most difficulty in compensating these. Similarities and Differences by Age. Both younger participants indicated that they used prescription medications. Older participants had tried medication, but did not endorse current use. Caffeine-‐use to boost performance was endorsed by all. Younger participants engaged in more at-‐risk sensation-‐seeking or mood-‐altering behaviors, whereas the two older participants tend towards thrilling outdoor experiences with mediated-‐risk (sailing, windsurfing, canoeing, high-‐adventure).

All related the importance of exercise, most on the order of 1-‐2 hours/day being best. The younger pair were proportionately more able to achieve this, while the older pair were more often engaged with other life activities in work, family or civic contexts. Older age at diagnosis was associated with more intuitive coping, more retreat to better-‐fitted or more-‐permissive environmental contexts.


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Similarities and Differences by Age-‐at-‐Diagnosis. The younger woman was diagnosed earliest of all four and arguably demonstrated the most acceptance of her diagnosis, and the most active daily use of compensatory tactics and strategies. She was able to explicitly map her process in attempting to complete tasks, both when adapting dynamically to her challenges, and when not, and had some sense of factors affecting it. Later diagnosis seems to be associated with more difficulty in participants to self-‐correct entrenched habits. Mapping and Feedback

Vraniak shared a mapping of critical points and thresholds, assembled based on observing and hearing from all four participants (see figure).

Beginning the basic intra-‐individual-‐context issue of attention, at the bottom of the center column, and moving upward , the group felt the diagram reasonably captures the interplay of subjective reactions and external context events. The left and right columns represent different trajectories initiated by strong feeling; these are cognitive-‐affective loops with behavioral implications, depending on whether the internal compensation is one of minimization/denial (opposition/oblivion) or acceptance/withdrawal (defeat/despair).

The group discussed and found it a fairly accurate characterization of the pitfalls and did acknowledge that adequate pairing-‐to-‐partnering usually results in better outcomes when the partner can effectively help reflect and refract the difficulties, and the two can negotiate to form a better-‐fitted context. It was also admitted, however, that participants often feel it is difficult to locate and maintain such relationships in various key contexts. Personal Adaptations

With the given that introverted people often require time to process to the level of thoroughness that feels satisfying, and will give different feedbacks at two minutes, two hours or two days, the group shared reflections on how we might opt for new adaptations. Ironically, it was noted that all 4 tended to delineate autonomous individual strategies over inter-‐personal, despite the immediately preceding mapping. The participants considered it probable that the situational parameters (quick presentation of novel, complex stimulus relevant to self-‐and-‐other/s, plus brief processing time before being asked to respond: high-‐cognitive complexity, time-‐limited) were not fitted to the introverted style of processing, and that richer responses would result if additional time had been proffered. These observations have important implications for tailoring supports to individuals with introverted temperaments who also have ADHD.


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Key Features and Dynamics of introversion with ADD/ADHD

Features of both ADD/AHDH and introversion were very evident in the self-‐narratives, interviews and group conversation among these four participants. What was intriguing to see has consistently patterned (see Table 1) some aspects of both either seemed to intensify a particular characteristic or create an opposing tension: 1) Intensify – the high focus rumination, circular thinking and attention to detail of introversion combined with inattention-‐distractibility, disorganized thinking and singular yet temporary focus, to create an intensified experience of cognitive overload and confusion, being lost. A roiling mixture of the introverts commonly accumulating feelings of fear and anxiety, resignation, tiredness and exhaustion, despondency and/or depression was added to by the frequent feelings of frustration and anger, resentment, hopelessness and despair contributed by ADD/ADHD, so that a common feeling of feeling like a failure and low self-‐esteem was intensified, particularly as a tendency toward rash, risk-‐taking behaviors was ‘complemented’ by a highly sensitive perception of the often negative consequences that resulted. And the combination of low physical energy, apathy and lassitude, constantly feeling rushed and helpless of introversion with the high energy, impulsive out-‐of-‐control mobility of ADD/ADHD frequently led to the inability to complete many important tasks in a timely way or at all. 2) Conflict -‐ nn the other hand the introverted perceptiveness and insight conflicted with the obliviousness of ADD/ADHD, contributing to a vacillation between ‘going deep’ and ‘skimming’; both sensitivity and bold rashness often led to vacillation between extreme feelings of deflation and being excited; and the conflicts of feeling physical lassitude on the one hand and agitation on the other often led to an approach-‐avoidance vacillation, beign both over-‐ and under-‐stimulated. Table 2. outlines the common dynamics and thresholds, what Vraniak (2010) calls Leitmotifs, of patterns of compensation and adaptation involved in this combination of features: There is was a reported tendency to rationalize and manipulate by informants in this study, frequently externalize by blaming others and then to feel guilty, often attempt to be the one who always initiates and thus set the tone and maintain control in situations.

There seemed to be 3 thresholds or bifurcations during development that seemed critical in this patterning and that provided the opportunity for healthier coping mechanisms: 1) Physically at some point after self-‐ or other-‐identification of ADD/ADHD medication was tried and either discontinued or eventually continued after side-‐effects were successfully coped with. The successful use of medication significantly helped the person with some symptoms, while non-‐use tended to deepen adaptive challenges. 2) Emotionally there was a frequent minimization of challenges, that at some point, either led to a deeper denial or into a greater sense of acceptance of the reality of the challenges faced. Squarely acknowledging and facing the difficulty of the challenges led to more effective adaptive shifts, including greater reliance of others rather than (dismissal of them) and usually a lessening of low self-‐esteem. More convoluted and more deeply set defensive compensations usually


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resulted from denial. 3) Cognitively, some of the participants in this study experienced a sense of great relief, excitement and sense of transformation upon the realization about introversion being a part of their make-‐up, which is leading to new adaptive possibilities, given the greater clarity in understanding what is going on for them.


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Table 1. Characteristics of Introversion and ADD/ADHD that Conflict & Complement Introversion ADD/ADHD

Introversion-‐ADHD Complementarity Introversion-‐ADHD Conflict

Mental: inattention-‐distractibility disorganized thinking singular yet temporary focus oblivious Emotional: frustration-‐anger resentment

despair hopelessness rash Physical: high energy-‐mobility agitation-‐fiestiness unable to complete behind impulsive out-‐of-‐control

Mental: high focus-‐rumination circular thinking attention to detail perceptive Emotional: fear-‐anxiety resignation

despondency-‐depression tiredness-‐ exhaustion sensitive Physical: low energy-‐sedentary apathy-‐lassitude unable to complete rushed cautious helpless

Mental: vacillation … go deep -‐ skim Emotional: vacillation deflated-‐excited Physical: vacillation…avoid -‐ approach over, under stimulated

Mental: cognitively overloaded confused-‐lost Emotional: feel like a failure low self-‐esteem Physical: can’t finish anything periodically burned out


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Table 2. Introversion-‐ADHD Defenses and Dynamics: Leitmotifs (loops)

Mental: rationalize & manipulate … shift away from self-‐responsibility deny & pretend (shuck & jive) become authority minimize & manipulate, pretend & defend Emotional: blame & guilt … externalize or internalize … displace or

avoid, try to please or govern the irritation, displeasure, disappointment, disapproval and/or rejection by other adults and peers (project)

Physical: initiate & control … prevent (be a hard target, keep moving) intense exercise, sports, outdoors nutrition, medication, substance use


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Commentary, Conclusions and Recommendations The language used by scholars doing research and refining diagnostic systems regarding ADD/ADHD tend use pejorative terms that are slightly behaviorally inaccurate semantically, rather than more accurate, neutral terms. Primarily this misrepresentation rests upon a lack of focus on and study of the characteristics of the various and quite different contexts within children and adults exist. If you are in a rigid educational system that insists upon immobility, didactic lecture and passive learning the terms overactive and hyperactive might be used rather negatively, but if you are on a tall sailing ship the terms highly mobile and highly energetic might be used more neutrally or positively. Impulsive can also be frequently an initiator. Inattentive is especially inaccurate in that certain roles and contexts (e.g. military, law enforcement, parenthood) require and reward rapid shifts in attention that are of short duration that rapidly scan the entire environment beneficially for self and others. And certainly describing individuals as not being able to self-‐regulate or control their behavior is very different than capacities that direct, channel and place certain behavioral repertoires in the most relevant and appropriate contexts, within the best-‐fitted social roles. The majority of scholars and researchers, not having experienced the features of ADHD themselves, have thus tended to pattern these aspects in terms of syndromal constructs that place the ‘disorder’ within the individual, with only nominal attention to the relevance of context. One result of researchers’ and scholars’ lack of first-‐hand experience with the types of high-‐frequency reactions and responses by parents, partners friends, authorities and other significant persons (coupled with the use of constructs and semantics that result in skewed attributions), is that scholars have not approached mapping the ontological trajectories that gradually result for persons having high energy, high mobility and rapidly shifting attention-‐that-‐scans, in response to ill-‐formed institutional, social and interpersonal contexts. It is especially the case that this has not been done in terms of common compensatory patterns that then develop in adaptive, versus maladaptive directions. If a child moves about a lot, typically adults attempt to constrain the child, which results in frustration for the child. This frustration can move the child to try to ignore or avoid the adult, disagree with or directly oppose the adult, which then can result in disappointment and disapproval from the adult. This can escalate as frustration becomes anger by the child and then the adult may punish or apply controlling sanctions and consequences -‐ behaviorally, emotionally and cognitively – that may foster guilt in the child eventually. Enough repetitions of this unfortunate sequence and feelings of depression and thoughts of despair may be reinforced in the child as it becomes what might be called a ‘frustration and failure loop’. Such a mismatch between natural and native characteristics of the child and adult response eventually become unbearable for the child and perhaps for the adult, so that general compensatory mechanisms eventually and inevitably come


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into existence. A child may have athletic talent and a better fitted and ‘more adult-‐approved’ set of responses occur as the budding football, hockey or soccer star is praised for highly energetic mobility and rapidly shifting scanning behaviors (fit). Or a child may withdraw from adult oversight into the wilderness and become a budding naturalist, hunter, fisher (flee). A child may more directly and actively oppose tightly applied control and contingent regulating mechanisms applied by adults and become ‘oppositional and defiant’, perceived as a ‘troubled kid’ (fight). Some children and teens alternatively or additionally may seek release from these burdens and binds in substance use (freeze). However, there are more specific and internalized psychological compensations that may come into existence by the time adulthood is reached as a result of ill-‐fitted environments and poor responses by others. Compartmentalization, pretending, denial, manipulation, projection, and the creation of various of defensive mechanisms to blunt disappointment, disapproval, withdrawal, rejection and control by others, as well as self-‐despair and self-‐desecration. Let us map a couple of these that came out of the narratives of the self-‐reflections, pairwise refractions and group conversation representations we did in this investigation … Beginning at the bottom center of the diagram, with the shifting attention of the subject with ADHD, we can proceedback and forth up the box, with the words on the right describing the reactions of the other/context to the subject, and the subject’s response in return on left. Movement up each column box maps the escalating responses and reactions that tend to occur. At the top of the first box in the center is a tipping point in which the person with ADHD either accepts ineptitude and withdraws, or minimizes and denies the significance of their deficits. Although diagrammed separately, these are not necessarily mutually exclusive in the sense that both acceptance and denial can be partial and that the subject can both minimize and withdraw. That said let us pursue the left and right columns respectively. On left, the acceptant, withdrawer may on one hand descend into nonstriving, depression and despair, be labeled as the problem and experience alienation. Or being met with irritation, the subject may alternately avoid, be avoided, re-engage and be met with dislike of person or behavior; he or she may strive harder and yet have efforts rejected, resulting in low self-esteem and dejection. On the right, the minimizing denying subject may, on one hand, descend into pretense in order to escape the issues and instead become trouble for self and others, culminating in risky diversions often in the guise of play of ‘playing’ others. On the other, he or she may iteratively press, blame and manipulate others, ultimately externalizing responsibility and rationalizing failure. In this either this scenario, or/and the dejection condition, when things reach a crisis point


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Critical Points and Thresholds: Introversion and ADD/ADHD -‐ very sensitive -‐ assume control, tactless -‐ worst case tendency -‐ overly optimistic -‐ rumination -‐ oblivious, unaware -‐ exhaust easily -‐ never stop -‐ high standards -‐ low standards -‐ overly detailed, -‐ very fragmented, no overall picture no sense of priorities

sad/shame give up, reject guilt coerce, punish anger disapprove frustration constrain frequently move & shift attention

low esteem, dejection reject strive dislike re-‐engage avoid avoid irritation accept-‐withdraw

rationalize failure reject manipulate dislike blame disappointment press irritation minimize-‐deny

adaptive confidence communicate partner refract & assist lessen scale reflect & advise adjust context & pair

alienation label as problem depression & despair

pretend to escape become trouble drink, drugs & sex or exercise, sports

START


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there is opportunity for change, by making context adjustments and pairing. If the individual is able to locate an interpersonal resource who provides reflection of challenges and advisement, the subject may begin to rein in the scale of their frequent over-reaching; if the other is able to refract the individuals motives and interests, he or she may then begin to partner in new ways that promote beneficial communication and adaptive confidence. Implicit to this map is that, especially with children, the subject with ADHD is, in significant degree, dependent on what is ecologically available by way of context. To the extent that the situation may immediately afford occasion for pairing and partnering that aids the individual in identifying the relative goodness-of-fit between individual nature and context features, then he or she may take an early quantum leap towards either adapting her his strategies for coping with demand parameters or adjusting the form of the context – in effect moving into the upper central box without suffering the others, and in essence locating the kind of contexts and activities that provide optimal fit to her/his talents and tendencies.


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Supplemental Materials Supplement to ADHD with Introversion: The Misdiagnosis of Robin Williams Robin Williams Death: Combination of ADHD/Introversion often misdiagnosed and mistreated as Bipolar or Depression Robin Williams, Few understand what the combination of bursting forth, continual outpouring of high energy (ADHD), coupled with an exquisitely and excruciatingly sensitive heart (introversion), costs a person like you who has both. Throw in a brilliantly creative mind and while you entertained so many, you were so misunderstood and unmet in the competing impulses to go out and share, yet needing to withdraw, go in and rest. It is to our sorrow that we could not provide you with just the right love and support to moderate and settle the ongoing conflict between your indwelling and outgoing nature. Truly, may you rest, finally, in Peace. – Damian See ”Narratives of Introversion with ADHD” by Vraniak et al (2014) at www.academia.edu Those with ADHD have paradoxical reactions to medications (e.g. stimulants calm them down) … as Robin said, “cocaine doesn’t stimulate me like it does others, it clams me down’ … and with the wrong diagnosis and wrong medication suicide potential greatly increases. Similarly, introverts often are quite dosage sensitive to medications. Thus, this sub-‐population might seem to be exceptionally at risk for misdiagnosis and mis-‐medicated … at the very least, research should be undertaken to see if this clinical speculation is accurate. On the following pages I offer some of the basic templates and information I share with parents and spouses …. Damian Vraniak, PhD, Licensed Psychologist Director, Great Lakes Mental Health Center 15910N Company Lake Road Hayward Wisconsin 54843 (715) 634-‐6001 (office) (715) 790-‐8801 (cell) High Energy Youth Triptych


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Fundamental Principles and Approaches A. Understand and accept that high energy output by children diagnosed with AD/HD is something these children are born with (hard-‐wired) and that such shifting, high energy expression cannot be totally turned off or contained. B. This means that typically effective child rearing and teaching strategies (e.g. time-‐out, punishment, discipline) most often used by parents and teachers are not effective with these high energy children/students … alternative parenting and teaching approaches are necessary and required. C. Understand and accept that the continuum of openness in settings (outdoors and community most open and unconstrained, home moderately open and constrained, school significantly smaller and highly constrained), coupled with the number of people in those contexts (outdoors/community – varied, home – few, and school – many in a tight space), means that developmentally schools are the most challenging contexts for their high levels of energy. Suggested approaches to these challenges include: 1. Shift language from negative categories and labels (bad, naughty, wrong), to accurately descriptive (too high for context). 2. Intentionally insure that positive and negative adult responses are equally frequent. 3. Parents offer a self-‐monitoring map to the child that focuses upon energy levels that are well-‐fitted to context (green, just right), slightly much for others in context (yellow, caution), way too much for situation (red, danger) and the need for rest/recovery/recomposition (blue, reset). 4. Parents arrange and structure opportunities in the home that enable practice shifting between three positive activities (e.g. drawing or construction, reading, writing) in a rotation that promotes eventual completion of each activity, and that contains a brief break between each activity for cooling, calming and collecting (resetting) energy level. We might call such an activity rotation sequence ‘circuit training’ or ‘circuit learning’. Initially the length of time in each of the three activity stations might be quite short, but can be gradually lengthened with practice. 5. Parents facilitate and train their child in ways to scale down and concentrate energy, so that it does not move around a whole room, bump into various objects and/or people, but increasingly is expressed in a smaller area right in front of the child, perhaps through the use of doodle pads, finger beads or wrist-‐bands, small construction sets (magnetix, lego, electronics) and/or self-‐stimulating and self-‐soothing small, smooth, soft objects (rabbit’s foot, stone).


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6. Parents share and train teachers in what works at home, so teachers might employ some of these strategies in school. Similarly teachers collaborate with parents with methods that work at school that might be tried at home. 7. Parents of older High Energy Youth (HEY!) support parents of younger HEY!, particularly those parents and youth who have worked out effective and successful strategies of various sorts that they can share with younger parents, younger youth, and their teachers. 8. Other … 9. Other … 10. Other …


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Key Features & Factors for Adaptation by High Energy Youth (HEY!) A. Primary individuals interacting with High Energy Youth (HEY!): Parent Teacher Peer B. Scale of Context HEY! have to adapt to: Home – moderately large and open, indoors and outdoors; few people School – narrowly constrained (desk, classroom), indoors; many people Community – largely open; many different people C. Challenges faced by HEY! (lack of goodness-‐of-‐fit between child and context): Highly constrained space Highly adult-‐controlled activities Space containment and time constraints coupled with sustained focus (e.g. lectures, tests) Inadequate understanding of native wiring and inadequate mapping of how energy expression functions … by youth (self), parent, teacher and/or peer Inadequate help scaling down and applying (channeling) energy productively Inadequate options for shifting attention in a recursive, closed loop, facilitating completion and success Dealing with daily frustration, expulsion (timeout), rejection (discipline) and failure (task incompletion) D. Selected primary, proactive and positive support participants and participations: Creative trials by parent and youth Creative trials by teacher and youth Creative trials by youth and buddy (peer paired-‐learning) Pair-‐sharing between parents, teachers and peers regarding effective methods E. Selected primary, proactive and positive support strategies: Adapt context to fit how child is wired (e.g. testing alone with breaks) Scale down energy production so that it is non-‐intrusive for others (feet to fingers, fists to words) Intentionally select appropriate modality (feet, hands, heart, mind/words) most fitting for situation Offer limited circuit options of no more than 3-‐4 types of activity youth/student can sequence through repeatedly, fostering completion Creatively and imaginatively generate range of energy expression options Common Misconceptions About Interacting with High Energy Youth (HEY!)


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Medication will solve all the issues and challenges The most commonly used and most effective child-‐rearing and teaching techniques will work with HEY! (e.g. time-‐outs) Using language like right and wrong, good and bad will help the child to understand what s/he should and should not do and how to do it There are some contexts and roles perfectly fitted for how High Energy Youth are wired: + the battlefield where high vigilance, shifting attention is highly desirable + football, soccer and other sports where high bursts of short duration are highly valued + executive roles like administration, teaching, refereeing, executive management, where frequent shifts in attention and activity are necessary Over the course of life-‐time roles, probably the most ill-‐fitted context for High Energy Youth is K-‐12 schooling, since desks and classrooms highly constrain the expression of energy, since teachers are faced with multiple challenges of serving many children and agendas (e.g. core curriculum) which means they must tightly control student activity, and learning tasks/activities have traditionally involved sustained focus with paper and pencil. One of the most beneficial supports for parents and teachers are local adults (parents and professionals) who grew up as High Energy Youth and who have met these challenges successfully, as well as other parents of older HEY! who have already gone through what they are going through now.


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Books about ADHD for Parents Parenting Children with ADHD: 10 Lessons That Medicine Cannot Teach (APA Lifetools, 2005) by Vincent J. Monastra ($12.38 on Amazon) Biography Vincent J. Monastra, PhD, is a clinical psychologist and director of the FPI Attention Disorders Clinic in Endicott, New York. He is also an adjunct associate professor in the Department of Psychology at Binghamton University. During the past 3 decades, he has conducted a series of studies involving over 10,000 individuals with disorders of attention and behavioral control, resulting in the publication of numerous scientific articles, a book chapter, and the award-‐winning book Parenting Children With ADHD: 10 Lessons That Medicine Cannot Teach (American Psychological Association [APA], 2004). His skills as a master diagnostician and therapist have been recognized and are archived in several educational videotaped programs, including Working With Children With ADHD (APA, 2005). His research has led to several scientific awards, including the President's Award and the Hans Berger Award, bestowed by the Association for Applied Psychophysiology & Biofeedback for his groundbreaking research. He is listed among the innovative researchers recognized in Reader's Digest's 2004 edition of Medical Breakthroughs. New methods in this book work better than traditional ones By A.. Buyer on October 5, 2007 I am a grandparent of a 5 year old boy, diagnosed with ADHD at age 4. I have read several books on the subject, plus reseaching ADHD on line. If you employ the same methods by which you were raised, not having ADHD, or the methods your parents used to raise you, you are missing the target by a mile. ADHD children are different in many ways and you must learn how and what to do for them as individuals. They are precious little people with vast potential for love and success in life. Only by you learning how to help them manage their lives, in a loving caring manner can you help them. This book offers proven methods to help the child at home and in school and in life. I do recommend this book. You also need to read other books on the subject and try to find a CHAD group or other support group for yourself because you are not alone in your struggle to save your child and family. I also recommend ADDitude Magazine as well as, Making the System work for Your Child and The Gift of ADHD, all from Amazon.com. It takes a village to raise a child. Good luck. Most Insightful and Helpful Book on Parenting ADHD Children By LAMB's Mom on January 10, 2007 I am parenting five children with ADHD and have read a lot of ADHD literature. Dr. Monastra's book is the most useful I have read ever. Particularly helpful are his suggested accomodations in school, the "Time Stands Still" strategy and Parent "Self-‐Care" suggestions. His best chapter is called "Temperment May be


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Inherited...but...Emotional Control is Learned." He advocates ways to teach children emotional control that are so effective they should be shared with every parent with children :), ADHD or not. His book is life-‐affirming and practical. Thank you, Dr. Monastra, for making such a positive difference in the ADHD world. Taking Charge of ADHD, Third Edition: The Complete, Authoritative Guide for Parents (2013) by Russell A. Barkley ($15.66 from Amazon) From distinguished researcher/clinician Russell A. Barkley, this treasured parent resource gives you the science-‐based information you need about attention-‐deficit/hyperactivity disorder (ADHD) and its treatment. It also presents a proven eight-‐step behavior management plan specifically designed for 6-‐ to 18-‐year-‐olds with ADHD. Offering encouragement, guidance, and loads of practical tips. Updated throughout with current research and resources, the third edition includes the latest facts about medications and about what causes (and doesn't cause) ADHD. Winner-‐-‐Association for Behavioral and Cognitive Therapies Self-‐Help Seal of Merit The ADHD Workbook for Kids: Helping Children Gain Self-‐Confidence, Social Skills, and Self-‐Control (Instant Help Book for Parents & Kids) (2010) by Lawrence Shapiro PhD ($11.90 from Amazon) All kids with attention-‐deficit hyperactivity disorder (ADHD) want to manage their symptoms in order to get along better with others, build confidence, and succeed in school, but most don't have the skills they need to get their impulsive behavior under control. The ADHD Workbook for Kids offers a simple way to help children with ADHD learn these critical skills in just ten minutes a day. This workbook includes more than forty activities for kids developed by child psychologist Lawrence Shapiro that can help your child with ADHD handle everyday tasks, make friends, and build self-‐esteem while he or she learns to overcome the most challenging aspects of the disorder. Alone or with your help, your child can complete one ten-‐minute activity each day to learn how to make good decisions and discover easy techniques for staying focused when it's time to pay attention. Includes activities to help your child: Driven to Distraction (Revised): Recognizing and Coping with Attention Deficit Disorder (2011) by Edward M. Hallowell M.D., John J. Ratey M.D. Learning To Slow Down & Pay Attention: A Book for Kids About ADHD (2004) by Kathleen G. Nadeau , Ellen B. Dixon The ADHD Workbook for Kids: Helping Children Gain Self-‐Confidence, Social Skills, and Self-‐Control (Instant Help Book for Parents & Kids) (2010) by Lawrence Shapiro PhD


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Raising Boys With ADHD: Secrets for Parenting Healthy, Happy Sons Paperback (2012) by Mary Anne Richey , James W. Forgan Attention, Girls!: A Guide to Learn All About Your Ad/Hd (2009) by Patricia O. Quinn ADHD Toddlers: Signs and Symptoms of Attention Deficit in Young Children "I suspect my toddler has ADHD, but how can I tell?" one parent asks. "Can ADHD toddlers be treated at such a young age?" ADHD Parenting Blog | posted by Michele Novotni, Ph.D. | Thursday May 12th -‐ Symptoms of attention deficit hyperactivity disorder (ADD/ADHD) can be seen in toddlers as early as 1 or 2 years of age. Signs include high levels of activity -‐-‐ more than a typical child -‐-‐ and problems sleeping and napping. Making the transition from one activity to another is another clue. Signs of inattentive ADD/ADHD are rarely detectable until much later when the child enters school. Most doctors won’t treat a toddler who has ADD/ADHD with medication until they are at least 5 -‐-‐ except in cases where they present a danger to themselves or others. My son was so hyperactive and impulsive that the physician recommended he start taking medication when he was 2. He had been kicked out of every day care center in our area, and we had to hire two babysitters at a time to watch him. We didn’t start him on medication, though, until he was 5. If your toddler is younger than 5, these alternative treatments may be helpful: Find activities that soothe and settle your child. Busy environments like a shopping mall or a crowded park, as well as listening to music, can calm a hyperactive child. Some may find classical music soothing, while others settle down with country or even hip-‐hop. Test it out and see what your toddler responds best to. Engage in physical activities to help her burn off energy before sitting down at a restaurant or at someone’s house. Before leaving the house, play tag or a physically intensive game on Wii or engage in a favorite activity your toddler likes to do with you. Brain Gym (braingym.com) movements, which engage the body to activate and calm your brain, may also be helpful. Use a leash or harness to keep your child safe in public places, if a cart or stroller isn’t available. I used a leash with my hyperactive son, and it helped a lot. Change your schedule to limit activities that require your child to stay quiet and still. Perhaps your partner can stay home with your child while you shop or attend a local concert. When going out to dinner, select a place that is kid friendly -‐-‐ Friendly’s is better than a fine-‐dining restaurant. Another alternative: Call and order ahead to minimize waits at a restaurant. Many restaurants will accommodate the requests of parents with special-‐needs kids.


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Some parents calm their hyperactive children by giving them a little caffeine -‐-‐ like a glass of Mountain Dew -‐-‐ or Benadryl. Check with your doctor before trying this. A final note: It’s important for parents of hyperactive toddlers to take care of themselves and to get support. Raising a special-‐needs child is a marathon, not a sprint! Michele Novotni, Ph.D., is the former president and CEO of the national Attention Deficit Disorder Association (ADDA), a best-‐selling author, a psychologist, a coach, a parent of a young adult with ADD/ADHD, an ADDitude magazine writer, and a contributor to ADDitude's new ADHD Experts Blog. Journal of the American Academy of Child & Adolescent Psychiatry Volume 48, Issue 5, May 2009, Pages 484–500 The MTA at 8 Years: Prospective Follow-‐up of Children Treated for Combined-‐Type ADHD in a Multisite Study Brooke S.G. Molina, Ph. Stephen P. Hinshaw, Ph.D., James M. Swanson, Ph.D., L. Eugene Arnold, M.D., M.Ed., Benedetto Vitiello, M.D., Peter S. Jensen, M.D., Jeffery N. Epstein, Ph.D., Betsy Hoza, Ph.D., Lily Hechtman, M.D., Howard B. Abikoff, Ph.D., Glen R. Elliott, Ph.D., M.D., Laurence L. Greenhill, M.D., Jeffrey H. Newcorn, M.D., Karen C. Wells, Ph.D., Timothy Wigal, Ph.D., Robert D. Gibbons, Ph.D., Kwan Hur, Ph.D., Patricia R. Houck, M.S., The MTA Cooperative Group Objectives To determine any long-‐term effects, 6 and 8 years after childhood enrollment, of the randomly assigned 14-‐month treatments in the NIMH Collaborative Multisite Multimodal Treatment Study of Children With Attention-‐Deficit/Hyperactivity Disorder (MTA; N = 436); to test whether attention-‐deficit/hyperactivity disorder (ADHD) symptom trajectory through 3 years predicts outcome in subsequent years; and to examine functioning level of the MTA adolescents relative to their non-‐ADHD peers (local normative comparison group; N = 261). Method Mixed-‐effects regression models with planned contrasts at 6 and 8 years tested a wide range of symptom and impairment variables assessed by parent, teacher, and youth report. Results In nearly every analysis, the originally randomized treatment groups did not differ significantly on repeated measures or newly analyzed variables (e.g., grades earned in school, arrests, psychiatric hospitalizations, other clinically relevant outcomes). Medication use decreased by 62% after the 14-‐month controlled trial, but adjusting for this did not change the results. ADHD symptom trajectory in the first 3 years predicted 55% of the outcomes. The MTA participants fared worse than the local normative comparison group on 91% of the variables tested.


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Conclusions Type or intensity of 14 months of treatment for ADHD in childhood (at age 7.0–9.9 years) does not predict functioning 6 to 8 years later. Rather, early ADHD symptom trajectory regardless of treatment type is prognostic. This finding implies that children with behavioral and sociodemographic advantage, with the best response to any treatment, will have the best long-‐term prognosis. As a group, however, despite initial symptom improvement during treatment that is largely maintained after treatment, children with combined-‐type ADHD exhibit significant impairment in adolescence. Innovative treatment approaches targeting specific areas of adolescent impairment are needed. Article Randomized, Controlled Trial of OROS Methylphenidate Once a Day in Children With Attention-‐Deficit/Hyperactivity Disorder Mark L. Wolraich, MD*, Laurence L. Greenhill, MD‡, William Pelham, PhD§, James Swanson, PhD‖, Timothy Wilens, MD¶, Donna Palumbo, PhD#, Marc Atkins, PhD**, Keith McBurnett, PhD‡, Oscar Bukstein, MD§§, Gerald August, PhD166, on behalf of the Concerta Study Group + Author Affiliations ABSTRACT Objective. A new once-‐a-‐day methylphenidate (MPH) formulation, Concerta (methylphenidate HCl) extended-‐release tablets (OROS MPH), has been developed. This study was conducted to determine the safety and efficacy of OROS MPH in a multicenter, randomized, clinical trial. Methods. Children with attention-‐deficit/hyperactivity disorder (ADHD; n = 282), all subtypes, ages 6 to 12 years, were randomized to placebo (n = 90), immediate-‐release methylphenidate (IR MPH) 3 times a day (tid; dosed every 4 hours; n = 97), or OROS MPH once a day (qd;n = 95) in a double-‐blind, 28-‐day trial. Outcomes in multiple domains were assessed, and data were analyzed using analysis of variance and Kaplan Meier product limit estimates for time to study cessation. The primary time point for analysis was the last available patient visit using last observation carried forward. Results. Children in the OROS and IR MPH groups showed significantly greater reductions in core ADHD symptoms than did children on placebo. This was true both at the end of week 1 and at the end of treatment on the basis of mean teacher and parent IOWA Conners ratings. IR MPH tid and OROS MPH qd did not differ significantly on any direct comparisons. Forty-‐eight percent of the placebo group discontinued early compared with 14% and 16% in the IR MPH and OROS MPH groups, respectively. Conclusions. For the treatment of core ADHD symptoms, OROS MPH dosed qd and IR MPH dosed tid were superior to placebo and were not significantly different from


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each other.attention-‐deficit/hyperactivity disorder, methylphenidate, OROS, Concerta. Received June 5, 2000. Accepted March 2, 2001. Copyright © 2001 American Academy of Pediatrics European Child & Adolescent Psychiatry July 2004, Volume 13, Issue 1 Supplement, pp i102-‐i116 Non–stimulant medications in the treatment of ADHD Dr. T. Banaschewski, V. Roessner, R. W. Dittmann, P. Janardhanan Santosh, A. Rothenberger Abstract Background Stimulants are the first–line medication in the psychopharmacological treatment of attention–deficit hyperactivity disorder (ADHD). However, 10 to 30% of all children and adults with ADHD either do not respond to or do not tolerate treatment with stimulants. Objective To describe alternative treatment approaches with various non–stimulant agents, especially atomoxetine. Method General review of empirically based literature concerning efficacy and safety of the substances. Results A large and still increasing body of data supports the usefulness of atomoxetine, a once daily dosing, and new selective noradrenalin reuptake inhibitor, with few side effects. Atomoxetine has been licensed in the US for use in ADHD across the lifespan, and is currently under consideration in Europe. Other non–stimulant substances, such as tricyclic antidepressants (TCAs) and alpha–2–adrenergic agonists, which are used to treat ADHD, are also reviewed. TCAs have been well studied and shown to be efficacious in the treatment of ADHD, but are limited by side effects. The number of studies documenting the efficacy of alpha–2–adrenergic agonists is still limited. Some experimental studies support a potential role of cholinergic drugs such as acetylcholinesterase inhibitors (tacrine, donepezil) as well as novel nicotinic analogues (ABT–418). Conclusion Non–stimulant agents have been shown to be effective in treatment of ADHD. Especially, atomoxetine seems promising and newline drugs are in development.


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A.D.H.D. Experts Re-‐evaluate Study’s Zeal for Drugs Ramin Rahimian for The New York Times Stephen Hinshaw, a University of California, Berkeley, researcher in an influential 1990s study, said skills training should be a priority in A.D.H.D. cases. By ALAN SCHWARZ Published: December 29, 2013 Twenty years ago, more than a dozen leaders in child psychiatry received $11 million from the National Institute of Mental Health to study an important question facing families with children with attention deficit hyperactivity disorder: Is the best long-‐term treatment medication, behavioral therapy or both? The widely publicized result was not only that medication like Ritalin or Adderall trounced behavioral therapy, but also that combining the two did little beyond what medication could do alone. The finding has become a pillar of pharmaceutical companies’ campaigns to market A.D.H.D. drugs, and is used by insurance companies and school systems to argue against therapies that are usually more expensive than pills. But in retrospect, even some authors of the study — widely considered the most influential study ever on A.D.H.D. — worry that the results oversold the benefits of drugs, discouraging important home-‐ and school-‐focused therapy and ultimately distorting the debate over the most effective (and cost-‐effective) treatments. The study was structured to emphasize the reduction of impulsivity and inattention symptoms, for which medication is designed to deliver quick results, several of the researchers said in recent interviews. Less emphasis was placed on improving children’s longer-‐term academic and social skills, which behavioral therapy addresses by teaching children, parents and teachers to create less distracting and more organized learning environments. Recent papers have also cast doubt on whether medication’s benefits last as long as those from therapy. “There was lost opportunity to give kids the advantage of both and develop more resources in schools to support the child — that value was dismissed,” said Dr. Gene Arnold, a child psychiatrist and professor at Ohio State University and one of the principal researchers on the study, known as the Multimodal Treatment Study of Children With A.D.H.D. Another co-‐author, Dr. Lily Hechtman of McGill University in Montreal, added: “I hope it didn’t do irreparable damage. The people who pay the price in the end is the kids. That’s the biggest tragedy in all of this.” A.D.H.D. narrowly trails asthma as the most frequent long-‐term medical diagnosis in children. More than 1 in 7 children in the United States receive a diagnosis of the disorder by the time they turn 18, according to the Centers for Disease Control and Prevention. At least 70 percent of those are prescribed stimulant medication like Adderall or Concerta because, despite potential side effects like insomnia and


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appetite suppression, it can quickly mollify symptoms and can cost an insured family less than $200 a year. Comprehensive behavioral (also called psychosocial) therapy is used far less often to treat children with the disorder largely because it is more time-‐consuming and expensive. Cost-‐conscious schools have few aides to help teachers assist the expanding population of children with the diagnosis, which in some communities reaches 20 percent of students. Many insurance plans inadequately cover private or group therapy for families, which can cost $1,000 a year or more. “Medication helps a person be receptive to learning new skills and behaviors,” said Ruth Hughes, a psychologist and the chief executive of the advocacy group Children and Adults With Attention-‐Deficit/Hyperactivity Disorder. “But those skills and behaviors don’t magically appear. They have to be taught.” Accepting no support from the pharmaceutical industry — “to keep it clean,” Dr. Arnold said — the National Institute of Mental Health gathered more than a dozen top experts on A.D.H.D. in the mid-‐1990s to try to identify the best approach. Over 14 months, almost 600 children with the disorder ages 7 to 9 across the United States and Canada received one of four treatments: medication alone, behavioral therapy alone, the combination, or nothing beyond whatever treatments they were already receiving. The study’s primary paper, published in 1999, concluded that medication “was superior to behavioral treatment” by a considerable margin — the first time a major independent study had reached that conclusion. Combining the two, it said, “did not yield significantly greater benefits than medication” alone for symptoms of the disorder. In what became a simple horse race, medication was ushered into the winner’s circle. “Behavioral therapy alone is not as effective as drugs,” ABC’s “World News Now” reported. One medical publication said, “Psychosocial interventions of no benefit even when used with medication.” Looking back, some study researchers say several factors in the study’s design and presentation to the public disguised the performance of psychosocial therapy, which has allowed many doctors, drug companies and schools to discourage its use. A.D.H.D. Experts Re-‐evaluate Study’s Zeal for Drugs (Page 2 of 2) First, the fact that many of the 19 categories measured classic symptoms like forgetfulness and fidgeting — over academic achievement and family and peer interactions — hampered therapy’s performance from the start, several of the study’s co-‐authors said. A subsequent paper by one of those, Keith Conners, a psychologist and professor emeritus at Duke University, showed that using only one all-‐inclusive measurement — “treating the child as a whole,” he said — revealed that combination therapy was significantly better than medication alone. Behavioral therapy emerged as a viable alternative to medication as well. But his paper has received little attention.


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“When you asked families what they really liked, they liked combined treatment,” said Dr. Peter Jensen, who oversaw the study on behalf of the mental health institute. “They didn’t not like medicine, but they valued skill training. What doctors think are the best outcomes and what families think are the best outcomes aren’t always the same thing.” Just as new products like Concerta and extended-‐release Adderall were entering the market, a 2001 paper by several of the study’s researchers gave pharmaceutical companies tailor-‐made marketing material. For the first time, the researchers released data showing just how often each approach had moderated A.D.H.D. symptoms: Combination therapy did so in 68 percent of children, followed by medication alone (56 percent) and behavioral therapy alone (34 percent). Although combination therapy won by 12 percentage points, the paper’s authors described that as “small by conventional standards” and largely driven by medication. Drug companies ever since have reprinted that scorecard and interpretation in dozens of marketing materials and PowerPoint presentations. They became the lesson in doctor-‐education classes worldwide. “The only thing we heard was the first finding — that medication is the answer,” said Laura Batstra, a psychologist at the University of Groningen in the Netherlands. Using an additional $10 million in government support to follow the children in the study until young adulthood, researchers have seen some of their original conclusions muddied further. Many experts interpret these more recent findings as showing the dissipation of medication’s effects; others counter that going off the medication, as many children did, would naturally dampen continuing positive effects. Most recently, a paper from the study said flatly that using any treatment “does not predict functioning six to eight years later,” leaving the study’s original question — which treatment does the most good long-‐term? — largely unanswered. “My belief based on the science is that symptom reduction is a good thing, but adding skill-‐building is a better thing,” said Stephen Hinshaw, a psychologist at the University of California, Berkeley, and one of the study researchers. “If you don’t provide skills-‐based training, you’re doing the kid a disservice. I wish we had had a fairer test.”


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