Sometimes, Friendship Is the Best Medicine

FRIENDSHIPS

Sometimes, Friendship Is the Best Medicine

Medication and counseling can help treat ADHD symptoms, but, for many adults, having a good friend is the best alternative treatment.

BY ZOË KESSLER
two older women with ADHD talk and enjoy each other's company
Nan Bailey, 42, a marketing consultant, was diagnosed with attention deficit hyperactivity disorder a year and a half ago. Medication and yoga have been helpful, but Nan’s best weapon against ADHD symptoms has been her friend Janice, a graphic artist, who occasionally works with her. She understands Nan’s behaviors, and helps her manage them.
“If I’m working on a project with Janice, she’ll say, ‘How are you doing with this? How close are we to getting this finished?'” Nan says, laughing. “She knows that I procrastinate and overthink things. She’ll say, ‘Let’s make a decision on this, and move on to the next thing.’ And we get our projects done that way.”

Why Friends Help Treat ADHD Symptoms

Research underscores the importance of friendship to adults with ADHD. In a study called “Biobehavioral Responses to Stress in Females: Tend-and-Befriend, Not Fight-or-Flight,” published in Psychological Review, UCLA researchers suggest that having a close friend helps women handle stress and live longer, healthier lives. Friendship is especially important to women with ADHD who were diagnosed in their 30s and 40s. Many of these women have lost a job, friendships, possibly a marriage, and some isolate themselves and avoid trying to make friends. Women with close female friends, however, are better able to take control of their lives and heal ADHD-related hurts from the past.
“Women with ADHD find it more difficult to make friends and socialize,” says Timothy S. Bilkey, M.D., director of Bilkey ADHD Clinics, in Ontario, Canada. “If a woman has lost friends because of an impulsive comment or something she has said, her self-esteem will suffer. Women with ADHD are unaware of inappropriate remarks or other offensive behaviors that alienate someone. These women are sensitive to rejection. Finding a good friend is critical to breaking through this wall.”
“Having someone who can relate to your struggles is extremely important for self-esteem and promoting self-understanding,” says Nancy A. Ratey, ADHD coach and author of The Disorganized Mind. Ratey was diagnosed at age 29, and she draws from her experience when coaching adults with ADHD.

How the Right Friends Can Help ADHD Symptoms

While ADHD coaching is recommended as one element of treatment, many women look to their friendships to provide ad-hoc coaching. Nan has friends with and without ADHD. Of her non-ADHD friends, she says, “A few have discovered that I am overwhelmed by simple tasks — filing papers or housework like vacuuming and dusting — which leaves me with a shockingly messy home. My friends help me without making me feel guilty. They have laundered my clothes and balanced my checkbook.”
Amelia, 49, is a visual artist and poet. Diagnosed with adult ADHD three years ago, she has one close female friend. “She offers suggestions and input to help me navigate a world I don’t quite understand,” she says.
A key to lasting, productive friendships is choosing friends wisely. I — and many of my friends with ADHD — look for patience, support, and a good sense of humor in a friend. My friends have helped me manage my deep-seated insecurity and anxiety. To this day, when I find myself in a situation in which someone is abusive, irrational, or acting inappropriately, I wonder if my social skills are to blame. This is probably due to the fact that my family saw my hyperactivity as willfulness. They thought I could control my behavior, but chose not to. A call to my dearest friend puts things in perspective. She knows what I feel in my gut — that it’s not always me who’s wrong.

ADHD or Non-ADHD Friends?

“Friendships with other ADHD women are hard,” says Amelia, “because they seem to exacerbate my symptoms. Your own ADHD is annoying enough; dealing with it in others makes you aware of your shortcomings.”
Nan agrees. “I have a friend with ADHD-like behaviors,” she says. “Her disorganization and clutter drive me mad! We’re both easily distracted, and can let projects sit idly for months.” On the positive side, “I’m less disappointed in myself when I’m with her.”
Sarah, 33, who was diagnosed with hyperactive/impulsive ADHD at 24, says her non-ADHD friends calm her down, while her high-energy personality draws out their lighter side. “I admire and enjoy quiet, calm types.”
For some, though, friendships with others with ADHD work best. “I can back out on my ADHD friends any time,” says Ratey. “But if I back out on my neurotypical friends, they take it personally. It’s seen as lack of commitment, a lack of caring.”
Being friends with ADHD adults is important for Ratey, because they understand her eccentricities and can laugh about them. “Other women do not understand how hard it can be to shop at the grocery store,” she says. “Women with ADHD know all too well. If you jump from topic to topic, they are able to follow you.”
Ratey remembers making friends with a woman who, like Ratey, had been recently diagnosed with the condition. Neither of them had started taking medication. While other college kids were popping pills to get high, they sat together on a campus bench, holding their medication in their hands. In that classic bonding moment that only those with ADHD can experience, they started taking their meds together! They have been friends ever since.

How To Maintain Adult ADHD Friendships

Making friends is not hard for most adults with ADHD. Given their abundance of charm, intelligence, and humor, what’s not to like? Sustaining friendships is another story. Erratic or offensive behavior, impulsivity, and unreliability become tiresome.
“The challenge in maintaining friendships is making the effort to pay attention and remember things, like a friend’s kids’ names, where she works, and why she won’t eat at a certain restaurant,” says Amelia. “Most people don’t mind reminding you once or twice, especially in the beginning stages of a friendship, but after telling you for the twelfth time that her son’s name is Jason, it’s understandable that someone would get annoyed.”
For all its challenges, friendship makes the difference between a fulfilling life and that state of feeling overwhelmed by stress that many of us experience. Says Ratey: “If a friend does not add to your growth and self-acceptance, that person does not belong in your life.”

Friendship Tips For Adults with ADHD

Take responsibility for managing your ADHD to the best of your ability (meds, therapy, coaching, support groups).
Strive for self-awareness to know how you come across to others.
Enter friendships cautiously and go slowly; remember that not every acquaintance is a potential friend.
Agree to disagree. It’s not always you who is in the wrong. But it shouldn’t be a deal-breaker if you don’t see eye-to-eye on something.
Follow through on commitments; keep dates made with friends.
Admit it when you mess up – and apologize.
Don’t take friends for granted.
Listen to your friend when she’s talking, even when your brain would rather be rewriting the grocery list.
Show interest in the other person; think about what’s important to her. Some friends expect you to remember their birthdays, others are OK with a belated wish. Some like calls returned, others like to meet regularly.
Be aware of, and up-front about, your own needs.
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The Adult ADHD Mind: Executive Function Connections

THE ADHD BRAIN

The Adult ADHD Mind: Executive Function Connections

A chef who can’t find her ingredients. An orchestra trying to play without a conductor. Thomas Brown, Ph.D. uses these metaphors — as well as a strong dose of hard-hitting science — to break down what’s really going on in the mind of an adult with ADHD. Read on for clarity.

BY THOMAS E. BROWN, PH.D.
ADHD Businesswoman in Office
For decades, the syndrome now known as attention deficit hyperactivity disorder (ADHD) was seen simply as a childhood behavior characterized by chronic restlessness, impulsivity, and an inability to sit still. Not much more was known about ADHD or how it affected the brain.
In the 1970s, the number of ADHD diagnoses rose when doctors recognized that hyperactive children also had significant problems paying attention to tasks or listening to their teachers.
This discovery paved the way for changing the name of the disorder in 1980 from “hyperkinetic disorder” to “attention deficit disorder” and to recognizing that some children suffer from chronic inattention problems without significant hyperactivity.
That change — from an exclusive focus on hyperactivity and impulsive behavior to a focus on inattention as the principal problem of the disorder — was the first major paradigm shift in understanding this syndrome.
In recent years, there’s been another major shift in our understanding of ADHD. Increasingly, researchers are recognizing that ADHD symptoms overlap with impairments in what neuropsychologists call executive functions. The term refers not to the activities of corporate executives, but to the brain’s cognitive management functions. The term is used to refer to brain circuits that prioritize, integrate, and regulate other cognitive functions.

Inconsistent Inattention

Everyone I’ve ever evaluated for ADHD has some domains of activity where they can pay attention without difficulty. Some are artistic, and they sketch intently. Others are childhood engineers, constructing marvels with Lego blocks and, in later years, repairing engines or designing computer networks. Others are musicians who push themselves for hours at a time to learn a new song or to compose a new piece of music.
How can someone who is good at paying attention to some activities be unable to pay attention to other tasks that they know are important? When I pose this question to patients with ADHD, most say something like: “It’s easy! If it’s something I’m really interested in, I can pay attention. If it’s not interesting to me, I can’t, regardless of how much I might want to.”
Most people without ADHD respond to this answer with skepticism. “That’s true for anyone,” they say. “Anybody’s going to pay better attention to something they’re interested in than to something they’re not.” But when faced with something boring that they know they have to do, those without ADHD can make themselves focus on the task at hand. People with ADHD lack this ability unless they know that the consequences of not paying attention will be immediate and severe.

Metaphors for Executive Functions

Imagine a symphony orchestra in which each musician plays his or her instrument very well. If there is no conductor to organize the orchestra, to signal the introduction of the woodwinds or the fading out of the strings, or to convey an overall interpretation of the music to all players, the orchestra will not produce good music.
Symptoms of ADHD can be compared to impairments, not in the musicians but in the conductor. Typically, people with ADHD are able to pay attention, to start and stop their actions, to keep up their alertness and effort, and to use their short-term memory effectively when engaged in certain favorite activities. This indicates that these people are not totally unable to exercise attention, alertness, or effort. They can play their instruments very well — but only sometimes. The problem lies in their chronic inability to activate and manage these functions in the right way at the right time.
One way to consider this broader view of attention as executive functions is to observe situations where tasks are not dealt with effectively. Martha Bridge Denckla, M.D., professor of neurology, pediatrics, and psychiatry at Johns Hopkins University School of Medicine, in Baltimore, has written about intelligent patients with no specific learning disabilities who have chronic difficulties in dealing effectively with tasks. In Attention, Memory, and Executive Function, she compares these people to a disorganized cook trying to get a meal on the table.
“Imagine a cook who sets out to cook a certain dish, who has a well-equipped kitchen, including shelves stocked with all the necessary ingredients, and who can even read the recipe in the cookbook. Now imagine, however, that this individual does not take from the shelves all the relevant ingredients, does not turn on the oven in a timely fashion so as to have it at the proper heat when called for in the recipe, and has not defrosted the central ingredient. This individual can be observed dashing to the shelves, searching for the next spice mentioned in the recipe, hurrying to defrost the meat and heat the oven out of sequence. Despite possessing all the equipment, ingredients, and instructions, this motivated but disheveled cook is unlikely to get dinner on the table at the appointed hour.”
The “motivated but disheveled cook” sounds very much like a person with severe ADHD who tries to accomplish a task but is unable to “get it together.” Individuals with ADHD often describe themselves as intensely wanting to accomplish various duties for which they are unable to activate, deploy, and sustain the needed executive functions.

Executive Functions and Awareness

A 43-year-old man came to my office with his wife to be evaluated for attentional problems. Both of the couple’s children had recently been diagnosed with ADHD and had benefited from treatment. When I explained that most children diagnosed with ADHD have a parent or other close relative with ADHD, both parents laughingly responded, “Those apples haven’t fallen far from the tree.” Both agreed that the father had more ADHD symptoms than either of the children. Here’s how the wife described her husband:
“Most of the time he’s totally spaced out. Last Saturday he set out to fix a screen upstairs. He went to the basement to get some nails. Downstairs he saw that the workbench was a mess, so he started organizing the workbench. Then he decided he needed some pegboard to hang up the tools. So he jumped into the car and went to buy the pegboard. At the lumber yard he saw a sale on spray paint, so he bought a can to paint the porch railing and came home totally unaware that he hadn’t gotten the pegboard, that he had never finished sorting out the workbench, and that he had started out to fix the broken screen that we really needed fixed. What he needs is a lot more awareness of what he is doing. Maybe that medicine our kids are taking can give him that.”
From this wife’s description, one might conclude that the central problem of ADHD is essentially a lack of sufficient self-awareness. She seems to believe that if only her husband were more steadily aware of what he is doing, he would not be so disorganized, jumping from one task to another without completing any single one. But most people do not require constant self-awareness to complete routine tasks. For most people, most of the time, operations of executive functions occur automatically, outside the realm of conscious awareness.
For example, while driving a car to the local supermarket, experienced drivers do not talk themselves through each step of the process. They do not have to say to themselves: “Now I put the key in the ignition, now I turn on the engine, now I check my mirrors and prepare to back out of my driveway,” and so on. Experienced drivers move effortlessly through the steps involved in starting the car, negotiating traffic, navigating the route, observing traffic regulations, finding a parking place, and parking the car. In fact, while doing these complex tasks, they may be tuning their radio, listening to the news, thinking about what they intend to prepare for supper, and carrying on a conversation.
Even the simpler example of keyboarding on a computer illustrates the point. If one can type fluently without stopping to consciously select and press each individual key, one’s mind is left free to formulate ideas and to convert these into words, sentences, and paragraphs that convey ideas to a reader. Interrupting one’s writing to focus on and press keys one at a time costs too much time and effort; it cannot be done very often if one is to write productively.
Many other routine tasks of daily life — for example, preparing a meal, shopping for groceries, doing homework, or participating in a meeting — involve similar self-management in order to plan, sequence, monitor, and execute the complex sequences of behavior required. Yet for most actions, most of the time, this self-management operates without full awareness or deliberate choice.
The problem of the “unaware” husband is not that he fails to think enough about what he is doing. The problem is that the cognitive mechanisms that should help him stay on task, without constantly and consciously weighing alternatives, are not working effectively.

The Brain’s Signaling System

Some might take my orchestra metaphor literally and assume that there is a special consciousness in the brain that coordinates other cognitive functions. One might picture a little man, a central executive somewhere behind one’s forehead, exercising conscious control over cognition like a miniature Wizard of Oz. Thus, if there is a problem with the orchestra’s playing, one might attempt to “speak” to the conductor, requesting — or demanding — needed improvements in performance.
Indeed, this presumed “conductor,” or controlling consciousness, is often the target of encouragement, pleas, and demands by parents, teachers, and others as they attempt to help those who suffer from ADHD. “You just need to make yourself focus and pay attention to your schoolwork the way you focus on those video games!” they say. “You’ve got to wake up and put the same effort into your studies that you put into playing hockey!”
Alternatively, they may impose punishments on people with ADHD or shame them for their failure to “make themselves” do consistently what they ought to do. These critics seem to assume that the person with ADHD needs only to speak emphatically to the “conductor” of his own mental operations to get the desired results.
In reality, there is no conscious conductor within the human brain. There are networks of neurons that prioritize and integrate all of our cognitive functions. If these networks are impaired, as they are in ADHD, then that individual is likely to be impaired in the management of a wide range of cognitive functions, regardless of how much he or she may wish otherwise.

How Medication Helps

There is now considerable evidence that executive functions of the brain impaired in ADHD depend primarily, though not exclusively, on two particular neurotransmitter chemicals: dopamine and norepinephrine.
The most persuasive evidence for the importance of these two transmitter chemicals in ADHD impairments comes from medication treatment studies. Over 200 well-controlled studies have demonstrated the effectiveness of stimulant medications in alleviating symptoms of ADHD. These medications work effectively to alleviate ADHD symptoms for 70 to 80 percent of those diagnosed with this disorder.
The primary action of medications used for ADHD is to facilitate release and to inhibit reuptake of dopamine and norepinephrine at neural synapses of crucially important executive functions. Improvement produced by stimulants generally can be seen within 30 to 60 minutes after an effective dose is administered. When the medication has worn off, ADHD symptoms generally reappear at their former level.
Stimulants do not cure ADHD; they only alleviate symptoms while each dose of medication is active. In this sense, taking stimulants is not like taking doses of an antibiotic to wipe out an infection. It is more like wearing eyeglasses that correct one’s vision while the glasses are being worn.
Given the often-dramatic alleviation of symptoms experienced by people with ADHD when they take stimulant medications, it is very difficult to sustain the notion that ADHD impairments amount to a lack of willpower.
Much more remains to be learned about how the brain’s complicated neural networks operate to sustain the broad range of functions encompassed in “attention.” Yet it is clear that impairments of executive functions, those brain processes that organize and activate what we generally think of as attention, are not the result of insufficient willpower. Neural-chemical impairments of the brain’s executive functions cause some individuals who are good at paying attention to specific activities that interest them to have chronic impairment in focusing for many other tasks, despite their wish and intention to do otherwise.
This article is from Attention Deficit Disorder: The Unfocused Mind in Children and Adults by Thomas E. Brown, Ph.D., and published by Yale University Press. Reproduced by permission.

The Truth About ADHD: It’s Not Black and White

ADHD is black and white, where one either does or does not have the characteristics, where there is no “almost” or “a little bit.” ADHD is more like a mood disorder, which occurs along a continuum of severity. Everyone occasionally has symptoms of a low mood. But it is only when symptoms of a mood disorder significantly interfere with an individual’s activities over a longer time that he is eligible for such a diagnosis.
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ADHD Is Not the Boss of You

SUPPORT & STORIES

ADHD Is Not the Boss of You

ADHD is just one aspect of your life. Learn how choosing the proper treatment, staying organized and learning when to ask for help taught this writer to take control of her ADHD.

BY KATY ROLLINS
Adult ADHD Treatment: Managing Symptoms and Evaluating Options
I am writing myself, and all of you, a little reminder: attention deficit hyperactivity disorder (ADHD) does not make our choices for us and is not the sole voice in the choir of our waking thoughts. Every day you and I have choices. Here’s a bit more about how I take control of ADHD:

1. Choosing to Treat ADHD

Part of my adult ADHD treatment is learning which choices are available to me, and making the most effective ones.
For me, because medication is part of my treatment, my first choice most mornings is to take it before I get out of bed. This clears the fog of confusion that plagues me when I wake up. Clearing the fog makes me less grumpy and when I’m less grumpy, I’m better able to prioritize my actions and thoughts.

2. Considering Every Option

I like options, even though too many of them overwhelm me. When I’m stressed — I have a husband, three step children, two dogs, and two cats swirling around me while I’m trying to think — I remind myself to sit down, review the situation, and list my options. I write them down because, duh, I have ADHD, and I don’t remember things unless I do. So I look at my list and try to make a plan.

3. Prioritizing

Sometimes I draw pictures of all my choices, especially if particular tasks suggest a visual approach. I do event-planning and, to keep myself engaged, I draw a person in the middle of a poster board (me!) and big talk-balloons above my head, filled with the things I need to do. I number them to remind me which ones to do first.

4. Asking for Help

If I find it hard devising the list, or the plan that follows from it — because I’d rather be, oh, I don’t know, learning the tango or eating a sandwich – I talk it over with my therapist. She frames things in a way that make choices less overwhelming, and then lobs them back in my court.

5. Starting the Day Off Right

I can choose to stay in bed too long, and have a rushed, crappy morning, or I can choose to get up on time. Then I can choose to leave the house on time or let my mind wander. This takes work, because my mind loves to wander and I have lots of ideas in the morning. I can choose to pack a snack, or be miserable an hour later when I’m at work and feeling hangry (hungry plus angry equals hangry!). I hit the mark more often than not.

6. Practicing, Practicing, Practicing: Symptom Management

I can choose among a lot of little things, too: putting my ATM card back in my wallet, filling my gas tank, instead of only asking for $5 worth, because I can’t sit still long enough at the pump. I can choose to sort my laundry when it comes back from the ‘mat … instead of starting off the day with wardrobe confusions or underwear shortages.

7. Remembering That the Little Things Mean a Lot

I mention these minutia of daily life for two reasons:
For Those Without ADHD: Understand that mundane details mean more to us than they do you. These are the devils that regularly frustrate us. You may not think these are real chores for us, but that’s the point. It is in the nature of ADHD, and its impact on people’s lives, that small things are difficult, that we must approach them mechanically. Hyperactive adults aren’t intentionally aggravating you. ADHD isn’t about the big disruptive things that people do. It’s best defined by the little things that shouldn’t be so hard.
For Those With ADHD: I find it helpful — and I hope you do, too — to think of the day as a series of choices to be made. I don’t always make perfect ones, but I try for a decent batting average. Each day I remind myself of the penalties of not making better choices (and I do mean remind, not torture, myself). By good-faith efforts at making better decisions, we do not cure ourselves, but we manage the symptoms that would otherwise be making decisions for us.
It’s not easy, but do we have another choice? We do, but I would argue — I just did — that it’s probably not the better one.
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You’re Wasting Time. And That’s Bad for Your Health.

TIME & PRODUCTIVITY

You’re Wasting Time. And That’s Bad for Your Health.

You don’t know where to start, so you procrastinate. Or you spend your day chasing emails rather than tackling to-do items. Or you lose the forest for the trees. Learn how to solve these common time-management problems with these 5 expert strategies.

BY SUSAN LASKY, M.A., BCC, SCAC
A calendar with a marked deadline can help people with ADHD manage time.
Every 24 hours, 1440 credits are deposited in our personal time banks. These are the minutes of our lives. How we spend those credits is up to us, but each day the balance reverts to zero. Ask yourself, “How wisely do I invest my daily allotment of credits? Do I respect and treasure these irreplaceable moments of my life? What are my goals and priorities, and am I living the life I choose?”
To accomplish our goals we have to be clear about what they are, why we’re committed to them, their priority, and how we can structure our lives to get them done.

Project vs. Task Management

You can’t “do” a project, you can only do a task. One of the biggest barriers to getting things done is to think of a project as a task. A project consists of many different tasks, and unless we break it down into tasks, it may seem overwhelming, and we’re likely to walk away from it.
So the first step in any project, whether it is setting a routine for cleaning a house or redoing your website, is to create a project sheet. Write the name of the project on top, and the expected due date. Then answer some questions:
  1. Why am I doing this — what do I want out of it? Sometimes we put more time and effort into something than it merits. This step helps to put it in perspective and stay focused on the goal.
  2. Am I doing this project for myself or for someone else? Am I clear as to what they want, and when they want it? Do I know how to get this done, or should I ask? If we’re not sure, we’ll go into avoidance mode.
  3. What resources will I need — time, money, other people?
  4. How do I feel about working on this project? You may have to do it, but it’s helpful to know that you’d rather not, so you can be wary when you find other things to do.
Now list all the steps to accomplish the project, along with due dates for each step (working backward from the deadline, if there is one).

Focus Daily

The Daily Focus form is not your to-do list, which could be 20 pages long! It is a grounding list, with space for only three primary tasks that are critical to accomplish each day. You can tackle three secondary tasks if you complete the first three.

Smooth Transitions

Transitions are difficult. Many of us find it easier to focus on one type of activity at a time, so you might want to use time blocking to plan your week. The idea is to set aside a block of time to devote your energy to a particular activity. For example, you might decide that Mondays are administrative days, Tuesdays are sales days, and so on.
Some people divide their days into blocks of time, so they don’t lose an entire day to one activity. An example would be setting aside a morning block of time for planning and review, a late-morning block for sales activities, an early-afternoon block for meetings, and a late-afternoon block for marketing activities. You can check your e-mail between the time blocks. Use the transition time to walk or snack, to recharge your energy.

Plan (and Other Strategies)

  1. Begin each week with an extended planning session. You will gain about 20 minutes of work productivity for each minute spent on planning.
  2. At the end or beginning of each day, review your progress and commitments, and adjust your plans as necessary.
  3. Leave “blank space” in your daily calendar. No matter how busy you are, don’t overbook. Leave time to catch up on tasks that take longer than planned or to add in new time-sensitive tasks.
  4. Plan realistically. If things take you extra time to complete, better to account for it than to miss deadlines.
  5. Accept that you will occasionally have an “I don’t feel like it” moment. Remember: You can do anything for 10 to 15 minutes. Set a timer. The problem is usually one of getting started; once you’ve begun, you’ll be able to continue.
  6. Check things off your lists, so you have a sense of accomplishment.
  7. Stay with your commitments. Use the ITTT method (“If This, Then That”). “If it is 3 P.M. on Thursday, then I do my expense reports or pay bills.” We are good at talking ourselves out of doing things, but this concept makes it more difficult to not follow through on a commitment.

Deadlines Are Key

People with ADHD need deadlines. Don’t say “yes” if you can’t say “when.” We usually work better when it’s down to the wire. The adrenaline rush of having to get it done stimulates our brains. However, be kind to yourself. Just because you do better as a burst worker doesn’t mean you shouldn’t be thinking about what you need to do and how you’ll get it accomplished.
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