When ADHD goes from bad to worse

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This thread was started at the request of Millie after the topic was raised in another thread.

How I was diagnosed

At the beginning of the year we appointed a new staff member, a woman with ADHD. She explained her condition to us and also explained what would make her working environment more productive for her, given this condition. Even from that first day I noticed that I had much in common with her and began wondering if I had ADHD too. Eventually I secretly took myself off to a psychiatrist. By the time I was diagnosed with ADHD (and Asperger's Syndrome, to my surprise) I was in a terrible state, and could not even go into hyperfocus (q.v.) anymore.

From worsening ADHD to meltdowns

ADHD typically means you struggle to concentrate on certain types of activities (and may keep switching between them), but you also have the ability to focus for hours on end on other activities. This later state is known as hyperfocus.

Being unable to concentrate and thus unable to work productively is very stressful as it is important for me to make a contribution to the income and productivity of the business. Since I am autistic, such stress can lead to meltdowns (extremely emotional outbursts) as it did in my case on several occasions, for example, when I lost concentration in the design of some business cards, and had hundreds printed with the wrong telephone number on them. This was more distressing than it would be for most people, because accuracy is one of my talents, and to have made such a mistake made me feel that even what I had been good at was going bad.

Each meltdown makes you vulnerable for having another. My boss (who is also my best friend) was completely confused by my Asperger's Diagnosis and could not understand that my outbursts were not something willful. The lack of support from him sent me into a cycle of further meltdowns, which had been few and far between in previous years. At one point he even said, "Since you have been diagnosed as having Asperger's, you've started acting as if you do!" My ADHD colleague, her Asperger's Syndrome husband and various people online offered me useful advice about getting out when I felt it coming, going to a quiet place and shutting out sound and other stimuli.

Medication

As Millie requested, I will go into more detail about my experiences with ADHD later. The main thing I want to say at this time is that getting onto medication was an important step in my therapy. My psychiatrist monitors my dosage, and the specific type of medication, very carefully. I was not put onto Ritalin straight away, as he was concerned that I was already so tense that this could make things worse. He therefore prescribed Strattera, which has numerous side-effects I have learned to live with; I have also found that taking Strattera in the morning is not that good, while taking it in the evening (combined with melatonin, to counter-act the insomnia side-effect) is more effective. After two months he also added Ritalin which I take situationally, for example, when I expect to have to perform administrative tasks, or when I feel overwhelmed by the volume and variety of my work and struggle to concentrate as a result of it.

Where I am now

Over time, my boss/best friend started easing into the idea that my Asperger's Syndrome was real andnot just an excuse, as he started reading about AS and remembered specific things that happened over the years that fit the description. The strain in our relationship has eased a little with the knowledge that he wants to be supportive, even if he is not quite sure what to do yet, or when I am being Aspie/ADHD and when I am simply being willful and morally obstinate.(We've had some arguments about that, not fully resolved yet -- I want to take full responsibility for my actions and reactions, and can do so when I know how I am supposed to act, given what I have inside me.)

I am still not back to my usual productivity, but we're getting there. Much of the time I feel stupid at work compared to my ADHD colleague who is much younger than I am but who has much more mature coping strategies, and who, for all her problems, is extremely productive. She has been a blessing to me, though and I don't know what would have happened to me if it weren't for her friendship.

I was diagnosed with ADHD as an adult although the only H thing about it is my thought processes which are sometimes like a ricocheting ping pong ball. I had been struggling for most of my life to understand why I felt such mental lethargy and made such simple obvious mistakes from lack of focus. I was already on Prozac and the doctor added Wellbutrin with disastrous results. I was then on Ritalin for a while and then Concerta. After a point (several years) I suddenly developed severe facial tics. He took me off and it took about a month for the tics to go away. I still feel a tremor from time to time. All this medication has helped me maintain more focus in general but it certainly hasn't fixed anything. It wasn't until I read an article about executive ordering dysfunction that these struggles I've had my whole life made sense. I wonder if my adhd had been diagnosed as a child when my brain was more malleable there could have been something done to reprogram me. My chronic low grade depression and adhd remained undiagnosed and untreated most of my life I think because I'm female and we manifest differently and at that time it wasn't considered possible for a child to suffer from depression.
Alphabetania: Perhaps your young co worker had the benefits of earlier diagnosis and treatment.

Yes, she was diagnosed at the age of 3 and although her parents sometimes disagreed about what was best for her, they did at least start early with strategies to help her. Her medication wasn't sorted out until recently though, and at the moment she is going through an anxious phase, the origin of which is not yet known (she and her psychologist are trying to figure out whether it is chemical or situational); however, her ability to communicate, to develop coping strategies, etc., etc. is really very good.

She has been hospitalised for co-morbid depression too (she checked herself into the mental hospital) before she started work with us. We were aware of all this when she was appointed, and her schedule was developed around her mental health requirements. She works only 4 days per week, but she has sometimes worked late and on weekends as well (one of her roles is as systems administrator, and that inevitably is not an 8 to 5 thing).

She is a very lively, talkative person. I love it, because I talk too much too, and I don't have to hold back when I am with her because I won't talk her to death -- we take turns very nicely! Although I have several quiet friends who don't mind that I chatter away, they are not quite so easy to be with, because I must put more energy into concentrating on ensuring that their needs are met. With her, though, she'll just say whatever she needs so I don't have to worry that I am neglecting any social duties,

I did suffer from depression at various times in my life, but I don't have it now. I was a pretty serious teenager. The saying that "youth is wasted on the young" is true of me. I now know how to have fun, but my knee cartilage won't let me do everything I would like to do.

I was diagnosed with Aspergers at age 12, then later diagnosed with ADHD as well at around age 17.

I went on ritalin for my last years of school and it made a drastic difference to my grades (some of which went from D's to A's) and focus. But at the same time it increased my anxiety so that I became hyper tense, and I just couldn't live like that indefinitely, so I went off it for my first year of uni (last year). This year I've been on and off - there is no doubt that it helps me focus and get work done, but it increases my anxiety to an almost unbearable level.

thanks for this thread, alphabetania. It is fascinating and very helpful.
I have only recently learned I likely have ADHD.


When you say you can hyperfocus on some things, but get completely lost with others and switch between a number of other tasks...what are the "other" tasks?

Also, can you describe a bit more about how you switch from one task to another?

Do you see you meltdowns as a part of your ADHD or your autism of both?

Are there any ways of managing ADHD that are not drug-related?

Can you describe the ins and outs of not being able to hyperfocus? How were your thought processes then?

once again, thanks so much.

I get hyperfocus sometimes when doing certain activities, like art. Where I'll get intensely focussed and drawn in to the artwork I'm creating so that I don't see or hear anything that's going on around me and time just disappears. Same thing happened with reading fantasy.

It used to happen in class, where I'd be reading a book, or doing art, and I'd look up suddenly and realize the classroom was empty; everyone had gone and in fact lunch was almost over and the next class was about to come it. It was like a complete loss of time.

Last edited by sunshower on 05 Jun 2009, 8:04 am, edited 1 time in total.

Am I right? Is this hyperfocus? I don't really know much about ADHD either.

I know that at school I could be playing piano in the music room during spare straight after lunch, and I'd wander out after a while to check the time and find out that school had finished and I'd missed the first half of after school choir rehearsals (and I hadn't heard any of the bells go, or people coming and going between rooms).

^ Yes. we do have some very similar issues, sunshower.
I hyperfocus like this all the time. One of the problems with normal therapy was they kept telling me i had PTSD and while I did have PTSD for a while there, I also knew that what they called severe "dissociation" was something i had always experienced and was a part of who i was and was not reliant upon an external traumatic catalyst for its development in me. I had alwyas hypefocused like this in exactly the way you describe.

With your ADHD, what happens with scatty thought and flitting from one thought to another? can you describe it? what can one do about it?

I think all this is why I'm comfortable in my job, which is cleaning offices. It is low stress as long as I'm not overbooked which never happens anymore since I finally got my employers to accept that as a singe parent, I would gladly trade less money for more time with my son. It is so mindless it is almost Zen. I decided I wasn't going to see myself worth as dependent on my job. I have an excellent relationship with my clients and nobody ever condescends to me. This job leaves me with mental energy to relax and read at the end of the day. I'm afraid a job that would require a lot of focus from me and long stressful hours would put me back to a bad place. I mentioned the disastrous reaction to the combination of Prozac and Wellbutrin- I felt physically hyper and angry. I am usually pretty mellow but I wanted to go around b1tch-slapping people. When a friend commented on this I realized that this was the feeling I used to drink to get rid of. That was before meds when I was working 10 hour bartender shifts in a popular bar near a university. There were times when I would just shut down and my mind was just white noise. The mistake with the business cards? I would absolutely make that kind of mistake and frequently too. I drive my son's school crazy because I can't keep up with all the little forms. I told them at one IEP meeting there were things that he and I both struggle with. I know they think I'm odd but I don't think they doubt my dedication. Sorry, didn't mean to ramble. It's frustrating though to know you have a good mind but not to be able to use it effectively. I think of it as having good software but bad hardware.

I wish I knew really effective focus techniques. I find that sometimes a put a piece of scrap paper next to my computer, and while I'm working on an assignment every time my mind disconnects (about once every 5 minutes), I'll draw hundreds of varying cartoons on the paper, keeping my focus close in proximity to the task at hand, but keeping it on a reasonably basic task so that I can keep control, then when I feel ready I pull my focus back to the computer again and it goes back and forth like that. I used to play a simple maze game with a worm which worked quite well (really basic, like the ones you can get on the old mobiles).

I find what happens to me is that my mind constantly jumps from topic to topic (when it's not hyperfocussed), and it's a real chore keeping it on one thing. So I always try to get into a state of hyperfocus when working, but if it's not a task I enjoy that's almost impossible. It's hardest when I can't find the hyperfocussed state.

I find that if I go off and do something involving when my mind disconnects (like posting on WP, or writing music, or creative writing, or doing art), then I can never seem to get back to the original task, so I try to channel my "scatty thought" as you call it, onto basic repetitive tasks that get dull after some repetition.

Doesn't always work.

I guess I find it hard to describe, but I often call it a block - or almost like a repelling surface, like my thoughts keep bouncing off the topic I'm trying to think about and in all directions. So when it bounces off I try to stop it with another repelling surface (a repetitive basic task like drawing identical cartoon faces or a maze game) so that it bounces back to the original task.

I find the most effective treatment though was definitely ritalin - when I was on it I could focus on anything I chose to for hours at a time if I wanted to; it was amazing. But the side effects weren't good either; I became dangerously thin, and I couldn't ever relax as it kept me in a constant state of hyper-tension, "brittleness", and anxiety.

That was the reason my psychiatrist didn't want to put me on it in the beginning. But I don't think those side-effects happen to everyone under all circumstances. I haven't noticed such things from taking it yet (I've been on it on and off for a week or so). And I have one friend on Ritalin and another on Concerta who have been on this medication for some time, and they are both as overweight as I've always known them to be.

I don't know if it's the Strattera that's calmed me down, but I have been missing the physical side of my hyperactivity. I used to be able to go out when I was really tired, and my body would just go on and want to dance. I liked that. Now when I come home from work I make supper and get into bed with my computer.

I am no expert at this, but when I am at my worst, I find that it helps if I write myself a step-by-step recipe of what I am supposed to be doing. I can usually do programming without having to write down the steps, but when my concentration is unusually bad, I have to write down things like, "Create form; bring in headers from old database (save as subform, then insert); create view for users; create hidden view for lookups." This is how I survived and retained my sanity in the weeks before I was on medication.

I am very bad at administrative work, and that just happens to be my ADHD colleague's special superpower, so she helps me by writing down administrative steps for me. I like it when she tells me what to do. (Technically I am actually her boss, but I often wish I could get demoted.) She, on the other hand doesn't really like responding to e-mail enquiries, while I enjoy doing that.

Now I'm wondering if I have it too!! I was diagnosed with mild ADD when I was little, but I think its gotten worse as time went on, and I never had any medication for it. I took Aderall for a few months, but then stopped.

Now, I find that I can't sit througha movie, I never go to the movie theater anymore. I just watch movies on my laptop while I bead. I can't just sit and watch it without having a chat open, or be doing something else online. I also can't seem to NOT make "careless mistakes" when I think I'm doing a good job!!

When I was in school, I'd always make those little mistakes in math, my tutor called "careless mistakes" but I was really trying to do it right! Ugh......that explains a whole lot now. Thanks for the post!! !!

Sounds positive! Best wishes for your future development!

And interesting too.

I got ADHD without hyperfocus as far as I know. I didn't know you could lose hyperfocust. An interesting thought.

THis is very helpful information and what you are describing tends to match how things are for me.
i only recently learned to write lists of what I have to do in a day and it has revolutionised my life - bringing me back to a focal point that is not there at all unless i am involved in my special interest.

I shall think about some more things I want to ask.
If you think of other things you do to help with the ADHD i would like to hear about them.

I hope you're keeping the steps on the lists small? Generally, staring at lots of works literally impairs people with AD(H)D and they find that when they cut huge things into small pieces they suddenly can start (somewhat or lots) easier because the feeling of success and progress is actually within reach.