Everything you ever wanted to know about ADHD...continues! WOOHOO! Go back and check out Parts I & III, or start here to learn more about dopamine, how to differentiate someone with ADHD v. someone who is neurotypical, why folx with ADHD run late, and what the impacts are on school (sadly, so far, not great) when someone is labeled with ADHD and receives accommodations. The things that are easy, hard, and all the myths and misperceptions that exist about what is really not a deficit, but rather an abundance and variety of, attention. The third part of a series from David, who has lectured as an expert and advocate on this subject nationally, and assisted by Isabelle, who is eagerly sponging up the information. A neurodivergent and neurotypical blend of friends Christina, AJ, Gabe, and Isabelle's husband, Bobby, sit in to ask questions. (Part III of David’s Lecture Series)
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Isabelle & David welcome Isabelle’s husband, Bobby, and their friends, Christina, AJ, and Gabe, to continue to listen and learn from David’s tried and tested presentation on ADHD, which he normally gives to fellow clinicians (for the first and second parts of this talk, please see episode 4, All About ADHD Part I and episode 6, All About ADHD Part II). David talks about procrastination, and why it raises the stakes, thus generating more dopamine (the chemical in our brain that gives us a feeling of reward or satisfaction), which folx with ADHD are deficient in. He relates this to the idea that winning, or a win/lose condition, as something that generates dopamine: if we leave for somewhere that is 10 minutes away with 9 minutes to go, if we get there in time, we feel like we beat the clock (won). Also, as we run late to something, for example, we raise the stakes and leave so that we will run late—thus, giving us dopamine—but we’re often miserable and blaming ourselves the whole time. Miserable, and loaded with dopamine: reinforcing the behavior that we are also blaming/shaming ourselves for. How struggles with time management (guessing how long something will take or how all the pieces will fit together) make transitions and running late even harder, and how it is important for neurotypical partners and folx to know it is not done on purpose. How to differentiate (or diagnose) someone with ADHD when a lot of symptoms of ADHD also occur in neurotypical folx (like procrastination? Enjoying sex?). Most psychological diagnoses are connected to things many people experience (such as anxiety); and most humans will struggle with executive functioning skills, but all folx with ADHD will struggle with these skills (see below for a list of skills!). Furthermore, when we get into how people recognize and learn from mistakes, that’s when you see ADHD: a person with ADHD will make these mistakes a lot more often and also carry a lot more shame and self-blame for doing them because of just how often they make them. Neuropsych (short for neuropsychological testing) can help find an ADHD diagnosis but can also miss it. For example, audience member AJ names going to go to the store and seeing the coupons, but skipping the step of putting them in your pocket (ADHD)—and a pattern of this experience, over and over again (plus the “Why did I do this AGAIN!” feeling). David’s use of the Yoda voice “There is no later, only now!” Talking about the shame spiral of the pattern of this happening over and over again. Major consequences of growing up with ADHD - social and school. Folx with ADHD, if they are diagnosed as having it impact their learning (remember: ADHD is not necessarily a learning disability, it must be shown to be impacting learning), they are often tracked with lower level classes and are given accommodations to suit lower IQ students (make things easier). Dilemma there is most people with ADHD have above average IQ: with this setup, they are under stimulated in school, and also isolated and marginalized, systemically. Sharing different school experiences, from being in gifted programs to transitional programs, to having LD labels: and the validation of folx with ADHD often disliking school (especially when they receive accommodations). Seen as if you’re doing it on purpose. Especially kicks in around ages 9-10, when peers start normalizing your world v. Your family. Talking about kids will naturally accommodate themselves in school (figure out bare minimum grade, skip homework but do well on a test, for example)—but when they do this, for example, not doing homework, can be read as personal (by the teacher) or avoid the consequences.

Dopamine deficiency? ADHD is often understood as neurobiological (brain) difference, that includes lower levels of dopamine, the neurotransmitter (messenger chemical) in our brain that gives us feelings of satisfaction and reward—the feeling of YOU DID IT…ahhhhhhh. Another way of viewing it is a neurotypical person has a shot-glass-sized need for dopamine and so little bits of dopamine fill it up enough to feel that satiation, whereas a person with ADHD has a pint-glass-sized need for dopamine. At times, you need a lot more dopamine and are starving for it, but at other times, you have so much dopamine it is so rewarding (and perhaps the reward feeling while eating that doughnut is actually that much greater), but it also makes it even harder to pull away or transition from getting that dopamine to not (imagine how hard it is to not keep watching a show you love or how it would feel if someone suddenly unplugged the tv). Keep in mind that dopamine is just one of the neurotransmitters doing some fun other stuff where ADHD is concerned.

ADD or Attention Deficit Disorder: is an outdated diagnostic label that also used to a serve as a marker (often perpetuating some shame and stigma) differentiating a person from someone who had ADHD or the hyperactive part of ADHD. Currently, everything is called ADHD, with the following subtypes: inattentive type (too much brakes), impulsive type (too much gas), or combined type (too much of one or the other depending on the environment someone is in). Folx diagnosed with ADD will often present as ADHD inattentive or combined subtype.

Neuropsych(ological) Testing: can be very expensive, and is one way to get an official diagnosis for ADHD (another is meeting with a licensed clinician who does a thorough social/school/work/life history combined with self-diagnosis). Neuropsych tests assess your reactions and responses to different challenges, and can be helpful in either the validation of a diagnosis or awareness in what kinds of supports/accommodation and modifications might be helpful. It should be noted that these tests are largely dependent on the examiner's evaluation, and aren't perfect and can be wrong.

From the Cleveland Clinic: "A neuropsychological evaluation is a test to measure how well a person's brain is working. The abilities tested include reading, language usage, attention, learning, processing speed, reasoning, remembering, problem-solving, mood and personality and more"

Why do folx with ADHD procrastinate? Waiting for the last minute, or delaying starting can be self medication for someone with ADHD. Excitement, Anxiety, Anger are all feelings that trigger stimulate us (our heart rate increases). Once this happens we remove any delay in reinforcement, as all acts towards work completion reduce that feeling/stimulation. It can also really increase the feeling of winning, if deadlines are met. 

Executive Functioning Skills: Also known as forebrain skills because they are activated in the part of your brain right behind your forehead (the “fore” of your brain). Most humans will struggle with the following skills, because they are hard to do. However, everyone with ADHD will struggle with the following (to a greater or lesser degree, often dependent on the environment, structures, routines in place, etc.):

Response Cost: neurological skill that helps you know the consequences of your actions later on down the road
Delay of Gratification - receiving the reward or win, well after the behavior occurs.
Black and White Thinking - believing or acting as if there are only two ways of thinking right or wrong. Black and white thinking makes it harder to see middle paths during an argument
Time and Organization Skills - knowing how long tasks will take, planning transition times into tasks, appropriately guessing how long something will take, or all parts of time and organizational skills.

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Cover Art by: Sol Vázquez
Technical Support by: Bobby Richards