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Questions about ADD (AKA, what should I be sure to ask when I see my pdoc)


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Ok, here goes.

 

I am currently 28, 6'2", 250lbs. Married since September, but been in the relationship for 4 years. Currently finishing up my degree, and work full time as a Linux Sysadmin.

 

About two years ago, I was diagnosed with Adult ADD. Last few years I've had difficulty focusing, my mind would jump all over the place. I also have been getting somewhat of an antsy feeling. I'm not feeling hyper, as the buzzy tingly feeling even comes up even when I am feeling lethargic and can barely move. I was put on Adderall, which helps a bit, as I don't get the antsy feeling so much, and I can focus somewhat better. It isn't always a huge difference though, at least through my view point. The anxious antsy feeling, I only ever seem to notice when I have it, and not so much when I don't. My wife can tell though when I've missed a dose though. Sometimes, I get worked up, and I am all over the place. Usually it starts off with me absentmindedly doing something stupid, and panicing over it, messing more up, and giant snow ball effect while I am being freaking out. This stuff really seemed to start in the last 4 years or so.

 

Now, my current doctor said that ADD isn't ever adult onset. When I was a kid, I never had a problem focusing, never anxious. I was a little bit OCD, but I grew out of that. I didn't fidget or anything, but I had certain things I had to do. If I bumped something, I had to bump again so it would be an even number, and also I had to make sure it was symmetrical (so, bump my left elbow against something, I felt off and really bugged until I bumped the left elbow again, and then the right one twice). If I touched something that registered as unclean in my head, I had to wash up immediately. Didn't matter if I knew the item was clean and sterile. In the second grade, my parents had to talk to my teacher because I had done it so much my hands were chapped and cracked. Like I said I grew out of that, and no longer felt the urge to do anything like that anymore. That kinda happened, late elementry, into middle school (it was gradual fade). Most of Middle School, and highschool were trouble free on that front. Also, when I was younger, I tended to have a really good memory, able to retain the tiniest detail about things from years past. Now, it pretty much sucks, and I forget things all the time. The only oddity of sorts that has retained from my childhood is that caffeine doesn't really have an effect on me (I can go straight to sleep after chugging soda, coffee or energy drinks. I generally don't drink most of that stuff because it just tastes nasty, with no pick-me-up).

 

I do have an appointment with a psychiatrist, but it is about a month out. Insurance issues have delayed it a while (Pdoc's office billing service wouldn't use my insurance, despite the Pdoc's office saying that they accepted it). Was supposed to have seen one at the beginning of the year.  Posting now, because it seems like the adderall has less of an effect, and my doctor is raising the dosage from 30mg twice a day, to 3 times a day. It also has been the source of issues between myself and my wife. I've bounced back and forth between Adderall IR and XR (more insurance issues), and varying dosages (starting at 10, and working upwards to the current 30).

 

While I know that you guys aren't able to give a diagnosis, but do you think I may have ADD, or something else? Is there something I should ask my doctor, or the pdoc? My doc has said he isn't 100% sure he's treating the right thing, based on my general history. I'm wanting to make sure I am well armed with questions when I do go see the pdoc.

 

Also, side note: can Adderall effect triglyceride levels? I generally eat healthy, avoid a lot of soda (I limit myself to 1 per day, and don't always even have that), rarely drink alcohol, etc, but a recent blood test showed my HDL levels being low (28), and my triglyceride levels being 712. Previous blood tests, the highest my triglycerides were before was 186. I've had low HDL before, had that before I was diagnosed ADD, but I got everything back in check before I started on Adderall.

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Try reading this article about ADHD signs in children, and see if any of these signs applied to you as a child: http://www.helpguide.org/mental/adhd_add_signs_symptoms.htm

 

I have inattentive type ADHD, which often gets overlooked by professionals when you are a child. You don't have to be fidgety, loud and completely unable to stay on task in order to be diagnosed with ADHD. My major symptoms of ADHD include spacing out, being VERY easily distracted by extraneous stimuli (even people breathing can distract me), I don't pay attention to details and I can't pay attention to or retain verbal instructions. None of those are "stereotypical" ADHD symptoms, though they are very common. 

 

It's true, ADHD is not adult onset. So, in order to be diagnosed with it, you must have displayed symptoms as a child, before the age of 7 (though I heard someone on CB say 12 is also acceptable, don't quote me on that). 

 

If you read the article or do other research and decide that you definitely did NOT have ADHD as a child, then you're left with some confusing symptoms. What could be causing these symptoms in adulthood? That's something to ask a pdoc about. In fact, the article I linked even suggests that some physical problems (thyroid function) can mimic ADHD, for example. 

 

I would highly recommend printing out this post and bringing it with you for the pdoc to read. That way, you won't have to try to remember everything. 

Edited by Parapluie
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They raised the age limit of onset of symptoms for ADHD in DSM V. I think it's now maxed out on 11/12 but don't quote me on that, left my links at home.

ADHD is not adult onset. However it can vary in its presentation, even in the same person over time, and your environment can have a huge effect.

A common example I refer to, not saying this is you, is of the ADHDer who goes away to college. Previously they lived at home, did moderate to very well in school, never seemed to showcase ADHD symptoms (but a knowledgeable specialist will know what to look for.) They go away to college, leaving home for the first time, and BOOM now it's this huge issue. On the outside, that looks like adult onset. Keep in mind, my example refers to someone who actually has ADHD.

A key point is that ADHDers frequently do better in structured environments. Many of us can't seem to organise ourselves and impose our own structure, though some ADHDers somehow manage to compensate for this frequently through obsessive organisation. Anyway, between grade school and living at home, my theoretical ADHDer had a much more structured environment to help them cope. That's all taken away when they go away to college, and suddenly symptoms are manifesting in far more classic/textbook/obvious ways.

ADHD has two potential spectrums, and can include impulsiveness. The first spectrum is attention regulation. Most are familiar with one end, inattentive. Or as I say, "OH LOOK SOMETHING SHINY." Spacy, easily distracted, hop from topic to topic, can't focus on most or many things. When my inattention is really bad I can't even focus on the stuff I really love to do - interest can trump inattention but we frequently have little to no control over that. The other end of the attention regulation spectrum is hyperfocus, which you'll see in good books and. Articles aboutt ADHD from about mid to late 90's and onward. Ever read a book or been so into a TV show that you couldn't hear someone hollering your name literally in your ear, in fact they likely had to touch you for you to know they were there? Lots of people have experienced this, doesn't mean ADHD on its own, but it's a perfect example of the other end of the attention regulation spectrum. This one can lend itself well to obsessive tendencies though it is not obsession on its own. Hyperfocus can indicate ADHD if it is a frequent, pervasive, disordering problem. It can also be a useful tool, but again many of us struggle to have any sort of control over it.

This spectrum, you can move around it over time. You can only or mostly do one or the other. You can frequently do both. You can have one be more prevalent when you're young and the other more prevalent when you're older. And so many more variations.

The other spectrum is energy regulation. You can have adhd without being on this spectrum or without being on the first, or you can be on both. You can also vary in what spectrum you're on or how much of it is expressed, over time. Energy regulation is frequently only referred to as hyperactivity. This is one end of the spectrum. Even hyperactivity can present in different ways. The classic example is always on the move, out of your chair, drumming on the table, always being told to stop fidgeting, etc. But another expression, for example, can be talking LOTS and FAST. Like having manic pressured speech, just ALL THE TIME and it's not actually due to hypo/mania (other manic symptoms absent.) So, hyperactivity. The other end that is frustratingly rarely mentioned is HYPOactivity. The opposite of too much energy. Need I say more? Location and symptoms on/from the spectrum can vary in ways similar to how I described the attention regulation spectrum.

The wildcard is impulsiveness. Between distracted attention and boundless energy, it can be difficult to remember that you actually need to save your money for a bill you forgot about, and that shiny whatsit is something you need RIGHT NOW. You can act instantly and react instantly on your feelings and to surrounding stimuli. Some people with ADHD have such all-over-the-place moodswings, many times a day, that they wonder (in ignorance of what it is) if they have bipolar disorder - but it's a feature of impulsiveness instead. If your attention is diverted and you have the energy for it, you leap instantly upon your new fancy without realising what you're dropping in the process. You have tons and tons of half and never finished projects. Your money flies out of your hands.

Possibilities include: Kids LOVE you and adults get frustrated at being your caretaker. You have frequently been called lazy, told you're not trying hard enough. It's known that you SHOULD be able to do whatever it is, because you have successfully grappled with or done the same or similar in the past. Variable performance. Can read five books at once wiith the radio on or can't read a book to save your life. Think better while DOING something with your hands or body; others are baffled by the idea that doing more helps you focus on what someone else is saying. You lose and misplace everything, everywhere, always. You 'organize' things in scattered loose piles because if you don't see it, it doesn't exist. You interpret time thusly: NOW, and NOT NOW. You did schoolwork but never managed to get the hang of homework or you'd lose it or forget. Yoou forget the list that helps you remember things, you forget to check it, you forget to bring it. You are always meaning to do things but never seem to get around to them - unless a deadline comes up and you frantically scramble to put it all together at the last minute.

I could go on.

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From the article, it mentions inattention, hyperactivity, and impulsivenesss as the three factors for ADD. When I was younger, inattentiveness was never a problem. I easily became hyperfocused on things (but it was never a problem, so I was always still aware of stuff going on around me). Quite often my parents would  give me something to take apart, and I'd be quiet for hours. One time, I was at a swapmeet, and got an old parking meter, and I played with it for hours, just dropping a quarter in over and over again. My brother was hyper, always bouncing off the walls, but I was ever the "calm" one. The only impulsive stuff was related to my OCD. I wouldn't ever butt in, or be way off point, like you would traditionally think of an impulsive person. I just would get overwhelming urges for something, like the handwashing or the bump thing, or sometimes if I was buying something, one particular one on the shelf would be the one I had to get despite being identical to every other one. The OCDness seemed to start about 7 was worst when I was 8 or so, down to easily management levels (not really noticable) by 10, and pretty much totally gone by 12.

 

As far as the symptoms as an adult, I noticed that in my early to mid 20s, my memory wasn't as good as it used to be, I'd start forgetting things, but nothing major. I figured some of it may have just been due to some injuries I had (was in a workplace accident, hit my head and messed up my right arm). That happened when I was 20, and made me move back in with my parents (lost use of my right arm for over a year due to nerve issues in my arm, and I did hit my head at the time of the accident) When I was 23, I had a bout of depression along with anxiety attacks after a really really nasty breakup (dumped via email, and the ex started badmouthing me to people before I even got the email in what turned out to be an attempt to hide her infidelity. Was harassed by people for about a year afterwards). After this, I went to college going full time for compsci degree, along with starting a new job working in IT at a company that started going down hill and ended up being really crappy, and I met my wife which there ended up being problems between her and my family starting from early on in the relationship. About 2 years ago my wife and I moved in together, and earlier this year I lost my job at that place but got a much better job elsewhere. A lot of stress over the last 4 years, somewhat coinciding things getting worse, but the stress seems to be on the decline.

 

As it stands now, I am very easily distracted, and have very much an out of sight out of mind sort of situation (so easy to forget something if it isn't right in front of me). I do make lists to try and remember things, but yeah, I also forget to check the lists. When I have structure, I do well, because I find anymore that it is hard to be self motivated. I keep going "Oh I have time for that" or "there are other things that need to be done now". Inattention is really bad. My wife says I'm like Dug from Up with a squirrel. I tend to be more hypoactive than hyper active.

 

Mirazh, your last paragraph pretty much fits me to a T. I used to be awesome at multitasking, but now can't. and yeah, everything is just out in the open in piles, and even my computer is setup to have pretty much everything in the open. I've forgotten assignments that I've already done several time. The list thing, definitely me. Deadline comes, I'm in crunch mode, and get things done just in the nick of time. My nieces and nephews love me, and always want to come over to play games with Uncle Keith. My wife gets angry because she says she feels like she's my mother sometimes, due to messing things up. The variable performance part though, not so much. I can have multiple things on at once, but if I am reading a book, or watching a TV series, and start something else, I get wrapped up in the new thing and forget about what I was doing. I space out getting new games, or starting new books, for exactly this reason. I got the game Last of Us on Friday night, and played it that night, but then right afterwards I got a free copy of Saints Row from PS+, and haven't gone back to Last of Us. 

 

As far as the other issues, I guess I should say that my family does have history of having thyroid problems. My mom and my aunt both struggle with problems from their thyroids, and if I remember right, someone even had thyroid cancer (my family has had lots of various health issues, but at the same time many are very secretive about it. My grandfather on my mother's side had cancer, and people only found out after he had been in remission for several years because his wife let it slip at a family dinner).

 

Edit: I've thought more about what you guys said. The other thing that doesn't quite apply to me is the part about money. I've usually been pretty good about it, never really buying much, and traditionally bargain hunting when I do. Money is always set aside, bills are paid first, try to set aside what I can if there is any left over. But that may also because I never really had much money, and try to habitually be frugal. As far as the hyper focused tunnel vision, where it really hits me is with time. I'll start to do something, think a few minutes have passed, but it has been hours. When I am feeling antsy I do a lot of spontaneous action without putting a lot of thought into it, with just an idea of how it should be, and mess things up because how I thought it would be ends up being far different than reality. My wife will point it out to me, and say how it came across to her, and after that it seems obvious.

 

Also, you may be able to tell that sometimes I tend to go on and give too much information. Usually it isn't too bad, but it gets worse as I get the nervous feeling. With this, it seems that sometimes what should be a simple answer isn't, and I start adding to it to where it, as if I feel the need to explain it all. If I ramble on too much, I'm sorry, I'm just really wanting to get this under control. It seems like it has been worse lately.

Edited by Hellmark
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  • 4 weeks later...

Ok, just saw my PDoc this week, and he thinks that what I have isn't ADD since I didn't have the normal symptoms when I was a kid, and rather that they just manifested in my 20s. He also sees that anxiety has a large component to my issues.

 

He prescribed 0.5mg of lorazepam, and said to take 1-2 a day, play with the dosage, and try to find what works best for me. During this time I'm not to take the adderall. In 3 weeks, I'm to report back, and we'll find out what is going on.

 

Now, I have a few questions about this.

 

I know what my doctor said, but the prescription bottle says take 1-2 a day as needed, and my wife is saying that I shouldn't take it every day like I did with the Adderall because of that, and the chance of dependency. Should I be that worried about it?

 

Also, in this time I've been off Adderall, I've been feeling extra anxious. This hasn't been great, because my wife has been in and out of the hospital this week and last. I know that can make things worse, but last week when I was taking the Adderall I was much better about things. If I do not have ADD, then why would Adderall not react like it would for a normal non ADD person? For me, Adderall would typically either make me feel a bit calmer, or make me feel absolutely no difference, or somewhere in between. It didn't give me energy, or make me feel high or anything like that.

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This is a first person site, however you sound almost exactly like my DH.

 

My husband recently talked to his doctor about some of his symptoms, and he suggested he had to be ADD. She told him that it wasn't ADD at all because he did not have attention or concentration problems, and all of his "fidgetiness" was actually anxiety. His doctor, him, and I discussed what could really be happening and what could we do about it? After almost an hour and a half just talking each of us came to our realization of what it really was. Obsessive-Compulsive Disorder. He does not have ADHD at all, in matter of fact it is actually his obsessions & worries causing anxiety to make him feel like he couldn't focus or concentrate. As well, his compulsions that made him feel "in control", when he got interrupted he would get extremely angry and frustrated which looked like impulsiveness at times.

 

And in retrospect, your doctor is right. ADD is not onset in adulthood. AD/HD is more a neurodevelopmental-type disorder, which is with you when your brain starts to develop as an infant (which is why it is considered a "childhood" disorder); rather than an anxiety disorder (like OCD or GAD) which can manifest at any stage in life.

 

As well, a reason that Adderall might have helped a little is that it gave you energy that you probably needed due to the fact you use a lot of energy for "unnecessary" anxiety. As well, there could be a depression aspect to which is doing the same thing. The fact that it does not do anything at all at times, could be that maybe there is some attention-deficit symptoms that went unnoticed as a child. Or you could be like me, who is definitely "different brained" but to where you don't necessarily have ADD. And with that, caffeine makes you tired & stimulants don't do squat. Basically, I have no idea. Generally if you do not have ADD and you take stims you will get energy, however people are different. Some people have no ADD and don't do anything on stims. Some people have ADD and get energy or even hypomanic on stims. To be honest, it just happens.

 

PS Lorazapam is a Benzo, and yes usually it is addicting. The best thing to do however, is take it as prescribed. And if you find out you need less (or more) you talk with your doctor. If you take that as prescribed, you will not likely get addicted to it by the time you find out if it works. You may not like how it makes you feel & want less. If that is the case, that is fine. However it is important to listen to your doctor on medication issues. And if you (or your wife) are not comfortable with his primary dosage requirements, talk to him/her before you make up your own. These medications are made to change the chemicals in your brain, which means taking them can cause depression, anxiety, psychosis, and other symptoms. Your doctor knows your history and knows these medications, it would be wise to listen to him.

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For me, caffeine really has no effect. Energy drinks only taste nasty and don't do anything else.

For me I have spurts where my mind races and I jump between things, never able to focus. Large tasks can never be accomplished when I am this way. For instance, today I was working on the laundry, and she wanted me to finish the laundry and then clean the house while she napped. So I hit some snags with the dryer while doing laundry and it sets me off. I start doing stuff like tearing my truck apart looking for a fountain pen that I havent seen since she was in thr hospital the other day and a ton of randomness. When she wakes up 2 hours later, she is pissed because house hasnt been cleaned and the clothes still need to be put away. Plus, she says because the pdoc says I don't have ADD, that I am just lying about these freakouts (she's been saying that all week). I don't understand that because the pdoc said my problem wasn't ADD not that I don't have a problem.

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It sounds like anxiety to me still. Have you talked about anxiety to your pdoc? And your wife doesn't understand what you are going through it sounds like. And considering there hasn't been an *answer* yet, she probably doesn't think there is a problem.

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It sounds like anxiety to me still. Have you talked about anxiety to your pdoc? And your wife doesn't understand what you are going through it sounds like. And considering there hasn't been an *answer* yet, she probably doesn't think there is a problem.

She thinks there is a problem, but not a mental one. For me it is really frustrating, because I didn't use to have a problem with this.

 

I did talk to my pdoc about it, because I do definitely get antsy anxious feeling when I start losing it. Sunday, I started to get a mini panic attack, and threw up (not a full blown one, no loss of a consciousness, and wasn't the total disorientation when I have had them before). Today I had another one, Luckily i fell back into my chair at work.

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