I’ve been trying to figure out how to ask this for the past few days. I’m entering new territory and wonder if any of you can help me get oriented. The basic question is “What parts do the meds change? What parts are left over?” If I can find answers to those I may be able to find some way to work on the leftovers.

<background info> I was diagnosed a couple of years ago (at age 52 --- what an uplifting, buoyant time!). Since then I’ve read the standard shelf full of books and spent a lot of time with a therapist, less time with the doc who writes the prescriptions. I now understand what ADD is, and have been a having pretty darn amazing time rethinking my life. I made it to age 49 by using a lot of booze to both medicate my ADD and take myself to a place beyond frustration. Severe depression and a failing liver ended that run. I’m still on my first career and first family – stunned and grateful.

The principle components of my ADD are 1) general inability to focus; 2) inability to finish things once I see how I think they’ll end; 3) uncontrollable ability to hyperfocus on things that are usually peripheral, rarely on-task, 4) a bit of ODD – where I’ll do things any way BUT the way I’m asked; 5) inability to pick up the task that is most important – especially if it is more important to others than to me; 6) absolute slave to computer solitaire (it has taken me over an hour to write this much). Poor self-image follows along in due course. I’m light on the hyper/impulsive aspects. At least that’s what I think, others may disagree.
SO—the Adderall has made it so I can stay on task for several hours a day, several days a week. That is totally cool. In the years between alcohol and meds there were times when I’d go for weeks on end without being on-task. Thank god for email - at least it seemed like something was getting done.
</background info>


But I still can’t seem to choose the task I want to stay on. That’s the question – do the meds just improve my attention span, or do they help make it so I can choose what to attend to?? How do I get to the place where I can make promises to others with at least some hope that I’ll keep them?? I have yet to find in the books a clear description of what working meds actually DO.


Does this make any sense? Hoping it does, and thanks in advance……u

Umm well do you find that even though you don't fully apply your self but you are doing better then before the meds? Many people even non add people have trouble staying on task if they are not enjoying and are bored with thier task. Has it improved?

Oh yeah! The fact that I can maintain any concentration at all is new and wonderful. Sobriety, then ADD diagnosis, then the right meds, have each, individually, been giant steps. Each step has brought me to a new level, and each time I look around trying to get oriented. With sobriety it was "ok, I'm not going to die soon, I have a life to live". The diagnosis gave me "maybe I'm not just lazy and stupid". And the meds give "I can concentrate?" And the immediate next question is "do I get to choose what I concentrate on?".

I’ve been trying to figure out how to ask this for the past few days. I’m entering new territory and wonder if any of you can help me get oriented. The basic question is “What parts do the meds change? What parts are left over?” If I can find answers to those I may be able to find some way to work on the leftovers.

I have been thinking the same thing lately and have been trying to find something on line that tells what these meds do for you, the areas in which they help and/or not help. I guess for me right now I am still trying to get my meds sorted out, so far I'm not feeling much of anything, one day of superwoman and a sparkling clean house and after that....nothing. So I guess I am wondering what changes should I be noticing/watching for?

Sorry Ursus, that I don't have advice, but I'm glad you asked the question!:)

I think that's the order that a lot of people go through (minus the sobriety issues...although that can be quite common for many people with ADHD as well). Keep in mind that everyone else got to learn these lessons as they grew up, over several years, in a structured learning environment (school). We didn't get that...we technically were given the opportunity, but not the tools to use it at the time.

Meds do also help with giving you the ability to decide what to concentrate on, and that is every bit as important as the ability to concentrate itself. Prioritization is a major problem for people with ADHD, and research has hinted that the orbito-frontal complex, which is in one of the frontal-lobe areas that have been observed to be less active in ADHD people, may play a large role in prioritization and decision-making in non-ADHD people.

So meds can help activate this region, and they can give you the ability to choose what to focus on, which I think is sort of what you're asking, but they can't make the choices for you. In other words, meds aren't going to tell you which decision is the right decision, but they can give you the attention span and prioritization necessary to consider the options instead of just impulsively going with one or the other. That's ability.

What you're looking for is knowledge, or its cousing experience, those are a separate issue. The ability to make a decision carefully, or to prioritize a list of tasks, are useless without the knowledge and experience to guide you. Unfortunately, that's something that you'll probably have to build by yourself. So by now you can consider a number of possible tasks and pick between them, whereas before you would just do whatever was immediately in front of you, but you'll still need guidance in what ought to be most important.

The best thing that I can suggest is just listening, reading, learning. If you were like me, you probably had dozens of well-meaning but clueless people try to teach you different organizational systems or habits, or try to explain to you why it was important to do X before Y, and none of it worked before. Consider going back over some of that stuff again, because you might be able to use it now. Remember that a lot of the organizational tricks that they try (and fail) to teach us do work quite well for normal individuals. That's part of what differentiates ADHD from just general absent-mindedness and disorganization, the fact that no amount of effort can change it, whereas most normal people who are a bit disorganized can easily learn organizational skills.

What I started on was household tasks. I used simple mundane chores (which I hadn't really been able to do without meds), as practice for prioritizing and figuring out what to focus on. So I'd try cleaning up my room and using that to practice the skills of figuring out whether to focus on the laundry or the bookshelves or the electronics, for instance. I'd experiment with doing the tasks in different orders and in figuring out which order made the most sense in terms of time or effectiveness, and try to focus on things in that order. Then I'd try to apply those skills from that setting to other areas, now that I had some idea of the thought process that I'd need to go through.

Does that help at all? I've recently been going through some med issues due to my insurance company's choice to only employ people on the left end of the bell curve, so I've been having my attention span swing back and forth from "medical professional" to "goldfish" fairly regularly these past few weeks, and it's brought back a lot of memories of the stuff I had to go through back when I was diagnosed.

Oh, the other thing I've found is that these new abilities are just that: new abilities. New abilities require practice and training. Nobody picks up a basketball and immediately has a jump shot like Michael Jordan or Kobe Bryant. Nobody starts training in martial arts and immediately has kicks like Crocop or Jet Li. Practice is necessary to become better with these abilities, and unfortunately the rest of the world has had a helluva head start on us.

That's part of what I meant about the school thing. In school, while we were all wistfully staring out at the playground or trying to figure out how many boxes of chalk the teacher must go through in a year, the other kids in the class were actually practicing all of these skills, they just didn't know it at the time. All of that busy work that most of us would either forget to do or just lose in the black hole that was our backpacks was for the purpose of building these skills. Most people learn these things by adolescence, while many of us are just beginning to figure them out in adulthood with medication.

One of the things with this insurance fiasco is that I had to go from my steady 24hr cycle of Adderall XR into using IR tabs every few hours with one XR dose at night. This wound up breaking up my cognitive functioning, so I didn't have a steady stream of concentration, and I noticed that this made things more difficult. The meds were still helpful, but it was harder when I was only functioning part of the time. I stopped being able to carry thoughts or organization or acheivements from one portion of the day to the next...I wasn't able to keep "practicing" in other words, and I stalled.

I'm not saying that people should necessarily take meds around the clock, everyone is different, but what I'm saying is that you should definitely take your meds as prescribed and try to make sure not to miss doses. Think of the time on meds as "practice" time, it is very valuable experience, and the more time you can spend practicing those abilities, the better you will become at using them.

I think that's the order that a lot of people go through (minus the sobriety issues...although that can be quite common for many people with ADHD as well). Keep in mind that everyone else got to learn these lessons as they grew up, over several years, in a structured learning environment (school). We didn't get that...we technically were given the opportunity, but not the tools to use it at the time.

Meds do also help with giving you the ability to decide what to concentrate on, and that is every bit as important as the ability to concentrate itself. Prioritization is a major problem for people with ADHD, and research has hinted that the orbito-frontal complex, which is in one of the frontal-lobe areas that have been observed to be less active in ADHD people, may play a large role in prioritization and decision-making in non-ADHD people.

So meds can help activate this region, and they can give you the ability to choose what to focus on, which I think is sort of what you're asking, but they can't make the choices for you. In other words, meds aren't going to tell you which decision is the right decision, but they can give you the attention span and prioritization necessary to consider the options instead of just impulsively going with one or the other. That's ability.

What you're looking for is knowledge, or its cousing experience, those are a separate issue. The ability to make a decision carefully, or to prioritize a list of tasks, are useless without the knowledge and experience to guide you. Unfortunately, that's something that you'll probably have to build by yourself. So by now you can consider a number of possible tasks and pick between them, whereas before you would just do whatever was immediately in front of you, but you'll still need guidance in what ought to be most important.

The best thing that I can suggest is just listening, reading, learning. If you were like me, you probably had dozens of well-meaning but clueless people try to teach you different organizational systems or habits, or try to explain to you why it was important to do X before Y, and none of it worked before. Consider going back over some of that stuff again, because you might be able to use it now. Remember that a lot of the organizational tricks that they try (and fail) to teach us do work quite well for normal individuals. That's part of what differentiates ADHD from just general absent-mindedness and disorganization, the fact that no amount of effort can change it, whereas most normal people who are a bit disorganized can easily learn organizational skills.

What I started on was household tasks. I used simple mundane chores (which I hadn't really been able to do without meds), as practice for prioritizing and figuring out what to focus on. So I'd try cleaning up my room and using that to practice the skills of figuring out whether to focus on the laundry or the bookshelves or the electronics, for instance. I'd experiment with doing the tasks in different orders and in figuring out which order made the most sense in terms of time or effectiveness, and try to focus on things in that order. Then I'd try to apply those skills from that setting to other areas, now that I had some idea of the thought process that I'd need to go through.

Does that help at all? I've recently been going through some med issues due to my insurance company's choice to only employ people on the left end of the bell curve, so I've been having my attention span swing back and forth from "medical professional" to "goldfish" fairly regularly these past few weeks, and it's brought back a lot of memories of the stuff I had to go through back when I was diagnosed.
Excellent, excellent points Hyperion! What you wrote makes complete sense. Medication can be a great catalyst, but it can also be overwhelming to be suddenly able to harness your abilities in ways you hadn't been able to for most of your life. That comes with time and, as Hyperion said, with learning more about yourself and what methods work best for you. This is, in a way, like getting a car, when all along, you've had to walk to work. Your transportation is much easier now (and more in your control), but you still have to do the work to utilize the tools AND do the work.

Hyperion - thanks for the reply. I'm also hoping that as I get used to being able to focus I'll not be quite so panicky about pouncing on something, anything, to do out of the huge backlog of things I've started or promised. I have something that is top-dead-center right now. On Wednesday I'll get on the plane and fly to a meeting and confess that I have done virtually nothing of the task I promised the group I'd take on last Feb. For the past couple of weeks I've gone to work every day thinking "this is the day, I won't do anything else, not even email, until i've put at least a couple hours in and gotten one sub-subtask done." Then as soon as I sit down I'm off and running on something else which is of a lower priority - great progress on that other project though!.

My first visit to the psych I took in some magnets and held them N to N - tried to push them together and they just slid off sideways. I said "this is my brain, I know what I want to do, I know I can do it and like to do it and am good at it, but I just can't force myself to connect". At least she laughed.

So, I'm off to practice chosing what I connect to. Yes, I know some techniques (breaking out subtasks) that should be more useful now that I don't just loose the project outline.

Is there a place that I can read about that orbito-frontal complex research you mentioned? --u

Medication is helpful but it doesn't teach new skills. We can sometimes learn them on our own with the help of books and other resources. Quite often hiring different types of professionals like an organizer or a coach can also support us in learning skills that work for each of us.

Medication won't magically help us to learn to how to prioritize or how to manage time better. We either have to learn these things on our own or learn from somebody with expertise in these areas.

Tara -- What you say rings true. I went to a day-long class by Bill Dodson a while ago and he kept chanting "pills don't give skills". But his presentation really focused on what ADD was, then the meds. Nevertheless, several of us kept looking at each other wondering if he was going to get into the skills part. I live in a place without CHADD, and, as far as I can tell, without anyone who does anything close to what you do (I checked your blog etc.) That's why I'm excited to have found these forums. This is the biggest support group I have access to. That's a BIG thank you for your time, and the time of all the other folks who take the time to answer questions from us newbies. There is LOTS of expertise and experience being shared here, and I am deeply appreciative.

You already have a basic understanding of ADD, and seem to have a grasp of how ADD effects you as a person and you even know what it is you want to change, this is impressive.

I think what you are looking for is some one to help you prioritize and set goals better. If you have the finical resources it is my opinion that you are someone who may benefit from a coach. Coaches do not set priorities for you but they do help you set your own and are a source for accountability. I know for my self I do much better if I have a time frame and an accountability factor. With out the presence of a both time limit and accountability what ever it is won't happen,in this space time continuum that is just the way I am.

The time frame gives me a point of reference as to when accountability gives me the reason to actually get said project done.

This project that have eluded you so far, could it be your office or work environment is distracting?

The anxiety fear freezing factor?

Honestly why haven't you done this project?

You do not have to give me the answer but giving your self an honest answer may open up a an oppertunity for a change that will help you get started again.

Oh and one more thing, meds may give us the ability to control our focus how ever there are those things we must simply "make" our selves do.

Ursus,

I can place myself in your shoes regarding the task not started.

There would be a number of reasons why I would not have started the task. First, there is plenty of time left to get it done. Second, other items of some importance crop up and I elect to get them out of the way. It seems like I almost want to wait for the deadline pressure to come. When I finally decide to start the task, I either can finish it or become paralyzed. If the task is problem solving I can easially hyperfocus and pull it off (as i did so many times in programming classes in college). But, if the task involves "organizational thought", the realization might come that I cannot do it in the time left - then the anxiety comes on and prevents me from doing the task...

So, Here is what I do:

Find a place with no distractions, Put in ear plugs, turn off cell phones, email applications (outlook), and anything else that can bother me. Let people know that i need quiet time to focus, and then go sit and start thinking about the task. Sometimes my thoughts distract me away, some times the negative thoughts distract me from the task. But, in the quiet space, because, there are less distractions, I can address them fairly quickly and refocus on the task at hand.

In the quiet space, if the anxiety does not go away, I take 1/2 pill of lorazapram and take a 5-10 minute settling walk, trying to understand the anxiety and reconvince/remind myself that to accept whatever comes my way.
In your case, you may have to say you don't have much to offer - after more than enough time to prepare/execute.
After you have accepted what the consequences would be (you may find distracting thoughts causing you to regress), offer yourself the opportuinity to think or realize or decide that whatever you do now will make those consequences turn out for the better.

Just my two cents...

Wow, great thread. I can sympathize with the inability to get started with tasks, especially at work, but my reason seems to be all the things I have to do are Boring, with a capital B. I try to tell myself, just get started, boring or not it is paying the bills, but I can't. Boredom is a pandora's box for me.

But what is not boring for me? That is the question I ask myself constantly. About to loose another job because of it. I understand everyone, but especially those with ADD, need to do what you love. Not that I know what I love to do, but it won't meet the current problem of paying the bills.

Might be a subject for a different thread, but I believe boredom is a factor in starting tasks, following throught to completion and then sitting back and being prouf of what you have accomplished. Can't do that if I don't like what I am doing.

NJTrout

I'm 46 and started meds a couple of years ago. They helped a lot in some areas, but organization and procrastination were still huge problems for me. Recently I've been working through a book (not very long at all) called Mastering Your Adult ADHD by Steven Safren, etc. It is research based and the folks who went through it experienced a 50% reduction in symptoms over those who took only meds. They recommend going through it with a therapist, but I'm doing it on my own and experiencing good results. Things are short and to the point and designed with ADDers weaknesses and distractibility in mind.

As to what medication changed for me: I was a much better listener, I was better at remembering what I was doing at the moment, I was better at keeping the disarray somewhat at bay, I was better at reading and remembering what I read, I didn't lose things as often, and I had better control of my emotions. The things that were still weak were organizing, procrastination, anxiety (although it was somewhat improved), prioritizing, planning ahead, etc.

Hope things go well for you!


Take care!
Scattered

The meds will help you focus and stay on task, but I don't think they help you with choosing the task. I have found it helpful to create a list at the beginning of the day or week. I always know which ones are the most important, whether I chose to do them or not! Color sort files with red being the most important and keep that file with you. I took a time management course offered by the state for my job and I found that to be VERY helpful. I also took an organization class. They have helped me a lot.

With out the presence of a both time limit and accountability what ever it is won't happen,
Ahah! And if I don't acknowledge that importance (esp to other people) is a legitimate way to set time limits then I really have a problem. Instead what motivates is interest, challenge, novelty. The only deadlines I can reliably meet are those that involve standing up in front of a couple of hundred people I respect, but don't know, and explaining what I've been doing for the past year -- but it's always a last minute panic getting ready. And I've ended up in a work situation where accountability is pretty diffuse - a blessing and a curse.

So the question evolves to "how do I manufacture hard deadlines?".

You mention an ADD coach - I've not heard of such a thing in this town. I'll dig around more though. thanks...

Ahah! And if I don't acknowledge that importance (esp to other people) is a legitimate way to set time limits then I really have a problem. Instead what motivates is interest, challenge, novelty. The only deadlines I can reliably meet are those that involve standing up in front of a couple of hundred people I respect, but don't know, and explaining what I've been doing for the past year -- but it's always a last minute panic getting ready. And I've ended up in a work situation where accountability is pretty diffuse - a blessing and a curse.

So the question evolves to "how do I manufacture hard deadlines?".

You mention an ADD coach - I've not heard of such a thing in this town. I'll dig around more though. thanks...
Hi Ursus,
Some ADD/ADHD coaches will work with you via the phone, if you are unable to find one locally.

Mastering Your Adult ADHD by Steven Safren, Scattered
Scattered - !. I've just started a formal Cognitive Behavioral Therapy process with a therapist I really trust, and who is trained in CBT, but isn't an ADD specialist, so hadn't seen them. I gave her these books. I'll let you know if she works them into the program. I was there when she leafed through them, exclaiming "this is the stuff!"

I'll report back - at least I intend to report back.......

So the question evolves to "how do I manufacture hard deadlines?".

What I've tried to do with work related items is set a date a day before it is actually due. Now the ADD procrastinator in me can look at that day as a last minute buffer or I can honestly try to get it done the day earlier and have an extra day buffer to finish the details if needed.

I've also limited my to-do list to only a few items that have close deadlines.

NJTrout

Scattered - !. I've just started a formal Cognitive Behavioral Therapy process with a therapist I really trust, and who is trained in CBT, but isn't an ADD specialist, so hadn't seen them. I gave her these books. I'll let you know if she works them into the program. I was there when she leafed through them, exclaiming "this is the stuff!"

I'll report back - at least I intend to report back.......I'll be interested in knowing how it goes!

I don't if you need a Cognitive Behavioral Therapist and a Coach, but when you're done with therapy a coach might be useful. A couple of sources for coaches are: www.addconsults.com (http://www.addconsults.com); www.addcoaching.com (http://www.addcoaching.com); and www.nancyratey.com (http://www.nancyratey.com).

If you'd like me to e-mail her the overhead slides from the workshop I attended on "Using Cognitive Behavioral Therapy with ADHD Individuals" from the ADDA conference, I'd be happy to. The instructor e-mailed them to me and is mostly interested in getting the information out there. PM me if you're interested.

Scattered

S--

Coaching. I didn't know much about it. I've checked those sites and understand a whole lot more than I did. That's the progress for this weekend!!!

thanks! - and I sent you a message about the slides as well.

--u

Boredom is a Pandora’s box for me

Correct, Accurate description of ADD (http://www.addforums.com/forums/showpost.php?p=337125&postcount=9)





Might be a subject for a different thread, but I believe boredom is a factor in starting tasks, following through to completion and then sitting back and being proud of what you have accomplished. Can't do that if I don't like what I am doing.

Under arousal seeks arousal (http://www.addforums.com/forums/showpost.php?p=351683&postcount=15)

Meade,

The definition you link to states in part:

...mixed with your individual personality and experiences via the environment...

The possible variations of ones life in terms of the above definition is endless. It is like fighting gravity, pulling you down spiral pathway to a bottomless pit.

Did I just say that :)

NJTrout

Really excellent thread, just what has been on my mind & really informative. What a great point that ADD'ers often haven't learned the same skills everyone else did, and skills don't happen overnight.

Every time my task plans break down I have to go back and figure out what went wrong. Learning about hyperfocus and transition time, overwhelm, distractability etc. has been a life-saver. Just to know the words---how can you build the skills you need if you don't even have the words to identify to yourself or discuss what went wrong?

But I'm still missing some of the words... have to read some more books :)

Here's what I want: a list of ADD pitfalls and facets. That way I could just go down the list until I hit the one that fits.... like
hyperfocus
prioritizing difficulty
overwhelm
distracted by environment
distracted by thoughts
transition difficulty
Inaccurate time estimates
forgetful
?
?
Does such a list exist? I need to fill in the blanks, 'cuz in most areas I know what skills I'm working on but in some I just don't know what I'm looking at or what it's called. This isn't just to figure out what went wrong, but I also want to be able to set goals and measure progress, go back thru the list occasionally and be able to see where I've progressed and when I need the encouragement. Scattered, I'm on the same path as you on this, working thru the household stuff....glad to know someone else has been here!

The other question....I know neuropsychs and coaches can help each person to determine their strengths and weaknesses, get more exact on how well a person's working memory or time awareness is working... Are there any tests or lessons on the internet that would help a person isolate and study their own particular facets of ADD in this way? Not just that 'yes, I have difficulty with my working memory', but a way to measure or describe working memory or other ADD-affected skills.

Does such a list exist? I need to fill in the blanks, 'cuz in most areas I know what skills I'm working on but in some I just don't know what I'm looking at or what it's called.
... Are there any tests or lessons on the internet that would help a person isolate and study their own particular facets of ADD in this way? Not just that 'yes, I have difficulty with my working memory', but a way to measure or describe working memory or other ADD-affected skills.

Maybe you will find this paper useful:
Attention-deficit disorder (attention-deficit/hyperactivity disorder without hyperactivity): A neurobiologically and behaviorally distinct disorder from attention-deficit/hyperactivity disorder (with hyperactivity) (http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1474811)
Look for the section "Children With ADD, Like Adult Dysexecutive Syndrome Patients, Have a Primary Deficit in Working Memory"

Maybe you will find this paper useful:
Attention-deficit disorder (attention-deficit/hyperactivity disorder without hyperactivity): A neurobiologically and behaviorally distinct disorder from attention-deficit/hyperactivity disorder (with hyperactivity) (http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1474811)
This is a cool paper - thank for the tip. It really reinforced the notion that ADD and ADHD are really fundamentally different beasts. More than just flavors - or "types" of a single condition. Bringing together brain function, different med types/responses, etc. I imagine that within this kind of literature there is debate and disagreement about the assertions made here.

Personal victory-though. I actually read the thing all the way through (!!!!). Even though there are long sentences and not very many pictures. And even though that inline reference style makes tripping spots in almost every sentence. Before the meds that would been flat-out impossible. (whoopeeeee)

Maybe you will find this paper useful:
Attention-deficit disorder (attention-deficit/hyperactivity disorder without hyperactivity): A neurobiologically and behaviorally distinct disorder from attention-deficit/hyperactivity disorder (with hyperactivity) (http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1474811)
Look for the section "Children With ADD, Like Adult Dysexecutive Syndrome Patients, Have a Primary Deficit in Working Memory"What a great paper, and I've only glanced at it.

Scientific results that actually use the word "boredom". I am at my wits end to help my wife understand that my job performance is due to ADD "boredom". Now I have it in writing.

Thanks,
NJTrout

I'll quickly reply now cause I'm on my way out the door, but I'm right there with you! I was just diagnosed in the summer and the difference my medication made to my life.. unbelievable!! Suddenly, I could concentrate on things that would just wipe me out after only a few minutes.

Anyway, lately I've been finding myself procrastinating or spinning my wheels as I call it when I was writing my papers..

meds are only the first step. There's a lot more left!