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Adult Diagnosis & Treatment This forum is for the discussion of issues related to the diagnosis of AD/HD

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Old 01-28-13, 10:36 PM
tommo_66 tommo_66 is offline
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History and finding proper diagnosis

Hi

This is more for those who are ADHD-PI or at least familiar with it. Hyperactive ADHDers will probably get it intellectually but not "get" this in terms of their experience, since it is pretty different.

I wonder if anyone would have any thoughts on the following:

I have not been officially diagnosed with ADHD-PI by a psychiatrist, though I have strongly suspected this for years. A medical doctor had me fill a questionaire once (after the events described below) and prescribed wellbutrin based on a highly positive result from that (as well as celexa for anxiety). It has been ten years though since I have been on medication for that, or for anxiety or OCD.

I was indeed diagnosed with Anxiety Disorder and OCD in the mid 1990s. At that time the clinician doing the diagnosis did not think ADD was in question and cited my lack of trouble with the law and that type of thing. He said that there is an ADD without hyperactivity but seemed to dismiss that as something rare. Given what he said and the fact that at that time ADD without hyperactivity was viewed as more of a "girl thing" I have had the impression that he was just pretty "old school" about the matter and have continued to suspect that I wasn't nuts for thinking ADD (although the OCD and anxiety were certainly made perfect sense as well). Partly too, I think the obviousness of the anxiety and history of OCD "stole the show" as well, though it was a relatively mild case of it, especially by then. (This clinician made his assessment of my situation based on a letter I sent in advance - I had to travel hundreds of miles from where I lived at the time for the eval - and a little interviewing with me, though mainly about the contents of that letter.)

I tried to be a good patient for a good while, and buy the line that there was no ADD, but it was all anxiety and OCD, that they were enough to explain everything. I began to think I could make a case for it, kinda sorta maybe... but push come to shove it has never rung true for me.

This is what I really suspect the deal has been: I have had ADHD - PI with Sluggish Cognitive Tempo from childhood on. My belief is that after some years of dealing with all the crap that came with it, I developed anxiety and OCD in compensation. I was constantly called slow and "old man" (my mother liked to make that type of comparison in attempts to shame me into moving faster as I went about daily activity) as a child and teenager, both because of physical movement and because I had a very "serious" disposition. I was very much the classic "space cadet", and said to be in my "own world" a lot. I was withdrawn, known as "shy", and often outcast as a result of lacking physical coordination and prowess in sports (putting it kindly).

Bad grades were common in early years (in first grade I was constantly having my ears pulled by the teacher who was always yelling at me to "pay attention", after that other teachers were kinder, but the theme continued...and I had big trouble getting homework done...it was BORING and I didn't get the math), followed by a transition from 5th to 8th grades where I went up and managed to finish well in high school. I had to struggle for those good grades though, and I was typically among the last to hand in tests. In the one year of college following high school I did well but struggled time-wise and squeezed by in labs. I remember one lab instructor 'against his better judgment' allowing me to take a piece of minor equipment with me and return it later so I could finish a lab project which should have been completed within the alotted time. While I ultimately got the abstract mathematical concepts and did well in the algebra, trig, and calculus type classes, I am to this day not good at calculating, especially in my head. I have to use paper and pen for calculations most people routinely work out while looking up with their eyes for a moment.

Later when I went to work I would get a lot of down marks on evaluations for slow speed and it was once remarked to me "You're not lazy, but you have this pace..." basically it was another "speed up" message.

I always needed plenty of sleep, more than other people, and have tended to guard my rest, relaxation, and alone time carefully, at times being thought of as selfish and non-self-sacrificing by others for doing so. It was always my feeling that they didn't understand what it was like when I didn't get my rest. Indeed it can be bad. If I don't get my sleep, it really affects me. When I drive I hit curbing, and when I worked jobs with less down time than I have now, I was often prone to "jelly legs" if I did not get my rest.

Now I am back in school... 6 credits at a time while working full-time at night. It's media-related stuff, and while I have a creative enough mind, there are also many aspects to that industry that require heavy lifting from things that are my perennial weaknesses (I learned early on that cinematography would not be my thing...it is the ABSOLUTE KISS OF DEATH for one of those guys to EVER be called "slow," the very thing I've been called about nearly everything all my life).

It has occurred to me that I should revisit this issue. I can talk to my regular Dr. again about newer stuff and see if anything seems more promising. I've been leery of the idea of using stimulant meds because of the anxiety but obviously don't need to be sleepy all the time either. A tendency toward lethargy and difficulty motivating is already hard enough to deal with.

I wonder where I can get a proper diagnosis from clinicians who are familiar with the latest diagnostic techniques and who will not be too old school or attention-captured by the OCD history to consider all the possibilities. I really do think that was a problem I ran into before.
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Old 01-29-13, 06:06 AM
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Re: History and finding proper diagnosis

Well I am adhd-c so I dont know if my opinion matters but here goes... as far as I understand it, adhd-PI and SCT are 2 separate disorders. I didnt think that SCT was official recognized beyond theory but I could be wrong. As far as the doctors youve seen goes, it doesnt sound like they were the least bit competent in diagnosing adhd or understanding it. There is no ADD anymore, its adhd and a certain subtype. Having good or bad grades doesnt remove you from the possibility of having adhd nor does inteligence. Physical hyperactivity doesnt always happen for adults with the "H" in their adhd it can be just as much mental. I would consider finding a specialist or qualified psychiatrist to evaluate you properly. I wouldnt wate my time with a doctor that completely wrote of adhd as if it was impossible, I would get to the bottom of it. It could be many things contributing to your issues but starting out with a knowledgable doctor is the best start.
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Old 01-29-13, 10:49 AM
tommo_66 tommo_66 is offline
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Re: History and finding proper diagnosis

I'm sorry if I came across as insulting. Of course all comments count, I just wanted to specifically see if anyone who may have had experiences symptomatically more similar to my own would have thoughts on it. This is a field full of advice for the hyperactive but not so much for those experiencing what often seems like almost the opposite.

Anyway it has been over 15 years since that eval and I live in a large city now, so it may be worth revisiting.

The separateness of SCT and ADHD-I (maybe the term I should have been using instead of PI? It's all confusing at times) is still being sorted out, they may well be 2 distinct disorders. SCT is a researcher-generated term and not in the DSM currently. Until it's sorted out, what is called SCT will probably more often than not continue to be lumped into the ADHD "specrum" or at least viewed as a common comorbidity with ADHD-I. The DSM V is supposed to change things up again but from what I understand it's likely to be one of those compromises made to satisfy elements of opposing camps of thought and will do little to clear confusion. The matter will likely have to be revisited in earnest yet again down the road (what I heard in a lecture up on youtube - by an advocate of SCT as a separate disorder in fact - was that in the DSM V, ADHD will no longer be split up, but will be a single disorder, which will be said to have different "presentations": there will no more be ADHD-I, ADHD-C, etc., it will all be ADHD, but will "present" with this or with that).

Like many people I sometimes spit out the old term ADD when touching on a thing. This may not have been his exact term even then (the mid 90s).

What it may come down to for me is: should the anxiety and OCD be viewed more as comorbidities, or more as contraindications? A lot of stuff I have read talks about anxiety being common with ADHD-I and SCT (OCD is an anxiety disorder so I doubt it contradicts that either).

It would be good to get to the bottom of it at last. If nothing else it would bring some context to the whole experience.
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