ADHD Part 3 – Managing

ADHD (Attention Deficit Hyperactivity Disorder) is a complex condition that affects how you focus, behave, feel and interact with people. Realising that you have the condition allows you to begin making intelligent adjustments to your variant.

Part 1 – Defining ADHD [Link]

Part 2 – Experiencing ADHD [Link]

Managing ADHD

There are two primary methods to manage ADHD, and it recommended to use both where relevant and possible.

Therapy

CBT and DBT are the better methods to manage ADHD from a therapy and egocentric perspective. That is, with some suitable help, the person who meets the criteria for ADHD can learn to manage the symptoms that earn the label.

CBT

CBT (or Cognitive Behavioural Therapy) is a method for identifying specific problems and countering them with specific solutions. This looks at identifying the problematic behaviour and or thought process and developing a specific skill to address this which changes the behaviour or thought process. The advantage of this method is that it address unique presentations and develops unique solutions to meet the variance of the client. That is, it doesn’t give you a one solutions fits all, but it may take advantage of known useful tools.

DBT

DBT (Dialectical Behaviour Therapy) was initially developed to treat BPD (Borderline Personality Disorder) in a specific course like way. The course happens to also be very useful for learning to regulate mood dysregulation (a common experience for people diagnosed with ADHD) and social interpersonal skills (another common experience). While specific parts of the DBT modules can be used in isolation
(DBT informed therapy/therapist), most people gain the most use by doing the entire course in a group (may not be compatible for all people).

Advantage and Disadvantage of Therapy

Therapy is useful for addressing expected or identifiable skill deficits, giving power of control back to the individual who is often experiencing a chaotic life due to a lack of, or poor use of, life and self management skills. The problem often comes in with a basic aspect of the disorder itself – difficulties concentrating, difficulties sticking to a task and frequently learning disabilities. It is hard to learn any skill with this interference.

Medication

Medication is often used to help manage a major component of ADHD – task prioritisation. Given the hyperactive nature of ADHD, it seems odd to prescribe a stimulant. The brain is a wonderful and complex organism. While the specific parts that affect all people with ADHD are likely to be different, some common differences are found in the insula and the anterior cingulate cortex. The insula is often attributed to mood regulation and the anterior cingulate cortex is often attributed to attention. Both of these are frequently found to be smaller in people diagnosed with ADHD (more research required). It has been found that certain stimulants boost the abilities of these parts of the brain, compensating for their underperformance. That is, the underperformance of these two parts of the brain means the patient is likely to find their mood and attention span poorly self controlled; stimulating these parts increases the patient’s ability to self regulate, decreasing the most problematic symptoms.

(Reduced insular volume in attention deficit hyperactivity disorder [Link] and Anterior insula hyperactivation in ADHD when faced with distracting negative stimuli [Link])

If all brain scans had shown an equal problem with all people fitting the diagnostic criteria, this would be known as a neurological condition and the question would only be “how much of this one medication to prescribe?” Each brain scanned is a bit different, and not all people that fit the diagnostic criteria that were scanned have the same regions undersized. This means that medication is not going to work for all people who fit the diagnostic criteria, nor will the one type of stimulant match all peoples needs.

As such, a range of different medications have been found to be differently effective depending on the specifics of the individual person.

A very common co-occurrence of ADHD is drug addiction. Stimulants such as caffeine (coffee/tea/energy drinks), amphetamines (dexies, speed, meth amphetamines, ice) and nicotine are often used to help increase focus, while sedatives such as alcohol and diazepine are used to calm down from being hyper, and psychoactive drugs such as THC and LSD are often used to create an alternative state of mind that is easier to manage. Each of these are often used in conjunction to just self manage an undiagnosed condition.

Someone with undiagnosed adult ADHD who has a co-occuring Substance Use Disorder (SUD) will frequently struggle to be given a prescription for ADHD medication as it is either easy to dismiss the person as drug seeking (which ignores how easy it is to get illicit drugs compared to prescription), or difficult to manage due to the patient often continuing to take illicit substances. In Australia, psychiatrists are the health professionals who must diagnose and prescribe ADHD and ADHD medication. It is not uncommon for the patient to have to “go clean” prior to receiving necessary medication to manage their symptoms, which is incredibly hard; or to get frequent drug tests to ensure compliance with medication in the absence of illicit drugs.

(Treatment Strategies for Co-Occurring ADHD and Substance Use Disorders [Link])

Advantage and Disadvantage of Medication

Medication doesn’t work for all people diagnosed with ADHD, and when it does, it doesn’t always work equally. Going through various medication trials can seem daunting and frustrating as your body adjusts and adapts to the medication. Some people find medication as a gateway to illicit substances, however most people with undiagnosed ADHD have already attempted to moderate their experience via illicit substances, so this is a bit of a chicken and the egg fable – for those who are compliant with their prescription, this doesn’t seem to be an issue. Using medication to feel better and function better can have an existential query of “Who am I really? The person on medication, or the person off it?” or stigma questions such as “why does society only treat me alright when I am on the medication, but then blame me for taking medication to be ok?”

An advantage of medication is that when it works, even partially, it makes a profound different to your experience. It can be the launching pad for effective therapy, it can quiet the more destructive impulsiveness and it can allow you to focus enough to earn a degree, get a job and have good relationships with people.

BOTH Medication and Therapy

The best results often come when a person uses both approaches – medication and therapy. A person experiencing ADHD is likely to struggled to be able to focus and retain the information and drive to take in the therapy that upskills ADHD management without medication, while someone who takes medication now has that capacity to upskill, but doesn’t have a good mentor and guide to learn what skills are actually useful.

A good combination of both medication and therapy addresses these issues and gets the best results.

ADHD Part 2 – Real life experience

Understanding ADHD

ADHD (Attention Deficit Hyperactivity Disorder) is a condition that many people experience, even if it is undiagnosed. It can often be mistaken for anxiety and depression, behavioural problems, autism or cognitive impairment. Most write ups fail to describe what the condition is actually like, only citing medical criteria.

Below are some views from people who have been given the diagnosis of ADHD.

Part 1 – Defining ADHD [Link]

Part 3 – Managing ADHD [Link]

From the Inside

— S

Sometimes I would hyperfocus – do a thing obsessively until it was done. That hyperfocus is the reason I never thought I was [ADHD]. It helps to drown out the “noise” when there’s too much to think about or it’s too overwhelming. Prioritising can be challenging too. This is why I end up with mount foldmore [laundry].

I described it as my brain is like a pinball machine. I cannot type or speak as fast as my brain and that is frustrating for me. I’m constantly flitting from one thing to another, when I walk into one room to do xyz I see something else and get distracted by that. This results in many unfinished chores/projects. I particularly find it difficult to finish tasks I find boring, though I can obsess over tasks I find interesting. This makes life balance difficult.

It can waste a lot of time being so easily distracted. I used to wonder wtf was wrong with me. Everyone else can do it, why can’t I? I’m educated, intelligent, capable. The tasks are not difficult tasks. It can be incredibly frustrating.

Quite often I cannot get from one end of the sentence to the other. I will go off on tangents, at some point realise I’m rambling, then ask what the original point/question was. I am sometimes perceived as being rude because when someone says something I want to react, and can butt in before they are finished speaking. I’m not trying to be rude or not listen, I am just enthusiastic and if I don’t spit it out then and there I will get distracted and forget it. I forget things nearly every time I go to the shops. If it’s not put in my diary immediately I will forget it. It feels like most people live slower than me. They have a relaxed demeanour and an ability to finish tasks that I don’t understand. I don’t and can’t sit down and relax. That makes me anxious. I need to do SOMETHING, anything. I prefer written text over spoken word because I am able to review what I have said first.

Hammy from over the hedge on red bull is a very good representation of how I mostly feel. Meds help, a lot. They also illustrate my differences as I notice when they wear off. I’ve asked others for outside perspective and they said that’s just how I always was. It was only once I started my meds that I realised just how much different I am. That took some processing and support from very good friends.

Scattered, or as my friends and I call it, “squirrel”, is not an occasional thing – it’s every moment of every day. Have you ever walked into a room and wondered why you came in there? I do that ALL the time. Whereas others may remember after a moment, I have to backtrack to where I was to remember. Or more often than not I see something else and get distracted doing that. Until I walk back into the other room, see what it was that prompted me to go looking for something and go back to get/do it.

I have strategies in place to help. Like my keys go here, my phone goes there. I don’t have to remember where I put them because they have a specific place. I write lists. Appointments go in my diary. If they aren’t in there with reminders then I will forget. 

On meds I slow down. It’s not that I do things slower, though I do talk slower. It’s that I’m able to stay on task and stay focused. I can finish a sentence without getting distracted. For those that know me it’s very obvious when I have skipped, or when they wear off. Mine wear off about 6pm. If you are here with me from before that I’ll be talking normally, then over about half an hour I go to 1 million miles an hour. When I realise (usually when someone says something) sure enough I check the time and it’s between 6-6:30pm.

Hammy from the film Over the Hedge, just after drinking the energy drink, the world seems to freeze as tiem for Hammy

— M

As someone without medication, 3-5 thoughts a second, can’t focus on a single thing, forgetting where you put something 5 seconds ago walking into a room, “what am i doing in here”

— T
About a decade ago I was “diagnosed” by a GP with anxiety +/- depression. Recently I was re-diagnosed with ADHD and I am using medication for it. My psychiatrist thinks that the anxiety is mainly a result of coping with unmedicated ADHD. I’m inclined to agree with her as I’m now fairly stable on long acting dex and have been able to come off SSRIs [anxiety/depression medication].

I’m a good example of how inattentive type can easily be missed, especially in girls. I’ve never been overly physically hyperactive (but I am mentally and sometimes verbally). I’m still unpicking how much camouflaging I’ve had to learn in order to function and realising the emotional costs of that.

Some interesting things for me have been:

  • learning about hyperfocus and how it relates to inattention. It’s really the adhd superpower and most people don’t know about it. It helps to account for my awesome research skills but has drawbacks for interpersonal relationships.
  • the flip side of that is the intense antipathy I feel to things that don’t interest me. Housework is almost physically painful at times. I never realised how abnormal this degree of dislike of tedious tasks is.
  • rejection sensitive dysphoria is really really horrible. I’ve mostly learned to make friends (this took an active effort to change myself in my early teens) but still sometimes put people off and can’t always pinpoint why. I can very easily tell when I’m annoying people however and it spikes my anxiety something terrible. It’s very very hard for me to not care about what people think

Medication has been helpful, but with some challenging side effects. I’ve always had trouble getting to sleep at night, my brain runs at a million miles an hour. If I imagine a swing swinging, I often can’t get my brain to stop the motion. The first day I took dex, I felt physically energised but that night my brain felt calm. It was amazing!

Medication helps me focus more consistently and work on tasks that I need to, not just ones I’m interested in. The short acting dex had some pretty nasty physical crashes later in the day as it wore off. Long acting is better for me in that respect. It’s also helped me moderate my eating, not just by suppressing my appetite (which it does and can be annoying), but by reducing my use of food as an emotional crutch. Interestingly still, the less sleep I get, the more my diet goes to shit. Having kids certainly exacerbated my symptoms.

Ultimately I see the diagnosis as helpful. ADHD is poorly named and badly understood but has some positives. The hyperfocus for one. Also likely a tendency towards and enjoyment of creativity. I love brainstorming and coming up with creative solutions to problems and that seems to be more common in folks with ADHD. The emotional sensitivity can be painful, but can also be helpful in various situations (interestingly a lot of people I know with ADHD are heavily involved with charities, not for profits, goodwill projects and similar).

Another thing that may interest you. I first learned I may have ADHD by reading an article a friend linked to on FB. I was reading it to be a good ally, but then it sounded awfully familiar. Like they had cameras in my house! Both my GP and my counsellor were very dubious (my counsellor sees other people with ADHD, I gather they mostly have more challenges with it). But my GP wrote me a referral and my psychiatrist (who specialises in ADHD) had no hesitation diagnosing me after a thorough assessment.

Ultimately I do want to go public with the diagnosis, but I still have some unpacking to do first and I want to make sure as much as possible that it can’t be weaponised against me.


The difference between a regular conversation and an ADHD conversation, according to Dani Donovan [Link], who writes a great deal about their ADHD experience.

Public Perception

Public perception is often about blaming people diagnosed with or who fit the criteria of ADHD for their behaviours. People are accused of not trying hard enough when they don’t stick to a task, for being impatient when things go wrong. They are blamed for not taking things seriously when they don’t recall, or prioritise what J Average thinks is important. People are blamed for misbehaving when they haven’t managed to develop some level of impulse control.

People who take medication to help their ADHD symptoms are often seen as weak or drug addicts. This is odd as we don’t blame people who take diabetic medication to manage their blood sugar as addicts, nor blame them for having hyperglycemic or hypoglycemic incidents without their medication. Yet we want people who experience ADHD to manage without because of some judgement about their medical condition.

This creates a damned if you do take medication and damned if you don’t if you act out. People often feel justified for defining people diagnosed with ADHD or experiencing ADHD symptoms as naughty, misbehaving and annoying. A moral judgement is passed, as if this were a choice.

No all public perception is like this, there are many allies out there who comprehend that ADHD negative behaviours are not the fault of the individual, but rather are a side effect of insufficient support, understanding, and or treatment. Allies understand that changing the way a thing is done, or explained, or presented facilitate the quality of life and experience of someone with ADHD, but are also quite willing to call a person on bad behaviour, or point out boundaries that should be considered.

Carer Perception

— K

So what’s it like being a carer for an ADD child. Before he gets his meds in the morning and when they wear off in the evening he will not focus, it is hard to get him to do as requested as he is often in the midst of something he finds very important. This thing may be trivial to me but to him it is the world.

There are times when he will be willfully defiant too. Even if I get his attention, it will still take multiple repeated times of asking him to do as requested
such as getting reading for school.

Before he started on meds, his school work was lagging seriously. It was a chore to get him to write (mostly as I think it was hard for him and he couldn’t focus on the task at hand). Now, on the meds, homework and school work is much better. He still struggles to finish work given to him, but will readily attempt to write and read now. He once told me, the pill helps me to hear what people are telling me.

His massive temper tantrums have lessened while he is on the meds, he is more compliant with requests, less easily distracted (still is a bit but what 7 yr old doesn’t get distracted).

ADHD Part 1 – Medical Definition

ADHD (Attention Deficit Hyperactivity Disorder) is the most commonly diagnosed “disorder” applied to children. It affects children, teens and adults. It has high prevalence (5 to 8 of 100) and is a condition that is poorly understood. It can be difficult to manage, especially if the condition is misunderstood and mistreated.

Part 2 – Experiencing ADHD [Link]

Part 3 – Managing ADHD [Link]

Luis from the Marvel movie Ant-Man shows many classic examples of ADHD – odd conversation style, low ability to stay focused, easily distractible

Defining ADHD

ADHD describes a condition of low attentiveness (thus the Attention Deficit part of the name) caused by hyperactive brain activity that sometimes also affects the motor section. Common side issues of ADHD is doing behaviours with low regard to consequences and emotional dysregulation (mood varies chaotically and can be hard to control).

People diagnosed with ADHD often describe it as trying to work out what is the important thing to do, when that thing over there is more shiny, and now that, oh and look over there… Prioritising, concentrating and sticking to a chosen task is hard, while being distracted and becoming engrossed (hyper-focused) on an unimportant task is common.

The average adult has a 20 minute window of concentration, the average university student has evolved a 40 minute window of concentration. The average adult diagnosed with ADHD is about 5 and can train up to 10 minutes. If you can’t fit a task that isn’t shiny into 5 minutes, it won’t get done. Shiny is a personal definition – what is shiny for me won’t necessarily be shiny for you.

Working with someone with ADHD can be frustrating as they don’t stick to a task for as long as you want them to, get easily distracted by something else and seem to have a very different idea about what is important. Often we take out our frustration on the other, forgetting this this is frustrating for them too. Imagine knowing you need to do a thing, it is vitally important, but your brain just won’t let you. It’s like “I need to do this thing – I roll my two 6 sided dice to see if I do it, if I roll twin 6’s, I get to do it… and I guess I’m doing some other random thing instead”.

Steve Irwin – amazingly full of energy

Richard Giles [CC BY-SA 3.0 (http://creativecommons.org/licenses/by-sa/3.0/)]

ADHD vs ADD

Originally there were two conditions – ADD was used to describe people who seemed to fade out, or would easily get distracted, while ADHD was used to describe people who fidgeted, couldn’t sit still and were full of energy. While both of these were noted for attention deficit, it was considered to be two separate conditions.

In modern times it is recognised that these both have the same root cause (mostly) with different presentations. As such, ADHD has three subtypes – inattentive (classic ADD, now called ADHDi), hyperactive-impulsive (classic ADHD, now called ADHDh or ADHDhi or ADHDk) and combined (ADHDc). Many practitioners still use the old terminology to distinguish the subtypes – with hyperactive (ADHD) or without (ADD).

Prevalence and causes

In children under 18 years of age, 7.2% of people fit the criteria for ADHD. This will vary a little based on country and screening tools. This statistic is pulled from a meta analysis of 175 reliable studies.

Unfortunately adults with ADHD have not been as well studied. Studies in Europe, the Middle East and the United States of America indicate a likely 3.4% of people
fit the criteria for ADHD.

(General Prevalence of ADHD – CHADD [Link])

Some of this variance from childhood may be the end of puberty defiance, or it may be that the adults have learned how to temper themselves better and camouflage their experience. More study into this is needed.

Another confounding factor is that children are often screened by asking the parents questions. Parents who come from a stricter background are likely to over-report difficult behaviour, not necessarily because the child has a disorder, but because the parent’s definition of reasonable is variable.

While a specific gene has not been located for ADHD, it is well known that ADHD tends to run in families. It can also spontaneously appear, especially in the presence of certain pollutants, premature or underweight birth and brain damage. While ADHD is unlikely to be a learned behaviour, some environments promote ADHD symptoms over others.

(About ADHD – Symptoms, Causes, and Treatments – CHADD [Link])

What this amounts to is that in any group of 20 people, you are likely to have between 1 and 2 people who are likely to fit the criteria for ADHD. For most classrooms of 30 kids, you are statistically likely to have have two people who fit the criteria. Many schools will note these youth and put them into a specialty class that doesn’t actually address the ADHD issues well, but mostly aim to contain the disruption these youth bring to from the rest of the class. This does not help people with ADHD symptoms to learn to manage themselves, it promotes self blame and lowered self esteem.

Co-occurring conditions

As many as 65% of people who fit the criteria for ADHD also have a co-occuring (comorbid) presentation with at least one other condition, around 25% of people have two, and some have three or more. It can be difficult to determine if these other conditions are parallel (happen to be in the same person at the same time) or secondary (one promotes diagnosis of another).

Most common co-occuring conditions in children:

  • Oppositional Defiant Disorder (ODD) and Conduct Disorders (CD)
  • Specific learning disorders (language, learning and motor skills)
  • Autism Spectrum Disorder (ASD)
  • Intellectual disorder

Most common co-occurring conditions in adults:

  • Anxiety (General Anxiety Disorder, Social Anxiety, specific phobia)
  • Depression
  • Substance Abuse
  • Intermittent Explosive disorder(impulsive anger)

( Psychiatric Comorbidities in Patients with ADHD|ADHD Institute [Link] and ADHD And Co-occurring Conditions – CHADD [Link])

What this amounts to is the fact that people trying to manage ADHD symptoms are often also trying to manage other things as well, each of which often requires specific methods to manage, some of which contradict.

Relationship tips

Relationships can be hard, especially when you are not used to them, scared of being hurt, or there is some messy baggage with you. Here are some tips to cut through some of the more common problems.

Relationship Building

1. Work on the principle of Charity

When an ambiguous statement is made, such as “interesting hair”, assume the other person means the best version of that. Doing the opposite of this is looking for malice.

This also means that if you aren’t sure – that is, struggling to interpret with charity – you should ask for clarity. The other person needs to hear your request for clarity in the best light too. “What do you mean by that” should be a genuine request to explain, rather than “I think you mean me harm”.

2. Assume Trust

If you do not trust the relationship, it is time to call it what it is – over. If it isn’t over, then it is time to rely on that trust… even if you are struggling to feel it.

If the other person transgresses trust, then you have a discussion to have. Is the transgression major (cheating) or minor (didn’t call back when they said they would). Is a major transgression worthy of ending the relationship? Is it likely to ever happen again? How many transgressions do you allow before you end it? How many minor transgressions become a major transgression? These are all personal questions that you must figure out.

If it isn’t over, demonstrate trust, assume trust. Have conversations that build trust.

But when it is over, it is over.

3. Take things at face value

Frequently we try to read too much into what the other person means, just in case there is more. This is often fed by our own fears, or the other person being abusive.

When we take things at face value, we slow down the over processing that we are prone to when we try to work out tricky meanings. Instead assume that “it is” what “it appears to be”. For the majority of the time this is true. Sometimes things are different to how they appear and we can then adjust to that as needed. The overthinking comes in when you try to preempt the times things aren’t what they seem because we don’t trust our ability to adjust to that greater complexity.

If the other person is being abusive, there are some signs and symptoms of that (see Red Flags below). If the face value of a thing the other person said is not accurate to the situation, this may be a warning of deeper problems.

Often it is just poor communication.

4. Communication is key

We are not mind readers. We may make some excellent guesses, but that is both hard work and fraught with errors. What is better than assuming is discussing. Communication relies on trust, expectation that you are all working together for the greater good of the relationship and each other, and that there are no hidden agendas.

It is also very important that everyone actually have a say about how they feel, what they think and what they want without it turning into a tool to use against the other.

A temptation is for one person to do more of the communicating than the other, which unfairly gives them either greater responsibility for when things go wrong, or greater power for defining how things are going to be.

Safe and balanced conversation is tricky, but worth it.

5. Own your own stuff

Own when you make a mistake. It seems simple, but it can be really hard. Often we refuse to take responsibility for our mistakes, or we take far too much responsibility and own someone else’s mistakes.

It is time to get honest with ourselves. Did we do the thing? If so, own it. Own your part in it – it is rare that you are solely to blame, but don’t blame someone else for what you chose to do – don’t excuse it.

Also be real when you didn’t do the thing. If it wasn’t you, then don’t take the blame.

Most human interactions involve multiple people who are all partially responsible for what has happened. It can be tempting to start creating a false equivalence – you did this, I did that, so we are all to blame… but if you did 5% of the damage and I did 95% of the damage… then actually this is my thing to fix and I should accept my part in this. They are not equivalent parts.

Red Flags

Red flags are warnings that the relationship may be abusive. Just because one of these flags is true doesn’t mean that the relationship definitely is abusive – it may just be immature, poorly communicated, or full of various people’s baggage. Red flags indicate that there is a part of the relationship to be wary about and that work needs to be done to fix it.

Remember that it takes all parties to fix a problem.

  1. Shifting blame

A person who shifts blame is someone who does a thing wrong, but never accept responsibility for their actions. They will always blame someone else as the cause of the wrongdoing – for example: “I’m under a lot of stress at work”, “it isn’t me, it is you”, “look what you made me do”, or “I wouldn’t have had to do this if you hadn’t…”. Even when presented with evidence that they are directly responsible for what happened they try to shift the blame elsewhere.

While it is awful when other things are creating stress for an individual and a short temper can be understood, it is not a valid excuse to hurt another, nor can the blame for one’s actions be placed at the feet of another.

2. Movinggoalposts

If you feel that you can never win because the rules keep changing, or the measure of success keeps being redefined, then you may have a problem with moving goalposts.

It is important to have mutually accepted rules that are fair and understood. What is good for the goose should be good for the gander. There are limits on this, such as “I have an alcohol problem so won’t drink alcohol, but you are free to as you don’t” is fine, but “I can see my friends when I want, but you can’t” is not.

3. Walking on eggshells

This is where you are walking on eggshells, that is: waiting for the problem to crop up, or to be in trouble, or trying to avoid feeling guilty. There is an underlying fear to your interaction where you are very worried about how things will go because you will feel awful or be hurt in some way as a result of the outcome.

If you find that these red flags are dominant in your relationship and the other person in your relationship isn’t interested in addressing them, you might be in a domestically violent relationship [link]. If you are all interested in addressing these red flags, then following the first section will help to minimise the problems.

Outrage

In the early days of psychotherapy the legal process influenced how people saw sanity and insanity. One of the laws that were very influential in many countries was the illegality of homosexuality, specifically male to male. As a reflection of this, it was medically defined that homosexuality was a mental illness.

Many men were defined as insane because they desired love from another man
and or were attracted to men. The legal aspect attacked the body, the psychological aspect attacked the mind, the combined effect added to societies message which attacked the heart and soul of a large proportion of people.

Some men hid who they were, pretending to be straight, denying the aspect of themselves that was homosexual. Some men hid from society instead. Some men pushed back. Many men died.

Those who denied themselves often sought help to “be straight”. Gay conversion therapy in the USA was created by a psychologist who was trying to use the best tools of the time to address the distress of his clients who came in “wanting to love their wives properly” as society demanded, or “not to feel attracted to men”, which was defined at the time as wrong.

We now look back at this and are generally revolted. Gay conversion is banned in a number of countries. It does not “work” and misleads people into thinking that being homeosexaul is wrong and an illness to be cured. We now know that homosexuality is an aspect of being human. Not all people have it, but it is normal.

Homosexuality is like having blue eyes. Imagine if blue eyes were defined as a weakness, a failure to be part of the brown eyed majority, something to hide behind shaded glasses or contact lenses. Eye colour is a thing about you that is part of you. You cannot will your eyes to change colour, you can’t talk your way to changing the nature of your eyes and you shouldn’t have to hide it. Not all people have it, but it is normal.

Not all of society has caught up to the latest science and social attitudes.

People who have grown up in the transition phase from where homosexuality was defined as illegal and a mental illness to now where it is embraced by enough of society that people can be very open about their sexuality have a natural anger and outrage that who they are was once defined as wrong, as deviant, as insane.

We once thought that slavery was normal and fine. Well, those who weren’t slaves thought so. Now we know better.

I work with many clients over various representations of the human norm. The section that is filling my mind of late is the neruodivergent section. The diversity of mind that doesn’t really fit the current societal model and expectations. Sometimes this divergence comes with a handful of considerations, and sometimes people with a divergence happen to also have other things going on that are actual problems.

An example of a consideration is white skin at the equator. There is nothing wrong with having a low melanin count in your skin. If you do, it is important to note that you have a higher sensitivity to ultraviolet radiation, increasing your risk of sun damage in the forms of temporary burns and long term exposure can increase your risk of skin cancer. Sunburn and skin cancer are secondary to over exposure to ultraviolet radiation while at the same time having pale skin. People who have a high melanin count are less likely to get sunburn and skin cancer, but with a high enough exposure will also do so. They are just less sensitive to it. The flip side is, people who have a lot of melanin in their skin away from the equator are more prone to vitamin D deficiency, which can lead to a secondary problem of brittle bones. There is no “right” skin colour, because that implies a “wrong” skin colour.

A common secondary problem that comes with being divergent to the defined normal is anxiety and depression. Being told that who you are is an error enough times will make anyone terrified of being caught and exposed, lost in who you are and where you fit and your sense of self can be very damaged. Often you will spend a large amount of your early childhood resources trying to “fit in”, that is, camouflage yourself. This takes away from the resource you may use for learning and other things.

Imagine if we stopped this. Instead of telling kids “be like Johnny and Sue”, we said “be you” and embraced them. There goes the secondary anxiety and depression.

It is important to note that secondary anxiety and or depression are often mistaken for primary anxiety and or depression. Primary anxiety is a condition all on its own, which often has a neurological component to it. Secondary anxiety is a reaction to things you have experienced.

Look back at the example of homosexuality being defined as “wrong”. Many men spent a lot of personal resource not being found out, denying their own nature and feeling generally horrible about themselves on the assumption that society was right to define “them” as wrong. The suicide rate amongst homosexual people was very high (it still is, but it has dropped compared to 50 years ago).

Homosexual men often came to therapy anxious and depressed. Only once trust was made (rapport), would they also talk about their feelings of alienation and self loathing, their confusion about sexual identity and finally revealing, often reluctantly and with mixed denial, their homosexuality. In those early days, the next question would be “can you fix me?”

The answer to that, now, is “there is nothing to fix”. Instead of trying to fix homosexuality, the focus is to embracing who you are, finding like minded people and letting go of those who judge you, as they are backwards members of society.

There is understandable outrage at being judged by society as wrong when there is nothing wrong.

Experiments have been done with random “in group” and “out group” assignments with many school kids. It doesn’t matter what the arbitrary grouping is – eye colour, the flip of a coin, male vs female, the hidden witch etc – the results are the same. People form inclusion and exclusion for no good reason.

This is happening right now, and like the early days of society reform around sexuality, there is a burgeoning outrage by the divergent populations who are being currently defined as “wrong” for being a normal variance of “human”. We now understand that this idea of “wrong” is, in fact, wrong.

I work with people who use suicidal ideation,self harm and intoxication to manage their experience. A large proportion of them have no medical condition – such as gross perceptual hallucinations; psychosis; various neurological conditions; terminal illness; chronic pain – to explain their experience.

They have a social condition to explain their experience.

They are currently rejected by society because who they are is defined as “wrong”.

You are currently reading this, or listening to someone/thing else reading this. I wrote this on a computer, stored in the “cloud” on a website, displayed on a screen connected to “the net”, or printed on a page by a device – none of which was conceived or developed by “normal” people. Our entire technological “advancement” was made by people society defines as abnormal. The irony is that while we applaud the result, we deplore the people.

The outrage is good.

The outrage is normal.

The outrage is the first stage of standing up and fighting the false assumptions of wrongness.

It will drive us to become loud and normalise being us. I encourage those who have the strength to follow the example given to us by the homosexual community, the slaves, the women, the people of colour, all of the oppressed peoples – to have divergent pride and stop allowing people to condemning those who are different.

Get outraged.

Public Service Announcement…

If you find yourself often wondering what people mean when they say “that”, or how others know what to do so easily in social situations, or you keep waiting to find out what the rules are…


If you find yourself feeling anxious because there are people about, but you don’t have a really good reason for it…


If you find yourself wondering why you are alive, where you belong, what is the point of your life…


If a core thing about who you think you are is always being defined as wrong, and people tell you to be more like someone else, less like you, to stop being weird, or strange, or different…


If others are just exhausting to be around…


If you find that you keep holding onto people who are bad for you, because you fear being alone, and you just want those people to accept you for who you are, or who you pretend to be, if they would just acknowledge you for … you…


If you suspect you aren’t stupid, but you have doubts because people keep treating you like you are stupid, but you can do complex stuff, but you invalidate that complex stuff because you think you are stupid…


If you feel like a black sheep, an ugly duckling, alien, or just born in the wrong country, era, body…


If you find yourself in the crowd of people you should get on with, but never really one of the crowd…


If you’ve been diagnosed with anxiety and or depression that just doesn’t seem to shift, regardless of therapy for those and trying every medication under the sun…
If any one of these rings true… then you might be neurodivergent.


While there may not be many specifically like you, there are plenty of people who are not neurotypical. About 30% of the population – that is 1 in 3 people – are not typical.
It’s like the blue colour in the rainbow saying “we’ve got the biggest chunk of the rainbow, so if you aren’t one of us bluish colours, you are wrong”, and you are all like, …. “I think I’m yellow”, and blue says “you are a defective blue”. Green will get you not being blue, but green isn’t yellow either. You are both “not-blue”, or “neuro-atypical”, but you aren’t the same “not-blue” or “neuro-type” either.


Often we give a diagnosis for feeling like you don’t fit in, or for acting oddly when you do try to fit in, instead of saying… oh, you aren’t like that small bit of the rainbow. The diagnosis can be handy for working out what to do to compensate for those blues, but it will not make you blue, or define you as okay to not be blue.
Remember, you are normal for you, not a broken them.

Personal resource management

We humans react in different ways to different things, however this gives you some ideas about what to expect and what some of the traps are depending on where you are at verses stress.

Dead – nothing to do except go through the pockets looking for loose change… No resources available. This is the thing to avoid.

Crisis – A thing is happening right now that means you might die, so you have to get through this. Can last from minutes to a few hours. After that, it isn’t really a crisis and you have time to think, plan and resource. A misstep in crisis is critical, so resource management is often wasteful, the real cost of the thing is hard to determine because we are more focused on “will it keep me alive” than “what is the real cost of this to me later”. Any person who keeps you alive is someone you’ll use, regardless of the cost.

Survival – Trying to get through to tomorrow or the day after. Might have vague plans for next week, but really, it’s all about getting through today to get to tomorrow. There is time to think and plan, but the plans are about tomorrow. Resource management is poor because there is no point being frugal if you die. Solutions are survivable or just good enough rather than optimal. You will often attract people who will take advantage of you because you depend on them to survive.

Coping – waiting for the next pay day and trying to work out how to get to it. Often the timescape is about 14 days. Anything past that is ephemeral, while things within that are more concrete. You can take risks with your resources because dropping down to survival won’t kill you, it just sucks. This means you don’t have to put everything into getting through to tomorrow, so you can save a bit for later. You begin to weed out people who are abusive.

Managing – month to a few years worth of planning. Resource allocation is quite efficient, but you have enough daily costs that you need to continuously work to get things paid. Life is a grind, but it is a fairly pleasant and low risk grind. You have the resources to manage a few semi-abusive people because of some of the benefits of having those people in your life, but mostly your associates are positive and nice people.

Thriving – assets are paid off, you don’t really need to work much, the people you associate with are prosperous, life is good.

Camouflage and Autism – a quick study

Article Title: Quantifying and exploring camouflaging in men and women with autism

Sixty participants were scaled on their internal state of autism vs their observed level of autism (that is, their inherent traits vs their chosen behaviour) to rate how the level of camouflaging (trying to appear neurotypical) affects the individual (stress, anxiety, depression etc). and if there is a sex based predictor for who camouflages better.


Autism Awareness Ribbon – source Wikipedia

An example of camouflage is someone who would normally avoid eye contact having learned to maintain appropriate eye contact, even though it is uncomfortable for them. This effort is costly and increases stress which may affect anxiety and depression.

It was found that women generally camouflage better than men, but with a lot of variability in both (so not a clear winner).

Men who camouflage well had more associated depression, while women who camouflaged well had also developed better social detectors.

Keep in mind this is a small and targeted study that as of writing this post, has yet to be repeated by others.

Observationally in my practice as a counsellor working with various neurodivergent peoples, this is fairly cromulent – matches what I have seen. I would expect that the depression noted in both, but more prevalent in men, is to do with internal identity mismatch – who am I? Why can’t I just be me? Why aren’t I valued, just my behaviours? I would be interested in a study that looks at people who are comfortable with their identity and camouflage well to see if they still have associated depression.

I’m also interested in the anxiety that may come along with not camouflaging well. This was not looked at as far as I could read in this study. Is it a thing, or just something I have noted in counselling? Does learning to camouflage make a difference?

Authors: Meng-Chuan Lai, Michael V Lombardo,
Amber NV Ruigrok, Bhismadev Chakrabarti,
Bonnie Auyeung, Peter Szatmari, Francesca Happé
and Simon Baron-Cohen; MRC AIMS Consortium

Link to article
https://journals.sagepub.com/…/abs/10.1177/1362361316671012…

The Despair of No Progress

A client – I will call them Lee – was telling me about how bad their weekend was, with a negative family interaction prompting a negative personal reaction to it. I am being purposefully vague about the details because not only don’t they matter per se, but confidentiality.
 
Anyhow Lee felt they had made no progress because here they are, right back in the slump, having to start all over again. Lee felt that everything was bad, bad, bad. They listed their faults in great detail, lamenting that they would never improve.
 
I listened for a while and then asked if this is how they would have responded to the crisis 6 months ago. Lee started to say yes, hence their slump … when they paused, and admitted that a number of things had gone different this time over previous. I asked what those differences were and my client began to list quite a few. I asked why they were different and Lee admitted that they had made different choices because of the therapy opening up different options, that they were able to see some of the patterns as they evolved and paused long enough to not react, but rather act.
 
So, not the same slump?
 
It just felt that way at the time, because of that similar negative reaction. Even here, though, Lee admitted it wasn’t as bad, and lasted nowhere near as long. So even this was different.
 
I drew a diagram on the whiteboard (I use a lot of visual diagrams) of a valley going up a hill, then a small dip in the hill and up again, to another dip, before finally peaking at the top of the hill.
 
I pointed out that 6 months ago they were in the valley, now they are in the first dip. From the bottom of the dip, it looks like a valley, but when we pause to look at that bottom trough and compare it to before, it is quite different, despite looking and feeling the same at face value.
So be careful not to mistake feeling like you’ve made no progress for actually making no progress.
 

Anyway, I was looking at the board today before erasing it and thought I would share.

Goat jumping
Climb all the hills like a mountain goat

Neurodiversity Part 3 – Living with Neurodivergence

Neurodiversity recognises the spectrum of thinking types, from neurotypical (local average) to neurodivergent (specifically not like average). This framework changes how we see people who think differently – not as faulty, but just different. This article looks at what it is like to be neurodivergent but not know it.

In Part 1 [link], we examined some of the terminology of neurodiversity. Part 2 [link] looked at why the concept of neurodiversity is important.

Being Alien

Have you ever visited another culture and been completely lost by what  they are doing and why they are doing it? Perhaps you went to another country, or went to a friends family and found that their basic assumptions and methods of doing things are quite different.

When I went to India around 2008, my cultural awakening occurred on the way to Bangalore from the airport. While driving down a six lane highway, theoretically three lanes on either side for traffic, I watched as the locals ignored that and any other semblance of road rules. Eight vehicles were banked up parallel to each other in five and a half lanes going in the same direction (towards the city), with half a lane dedicated to the traffic going the other way. Lanes were a nice idea, but no one cared. The horn was used to warn motorists of where they were and seemingly their intent, traffic in lanes wove in and out and we had to dodge the occasional ox and cart trundling slowly down the highway. Scooters were very popular, loaded with a nuclear family of two parents, 3 kids and at least one grandparent and the luggage. I was very glad to not be driving.

What I am trying to say here is that what I was use to as average was very different over there. Their average was not my average. Who was better? I can see the logic that if several million people are headed into the city in the morning and only a few thousand people are leaving, then it makes sense to switch the direction of some of the lanes. If most of the vehicles are bikes, then it makes sense to have several in a single lane. If you need to dodge carts and slow tractors, it makes sense to weave in and out. I can see the logic of all of that, yet it seemed like chaos and a recipe for disaster – especially as I come from a city that can’t merge lanes or use car indicators. For all of that perceived chaos, I witnessed no accidents and my driver told me (hopefully truthfully) that accidents were rare.

I was a stranger in a strange land, not knowing the local ways and dithering between understanding why I think they do things and wondering why they do things that way, while probably just not getting any of it. My assumptions, values and solutions did not fit this strange land.

When I made inevitable social blunders in India, my skin colour and accent saved me. I clearly was a stranger and should not be judged for not knowing the local rules. While I was frequently embarrassed for not knowing how things were done, I also acknowledged that I was in a strange land and didn’t know the rules – the customs, the traditions, or the laws. So that made it okay.

Growing up

That isn’t how I grew up though. I grew up in a family that seemed to do things quite differently to me. I empathised with Kal-el, who was ejected from Krypton, crashed on Earth and was adopted by some country folk called the Kent’s. They called him Clark and raised him as human, trying to manage his oddities and help him hide his differences from everyone else. Eventually his amazingness would be revealed in his Superman persona, a fantasy that I knew I would never realise. I mostly empathised with the Clark part of Kal-el, the man who would be human. As I grew up in my family, I hoped that I was adopted and that would explain why I didn’t fit. Turns out that I wasn’t adopted.

I went to preschool and found myself managing kind of ok. Parallel play was the rage (as it often is at that age), so I could do my own thing, lost in my own world and not have to interact with the others. For all that, I decided I had a best friend and that poor sucker was kind of stuck with me as I followed them around and just tried to be wanted.

Primary school was awkward because parallel play was over. You are now supposed to play with others. But they made no sense. They couldn’t see the worlds that I saw, they didn’t play the games I liked and they couldn’t seem to explain what they were doing to any sensible level of satisfaction.

I have a memorable moment in my third or fourth year when we were given a teaser phrase to write a  creative story from. We were given the class lesson to write our story – probably an hour. I did so, quite enjoying the exercise, while at the same time dreading handing my beautiful work in to be criticised because the words I wrote were poorly formed, had gross spelling errors and sometimes just did not connect. The meaning of what I wrote was irrelevant, pailing  into insignificance compared to the fact that I can’t write. At least, not as they define it.

Once the hour was up, and to my horror, we were told to stand up at the front of the class and read our work.

Out loud.

To the whole class.

My instinct to hide and not be seen sent me into panic. You can’t hide at the front of the class. You can’t blend in. You are there to be judged. Holy crap on a stick. I contained my internal panic because even then, I had learned to hide how I felt.

I listened as almost thirty identical stories were read out. Polite applause after each one. Then, finally, it was my turn. I gathered myself and walked, slowly and reluctantly, to the front of the class, watching the whole class watching me, lining up their judgement rifles, ready to shoot me for being wrong. Again. I would plead my case, the squad would judge and I would be shot. I did not see friendly faces, I saw a judgemental firing squad.

I read my story. Because I wrote it, my poorly formed written words were not an issue. I knew what my story was. Unlike the brief paragraphs the horde had written, I tremulously read out the page and a half of fully formed story with a horror twist ending.

Silence.

More silence.

“Well… my… um…” said the teacher.

“You’re so weird,” offered one of the riffle men. Head shot. I was done.

On my way home, walking alone between a group of kids in front of me and a group of kids behind –  never with the kids you see – I began to wonder. Thirty identical stories. I’m sure they didn’t think the stories were identical, but compared to mine, they were. How did they know? How did they know what to write to be the same without talking to each other? Why was mine so different?

"You laugh at me 'cause I'm different. I laugh at you 'cause you're all the same" quote, The most neurodivergent phrase in existence
The most neurodivergent phrase in existence

I spent a lot of time hiding under tables. The world was too big and too confusing. I needed to make it closed in and manageable. There is this scene in “Man of Steel” where Clark hides in a closet. I cried when I saw it. I would run away from school a lot. School was hard. It was full of judgment and contradictory rules. The principal was often sent to retrieve me. I was considered stupid, retarded, incapable. I was in a lot of special classes. All my skills were in things they didn’t measure or care about. The way they taught me made no sense, so I spent lots of time in private research learning what I needed to know and struggling to get my mind recognised. I failed a lot.

Kal'el hiding in the closet "The world is too big mom"
Kal’el hiding in the closet “The world is too big mom”

The Effect to my Psyche

Unlike many that I now know, I didn’t develop an anxiety or depressive disorder. It is quite common to develop anxiety as you spend a great deal of energy trying to hide from everyone all of the time, becoming hypervigilant to the inevitable attacks, critiques and corrections. It is also common to develop depression as all your efforts fail, as every move you make is a disaster and you learn that it is better not to move at all. I did suffer a lot and become what is now known as emo. I spent a lot of time sad,lost and lonely, becoming very introspective as I tried to work out what the heck was wrong – with me, or the world, I wasn’t sure which. I learned all the ways to not fly a flag and be noticed. – wear plain colours, stay back, don’t act odd. Despite all my rage, I was still just a rat in a cage. Despite all my effort to hide, I was noticed anyway. Not because of flags that I flew or hid, but because it was me. I tried so hard to be average. Clearly, I failed.

I did develop a mood disorder. I spent so much time hiding who I was and second guessing all of my emotions (the feelings I show), that I suppressed my reactions and feelings in favour of intellectually calculating what others needed to see. One cannot have feelings and bottle them up – they will find ways to leak out. In my mid twenties I would recognise this and work out how to manage my moods.

One of the main moods I needed to learn how to manage was rage. I had rage against the world. Against the partner I had left, the parenting I received, the world that didn’t accept me, at how I had grown to be the person I was. I recognised that I had become a defensive mechanism, controlling all those around me to ensure my safety. I had grown up wrong.

I hated who I’d become.

It was time to change that. It took me some time, and I got some coaching, therapy and a new crop of friends and got there. That change isn’t the point of this part. The point is how I grew up in a land that was not mine, amongst people who were not mine and how I responded to that.

Thinking From a Different Angle

I often described the way that I think as different to anyone else I know. That I have learned how others think in order to compensate. This means I have at least two solutions to most problems – the one I’d use, and the one I expect that you will use. I use to describe thinking space as three dimensional sphere, where “normal” people were a circle in that sphere, and coming in at an acute angle was my circle of thinking – how I saw the world. At the intersection between mine and theirs was the only location that I had to implement the interface I use to compensate for this difference. I had to work out what made them tick and what they were likely to do, so that I could squash my instinctive responses and substitute theirs.

When they fail to do a thing, I use my other mechanism to survive – my natural instinctive one. When other people aren’t around, it is so much easier. I do “me” instead of “fake you”.

Many people claim that neurodivergent people are not empathic. I posit that this is sometimes true, but often false. Imagine you go to another country. Someone tries to talk to you with words you do not understand. Are you deaf? Or is it just another language you have yet to learn? Some people are deaf. Mostly though, you just don’t know the language. It isn’t your native tongue. You might learn some of the words, but you are slower to respond and can’t express yourself fully. Given time, you can learn their language, but you don’t think in it. You think in your own language first, then translate it into their’s, and then you say the thing and hope you got it right. They say a thing, you hear it, work out the words you do know, try to fit it into the presenting context and then translate it into the words you do know and hope you got it right.

That is me. Translating all the time. I’m not deaf to you – I just struggle to understand.