ADHD – Is it the Brain? Or the Medicine?

A Plan is not a fantasy:
Somewhere along the road from diagnosis to reasonable adjustment, one discovers the massive but elusive distinction between a Plan, and an Idea. When people discuss broken “commitments,” one wonders if they are, in fact, Commitments (as in, Plans), or are more like Ideas of what you Ought To Do, Want To Do, Could Do, Should Do, would like to Have Done, even Intend To Do. The category for what I Will Actually Do is much, much smaller than one imagines, and explains the many things, um, Not Done.

Performance problems:
Self esteem in our culture comes not so much from “feeling good” about oneself, but from doing what is esteemable. Children with performance problems are particularly at risk here. No matter how positive, and kind, and understanding, a child’s world is, she still has herself to live with. It appears, from my observations, that children develop early on a set of desires, ambitions and expectations for themselves that are reasonable, given their raw ability. But that Brain Disorder they have prevents them from using what they have, effectively. And, they know it.

Is it the Brain? Or the person?
The purpose in emphasizing to anyone with AD/HD that this is a Brain Problem is to keep them conscious that they are not failing; their Brains are failing them. Do you see the difference? Yes, I know, the Brain is in the skull, but as the conductor of a string ensemble, it is often asleep on the job, or was out carousing too late, or fell off the stage, or something like that. There’s nothing wrong with the musicians themselves.

Regulator trouble:
It strikes me that difficulty in waking can be attributed to the self-regulatory problems so common in AD/HD. Setting oneself in motion, or stopping an activity; calming oneself down from excitement, or getting motivated; sustaining attention, or shifting attention; attending to bodily needs — all these are often sources of difficulty for people with ADD. Trouble getting to sleep because one’s Brain isn’t regulating its activity level at bedtime isn’t so different, really, than trouble becoming alert on arising because one’s Brain isn’t regulating its activity level at wake-up time.

Is it the Brain? Or the medicine?
So when I tell a child her Brain is stuck, I am reminding her she’s all right. Medication cannot give a person anything more than that person already has. Someone I know reported having having had a conversation like this with her daughter soon after medications were started and the child put toothpaste on her toothbrush while talking – a first, ever, for her. She asked if her mother thought that was the medication, and her mother said No, it was she, and the medication was like an extension cord connecting a perfectly good window fan to a working outlet.

Brains of many ages:
The eight-year-old girl went on to describe her mental experience: it was, she said, as though she’d made a very big, elaborate block tower, well balanced, something a capable eight-year-old could make, and a two-year-old, entirely without warning, comes in and knocks the whole thing to the ground. For many adults, it’s more like a continuous tension between the mature, reasoned, deliberate, goal-oriented, well-adapted character that they have grown to be, and one little (and crucially instrumental) part of the Brain that keeps bollixing up the works with impulsive forays all over the map, which include ideas, words popping out of the mouth, unmodulated feeling, physical agitation…

Hyper-focus:
If “hyperfocus” is focusing exclusively on the same thing without being able to shift focus to something else, like going to the bathroom, or knocking off work for lunch, then that’s one of the signs that the Brain has not got its automatic transmission in good working order. The Brain is supposed to have at least one front and one back burner, and it is supposed to shift things from one to another, and back, automatically and with little to no effort/will on the part of the Brain’s owner.

Your Starter is broken:
Someone asked me awhile back about guilt, saying, for example, that she can be sitting at the computer, just dawdling, knowing in the back of her mind she should be doing this or that – until – someone asks her to do something else – then – she has an immediate urge to do whatever it was she wasn’t doing. Any demand on her time, attention, seems to be the catalyst to get her doing her original, put-off intentions

This would be a case, I suggested, of your Starter being frozen, and it taking an event, or a person, to animate you. It’s an experience that can be tinged with guilt, because it’s possible to dink around for ages until someone showed up and then the shame or guilt of idleness would seem to be the impetus that forces one into action. But it can just as well be the telephone ringing, or another, uninvolved person ringing your doorbell; and so we can only surmise it’s a broken Starter. The guilt may have had to do with things left undone, but it was not a motivator. Shame, likely from not doing what you wished you had done. Medication helps with this, but many people still have to develop structures and strategies to get, and stay, in motion, a lot of the time.

The medication decision:
It’s possible to be more effective at living — and if with chemistry one can render one’s brain a little more like the ones everyone else was given, that’s something for which to be grateful. I prefer a clean floor and the pleasure that gives me (both literally and metaphorically), and the ability to function more effectively in a clean house; to what I consider a false sense of self derived from doing it myself. This is why some people hire it done. Also, this kind of problem would not be a problem if it didn’t have to do with behavior, thinking and feeling. People who need them don’t throw away their glasses and declare they want to do it “on their own.” Nor do the ones in need of crutches burn them for kindling and say they want to do it “on their own.” People don’t even try to not have seizures by sheer force of will, and anti-seizure medications also work in the brain.

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