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Sunday, November 24, 2013

ADHD & Women: A hormonal issue

When I began researching ADHD, I found a number of websites that mentioned that the tipping point for many undiagnosed women to seek treatment is the birth of a second child. That was me! Now I'm finding that researchers have found a definite connection between female hormones and ADHD symptoms, with symptoms becoming markedly worse when hormone levels, estrogen in particular, drop during perimenopause.

It makes sense, then, that the hormonal crash after a pregnancy could drive an undiagnosed woman to seek treatment. My first pregnancy was unusual in that it was an IVF pregnancy, marked by life-threatening complications. For the first two months, I had to give myself daily injections of progesterone. My second pregnancy was spontaneous, occurring 4 1/2 months after I delivered B. During both pregnancies, contrary to the stereotype of the crazy, demanding, emotional pregnant woman, I felt the sanest I had ever felt. I was calm and happy, rarely overwhelmed. I was also aware of the neurological damage that persistent maternal stress has on a developing baby, so I took a very low dose of Sertraline through both pregnancies.

Though I hemorrhaged several times and was hospitalized for five weeks when pregnant with B, I was amazingly calm. I had different stresses when pregnant with D - I worked throughout the whole pregnancy, and had some issues in my life that made me quick to anger. I also experienced the sudden death of DH's brother from an overdose on Christmas Eve when I was 8 months pregnant, causing signs of early labor. (I can't find it now, but I read one study that indicated that if a mother experienced a death in the family a YEAR BEFORE pregnancy or during pregnancy, her child was at higher risk for ADHD. My grandfather died less than a year before my mom got pregnant with me). But, overall, I was happy. Much happier than usual. With D, I went to work on a Friday (with B in tow for a lecture to two classes about my pregnancies) and went into labor four weeks early on Sunday, prompting an emergency c-section on Monday - my labor wasn't progressing beyond my water breaking, and I was considered too high risk to deliver naturally.

Following B's birth, I couldn't return to work that school year (LONG story). So I had almost 9 months off with B. With D., I had to return to work as soon as medically possible, so 8 weeks after her delivery, I was back at work. Also, her birth was very, very stressful; within a few hours, she was the sickest baby in the specialized NICU at North Shore University Hospital. Ironically, I had chosen this hospital to deliver B at because it was such a difficult pregnancy and both our lives were in danger. I never thought that this hospital would save D, but I was so grateful. She was critically ill with pneumonia.

She was a very sick little girl, and I couldn't stop crying. I just focused on getting her home; I wasn't capable of processing that she was critical. I wasn't even allowed to hold her. However, the amazing team helped that fierce, resilient little girl beat the infection and she came home 8 days later.

It was a stressful start, compounded by the pink slip (and other work issues) that I received when she was two weeks old. The hormonal crash that occurred over the next few months was awful. The stress became overwhelming as it became increasingly obvious that B had issues and a perfect storm of other factors converged.

That is what set me on the path to healing. Untreated, undiagnosed adult ADHD is pure misery. I'm speaking out because there are so many of us out there, especially women, who wonder what's wrong with us, why we feel defective, why we can't just be normal, why we do what we do. There is help. There is peace, there is happiness! I am never going to be neurotypical and I'm embracing my differences, using my experience to try to help others.

Saturday, November 23, 2013

ADHD at school: The Time Out

I would love it if schools had a "time out" room. Students (and grown ups) with ADHD often have explosive anger or uncontrollable crying when highly upset. While they cannot control that, they CAN control how they react. The more self aware students have learned to remove themselves from a potentially explosive situation, sometimes by simply walking out of class. While this might seem to be insubordination, I would rather see a student walk out of class and possibly get into a little trouble than remain and get into BIG trouble. It reflects that the student is acknowledging that she cannot control her emotions at that moment but is being responsible enough to leave while she can still control her actions.

Usually, students who do leave go to student services or a trusted teacher's classroom, or even the AP office. A time out room, with guidelines in place to prevent abuse, would allow agitated students a designated place to go to cool off. The potential for abuse and staffing are two major issues, however.

Another issue is that it is so difficult for someone who doesn't have ADHD to understand how it is to have it. I was more empathetic than the average teacher before treatment, but I didn't understand JUST how hard it is to function with ADHD until I began the Strattera and started functioning more typically. I now have tremendous empathy and understanding for my ADHD students. But I wouldn't if I hadn't been diagnosed.

We all need a time out sometimes. One of the more important lessons of my adult life is the need to walk away at times from situations to defuse rather than remain and escalate.

ADHD as a Teacher

It was my students who first raised the possibility that I had ADHD, and I am forever grateful for that, because if they hadn't done so in 2002, I wouldn't have finally pursued obtaining a definitive diagnosis and treatment in 2013. I love teaching, and I love that I learn about the world, human nature, teenagers, and myself every day through teaching.

As odd as it may seem, my ADHD students have helped me cope with my diagnosis, providing me with support and relating to me their own experiences with ADHD. I'm easily distracted, even on Strattera; since being really open about my ADHD, most kids don't exploit that. When one student did, I pointed out that it's a disability; if a person were deaf in one ear, it would be cruel to speak into that ear to tease the person. The student then understood how teasing or intentionally exploiting a feature of someone's ADHD is wrong.

I let the kids know if I'm having a bad ADHD day, and I have improved measures in place to help me stay on track. I spend some time every day, especially in the morning, organizing any handouts and making sure my room is fairly neat. My room now compared to what it was last year is a tremendous difference - it's fairly neat and organized instead of looking like a paper monster vomited everywhere. I think it benefits my students, too, especially ones with ADHD - it's easier to concentrate in a neat environment.

With Strattera, I'm more on task, organized, and PATIENT. I'm not a fan of yelling, but I do it even less than I used to. Things that used to set off an ADHD rage no longer bother me so much, and I get over my anger much more easily. Even without treatment, though, I don't believe in holding grudges against kids and they know that, while I might be angry or disappointed one day, the next day is a new one and we move on.

What I find really difficult is managing the lesson planning for three preps: 12AP Language, 12 Regents, and 9 Regents. I do my plans on my computer, which I find easier in terms of having access to plans from previous years. However, I have a hard time with the grid format. I realize now that I have difficulty processing information in certain formats; trying to read the Common Core Standards charts drives me crazy. I'm in trouble if I have to list the standards on my plans as I did a few years ago; having to find the standards that applied to my lessons and adding them added HOURS to my planning time a week.

I also have difficulty with meetings. It is so difficult to sit still and quietly. It's much easier if I can multitask, such as grading papers. It depends on the context, however, and I have gotten in trouble before for seeming to not be paying attention when I was.

Remembering important things, such as an observation, is also not a strong area for me. I keep emails in my inbox until the event has passed or I have dealt with the issue. I also use my Google calendar and the Evernote app to remember important events and things to do.

Most jobs are more difficult with ADHD, teaching included. However, I like to think that it provides some advantages as well. I tend to be dynamic, creative in approaches, and highly empathetic. I'm different, and I live by - and promote - the concept that different is OK, and can even be wonderful.

Wednesday, November 20, 2013

ADHD Mom-ent

A day in the life of a mom with ADHD...
I was dressed nicely, prepared with multiple copies of B's IEP and other CPSE paperwork, and ON TIME for our conference with B's teacher and therapists.

The problem: We were there on the wrong day.

We were a day early. DH relies on me to do most of our scheduling; we both refer often to our shared Google calendar. I had somehow mistaken the day. And, of course, I couldn't find the letter from the school to verify whose mistake it was that I was early. The director apologized and admitted that one notice that went home said that the conference was on Friday, November 19. How I made that into Monday, November 18, I don't know.

But B's team was WONDERFUL and met with us anyway. We were very happy; we really, really like everyone we met, all my questions were answered, and B is progressing nicely. I owe them a thank you basket. As a teacher, I know how disruptive our unplanned visit must have been.

When I got home, I faxed Dr. H about upping the Strattera. We considered it but decided to wait pending blood work (routine). However, my insurance company decided that I could only have Strattera if I bought a 3-month supply. I figured I might as well increase now instead of AFTER buying 3 months' worth. The wrong day was the final straw. I've been very irritable, quick to become frustrated (to the point of almost crying), forgetful, etc. over the past two weeks. I'm on day 2 of the 80mg dose and I feel somewhat less cranky already. And when I gave a speech tonight at the NHS induction, I was very nervous right before I spoke, but it's nothing like I would have been pre-Strattera.

Wednesday, November 13, 2013

Hyperfocus - Jeff Emmerson Post

Jeff Emmerson, Adult ADHD advocate and blogger, has published a post here.

How timely. I had a hyperfocus weekend, and got an extraordinary amount of work done. It was great to get the work done, but not so great that I felt exhausted and spent by Tuesday. It's a double-edged sword. I try my best to harness the hyperfocus when it strikes - like the time this summer I organized the 5,000 or so pictures in our home. But sometimes it's so intense I can't even stop to eat - I'm so driven. Balance is key, and I try really hard to not let the hyperfocus take over my life. My toddlers don't allow that to happen much these days, thankfully!

Monday, November 11, 2013

Not Neurotypical

The possibility of having ADHD never occurred to me or my parents or anyone else until 2002, when I was 25. I had returned to teaching after a four year hiatus, and students in my three 9th grade classes kept asking me if I had ADHD. I remember one incident vividly. I taught in one classroom that faced a main road and I found it distracting; the noise from the street was constant, and ongoing construction provided a steady stream of noise difficult to filter out. One day, I stopped mid-sentence to exclaim, "Look! There's an orange porta-potty!"

Not long after this, I saw a doctor for a referral for counseling for anxiety. I asked him about ADHD and he agreed that I very likely had it, but I thought little of it. After all, I had achieved so much - BA at 20, a career in education, a stable relationship with the man who would become my husband - so what did it matter?

Fast forward to 2012. I now had two small children 13 months apart and a full-time job. I melted down - I was overwhelmed. I embarked on a serious self-help campaign, working hard to remain calm and connected to my spirituality. I began to live in the day instead of obsessing about the future. I let go of everything that I cannot control and focused on what I could. I strove to be proactive rather than reactive. I saw phenomenal results, but something still wasn't right. I forgot about an important observation at work. I was spending half of my time losing important items and looking for them. I slept poorly, as my restless legs had progressed to periodic limb movement disorder; I spent most of the night moving, from twitching to violently thrashing. The constant electric buzz in the background of my mind was worse than ever; others would call it anxiety, but the term didn't feel right. I felt as if I were in a constant mental fog, and I worried that it was related to my autoimmune illnesses (Sjogren's syndrome & fibromyalgia).

What finally pushed me to seek a definitive diagnosis for ADHD was my children. B was initially diagnosed at 2 with PDD; it took some time and effort, but I got him correctly diagnosed with apraxia and dyspraxia. D was also exhibiting delays, and while we continue to monitor her, she has mostly caught up - now we're waiting until she is old enough to be diagnosed with ADHD, because we're pretty sure she has it. I wanted to know why my children aren't neurotypical - did it come from me? And I was demanding the best for my children in terms of early intervention - didn't I deserve treatment if I too had a neurological disorder?

I found my doctor through Google. Dr. H is Harvard-trained and her practice specializes in ADHD; she specializes in adult ADHD. I pay out of pocket, but it's worth every dollar. In June of 2013, I finally was definitively diagnosed after a VERY thorough evaluation. In July, I began Strattera. Mindful of my health issues - in addition to the autoimmune illnesses, I have severe GI issues, including gastroparesis - she titrated my dosage conservatively. I began on the lowest possible dose - 5mg. Even at that low dose, within a week my night time movement completely ceased. It took until September to get to 60mg, but it was worth it. I experience a minimum of side effects and it has been nothing short of a miracle.

It's difficult to describe how treatment has changed my life, but it's been nothing short of a complete transformation. It's as if I were severely nearsighted my whole life and never knew it until I put on glasses. Or as if I lived somewhere where everyone spoke Italian and I spoke Spanish, not realizing they were different languages until one day I woke up fluent in Italian. I never knew just how driven by impulse I was until the impulses faded. or just how explosive or impatient I could be until I was calm. What professionals kept telling me was "anxiety" was NOT anxiety. It was the relentless revving of the ADHD brain, like a car stuck in neutral with the pedal to the floor.

It's taking time to come to terms with having ADHD, with not being neurotypical, with knowing that there was something wrong but not knowing what it was. I'm angry, I'm sad; it would be impossible to quantify what undiagnosed, untreated ADHD has cost me, but I have paid dearly. At the same time, I am so grateful to have the diagnosis and treatment now, and I am so grateful for what it has NOT cost me. I recently gave my husband this article: "ADHD: Why We Do What We Do" (PLEASE read, it's phenomenal) and he was amazed. Even before reading about ADHD, however, my husband was amazed by my transformation through Strattera. He pointed out that at least 75% of the poor decisions and disasters in my life never would have happened if I had been diagnosed and treated earlier.

But, as Dr. H pointed out, when I was as child, ADHD was considered a mild form of mental retardation. I was exceedingly intelligent and had an IQ report in my school file - so my boredom and inability to focus were attributed to my intelligence and in kindergarten I was pulled out of the classroom for "enrichment" activities, and I was taken out of 1st grade after a week and placed in 2nd. I was frequently inattentive because I was bored; one of my ADHD superpowers is fast visual processing/speed reading (hyperlexia) - so I didn't get in trouble because I just worked ahead. I always sat in the front of the room and I always had my hand up, feeling like I would burst if the teacher didn't call on me.

My ADHD history will unfold in future posts. What strikes me most today, however, is it is such a relief to understand WHY I did so many stupid, dangerous, and/or seemingly senseless things my entire life; when asked "why", I never had a good answer. I'm still responsible for my behavior, especially as a 36-year-old spouse and mother; however, now I know why.