Wednesday, January 25, 2012

Dealing with Undiagnosed/Untreated Adults, Part One

by Jim Karustis

FEW SYNDROMES HAVE BEEN MORE WRITTEN ABOUT, more deeply researched, than ADHD. You can find a host of qualified, experienced professionals. CHADD absolutely is there for you. And yet… and yet… what do you do if ADHD is suspected—or, as Richie Ashburn might have put it, “I would bet my house on it”—and it is not so obvious that ‘the suspect’ will be receptive to any feedback whatsoever? We are not discussing those in your closest, inner circle of intimates—not your spouse or child. Rather, let us consider relationships that have not been examined very much as yet—your boss, your employee, a vendor, that guy who works at the supermarket and chats you up (and up) each time you shop.

We are also not in the business here of cookie-cutter solutions; if those applied, you would have figured them out already and would not be reading this article. The premise is that it can often be gruesomely confusing and complicated to decide whether to say anything, what to say, and how to say it. No worries—although there is no particular formula for making these decisions, there are some solid points for consideration that should help you sort out matters.Look at yourself. Always start by looking in the mirror. Whose problem is this? When we are discussing coping with ADHD in one’s orbit, a primary issue to process is how much can you let go? I mean, truly let go of, not just externally appear to be ignoring (while your face is turning beet red).

Recently adult ADHD expert Gina Pera compiled the experiences of a number of CHADD members faced with this very question. One of the respondents offered an especially valuable perspective when he noted that “they are doing the best they can with everything they have to deal with.” Given how annoying and/or disruptive ADHD behaviors can be, it can be quite challenging to maintain such a perspective, but there is much truth in it. When speaking to various CHADD chapters, I often express a desire to have all members tattooed on the wrist with the reminder, “I don’t have to respond to that, I can let it go.”

So ask yourself, is it my problem, the other person’s problem, or some very real combination? We cannot skip this step—indeed, many classroom teachers have later thanked me for asking it, noting that in some cases the question has helped them to determine that in fact some particular behaviors did not require intervention.If your answer—at least for now—is that the behaviors you find offensive are truly more your problem than someone else’s, then you are in a remarkably powerful position. What I mean is that we can always examine and adjust our own attitudes. But as countless individuals in relationships with someone with ADHD have learned, just try and do that to or for another person! (see “I’ve Been Trying To Get Across To Him That…” on Karustis.com).

In sum, for your own emotional well-being, it will very often be advisable to not respond, to work on letting go. A few common scenarios:

The person in the cubicle next to yours rattles the wall, hums to himself. He never seems to shut up, and does not appear to realize that you are there to work, not just to plan lunches. If he does not get fired soon, then we can probably conclude that he has made the situation problematic for both of you, and you need to say something.

A vendor comes into your office once a week. She takes up over an hour on each occasion. For the life of you, you cannot remember the topics of conversation, because she jumps topics around so much and seems so uninterested in what you have to say. This time affects your work production and causes you fairly significant anger.

Your neighbor can be a lot of fun. He is often hilarious with his tales of risk-taking and misfortune, and often lights up a room with his presence. On the other hand, more often than not he seems to not know when to stop. He can get out of hand in his intensity, and once even broke the leg on your coffee table while regaling your dinner party. Equal parts entertainment and agitation.It is not your place, of course, to give a diagnosis, but remember that functional impairment is a crucial marker for ADHD.

In this case something is impairing adequate functioning, for both your associate and you. As Dr. Spock famously advised, Trust yourself, you know more than you think you do. If this person is regularly causing significant problems for you, there is a good chance that she is doing so with many others. Remember, you tried to let go and not respond.Look at yourself. Know thyself, buddy!

So you have decided that you should probably say something, but you are not at all sure how to approach the matter. Take another look in the mirror and consider your own behavioral patterns. Do you tend to be direct? Or are you generally more comfortable hinting at potentially sore subjects? It is acknowledged that such a dichotomy is an oversimplification. Many people who pride themselves on directness would be shocked to discover how often they are both indirect and passive in their actions. Conversely, more self-consciously indirect folk are frequently direct in their communications with selected individuals.

You will also want to be careful about inadvertently coming to diagnostic conclusions. This is easier said than accomplished, particularly for the truly informed person. Sometimes it may just seem obvious to you that another person has ADHD. Although not as common a phenomenon as many people assume, one should pay attention to the possibility of having “ADHD on the brain” and seeing it in people for whom such a label may simply not be appropriate.Consider the relationshipEach relationship is its own culture, so to speak. In some work settings, for example, you may find it much easier to bring up the subject of possible ADHD three months after you have moved to a cubicle on another floor. But in other situations a workstation relocation may not be a realistic option.

Those reading this article are likely to be individuals who already know someone with ADHD. Because we all have limited reserves of emotional energy, prioritization is in order. Do you really have the wherewithal and the desire to broach the subject with the person in your orbit who may have ADHD?

Let’s say your answer to the above question is “yes.” At the very least you feel you must do or say something, for your own reasons. One thing is fairly certain—namely, that the other person will not benefit by you being drained of your well-being. So if you must detach and have less contact with the person, then do so. And try to keep guilt at bay. Trying to maintain a relationship with an adult with ADHD can feel similar to when your car is stuck in the mud and you keep hitting the gas pedal. There is an illusion of doing something, and yet the muck just keeps getting deeper. Since it is possible, even likely, that this person has been (unknowingly) coping with ADHD for many years, you can be relatively sure that he has developed some sort of coping mechanisms. Repeated negative feedback from others, and in all likelihood fairly consistent failures, have probably resulted in a pattern of denial, projection onto others, and more. So try not to take it personally if your efforts to raise the ADHD topic do not appear to be welcome.And yet, and yet—you are an informed and experienced person. You have valuable insights to offer. Don’t slink away in discouragement.

As with parenting, one can never be sure when a seed has been planted. “Ever wonder if you might have ADHD?” Heck, if you can bring yourself to relate your own experiences, you may not even have to ask the question. Simply conveying your own, or someone else’s struggles, may get the message across. Since your purpose is not to attack this individual, there is no need to soft-pedal if the response is “Why? Do you think I might have ADHD?”Given that adults with ADHD have almost certainly received more negative feedback in their lives than those without the syndrome, do not be surprised if your queries are taken as personal attacks. Of course, this is a risk adults run in any relationship, the decision-tree marker being, “Is it worth taking this risk?” Since life offers no guarantees, we cannot know the answer for sure in advance. Do not, however, let the possible negative risk in and of itself make you silent. Your honesty will never be something for which you need to feel guilt.

Do not be overly surprised if your feedback is actually welcomed, even if the immediate response is not so warm. You are not shooting darts in the dark, after all—you know a bit about ADHD. Indeed, since you are likely to be speaking from experience, try to honor the resonance of truth that you bring to this relationship. And so, arm yourself with a few resources, whether they are support/educational organizations such as CHADD, perhaps a good clinician who can perform a full assessment, a knowledgeable physician, and others. Just as you have probably educated yourself, save your associate some additional pain and be ready with whatever resources you are able to offer, should these be welcomed.

A licensed psychologist based in Downingtown, Pennsylvania, Jim Karustis, PhD, has been active in CHADD for many years. “Dr. Jim” is a well-known speaker and writer on ADHD. He is the author or coauthor of many articles, as well as coauthor with Thomas Power and Dina Habboushe of Homework Success for Children with ADHD (Guilford Press). He writes the popular newspaper column “The Family Way with Dr. Jim.” He can be reached through his website, Karustis.com.

http://chadd.org