- Gender Identity and Expression
- Deciding on where I want to fit culturally, socially, and professionally
- Balancing my tendency stay hidden in my inner world of thoughts with the outside world of the senses and social interaction
Last week I finally had a formal evaluation for ADHD with a Board-Certified Psychiatric Mental Health Nurse Practitioner (PMHNP-BC) referred to me by my gender therapist of four years. I’ve been told several times over the years that the productivity tools I design AND the subjects I write about resonate with people who have ADHD, and I’ve suspected I might have the Inattentive form.
- The preliminary verdict: I do match the pattern of having the inattentive type of ADHD.
- The surprise bonus: I also match the pattern of being on the autistic spectrum, but not a form that is readily detected.
Being on the autistic spectrum was a new possibility that I’d never considered, but let’s roll with it and see where this goes!
Also, I received a trial prescription for Adderall, a drug that boosts levels of serotonin, norepinephrine, and dopamine.
The evaluation took 90 minutes over a telehealth session, during which Lisa (the PMHNP-BC) asked me about my education, childhood, and other prompts. At the end of the session Lisa noted that the sensory confusion and social awkwardness I described could fit the autistic pattern, though at a barely-detectable level.
After doing some preliminary review of what autism is like and talking with a few people in the DS Virtual Coworking Cafe, I compiled a list of my personal traits that might fit the autist pattern:
- I have learned how to make small talk with people by analyzing patterns in how people interact, following personal scripts to make it easier to manage an underlying discomfort with talking to people are do not share my interests very closely.
- I have come to realize that my intensity of interest is not often matched by the average person.
- I have long had the impression that I am consistently years behind other people in maturing, a perennial “late bloomer”.
- I have a relentless ability to absorb lots of data so I can find patterns (a form of hyperfocus?)
- I have a general discomfort with being touched.
- As a child, I was confused by people saying one thing with their mouth and another thing with their body language (that description, however, was made in my early 40s)
- I have an obsessive fussiness about documentation and information formatting.
I hadn’t thought that these traits were particularly weird, and had attributed them to other things like:
- being displaced from one culture to another half a world away when I was 9
- traumatic experiences with trust and expectations
- an ingrained tendency to nerd-out on stuff that were unpopular
I know very little about the range of autistic expression, so this was an interesting topic of inquiry as I started generic Adderall as a first treatment for ADHD-I. Would I experience a similar opening-up of my mind as I had with Bupropion?
The Adderall Experience after Five Days
Adderall is one of two types of drugs in the “first line of treatment” for ADHD, an amphetamine that boosts levels of serotonin, norepinephrine, and dopamine. Ritalin is a different kind of drug, a methylphenidate. It reportedly takes from 5-7 days to notice the first benefits as the body gets accustomed to the side effects. So far, I’ve only experience the side effect of having a pressure headache, and the more rare side effect of becoming very sleepy. What’s worse is that my focus has gotten worse as my thoughts seem to fade out rapidly, and it’s more difficult to form them in the first place. A couple hours after taking the morning dose of 10mg, I become so fatigued that I have to lie down for 2-3 hours. I start to feel better around 430PM, but this leaves very little time in the day to get work done. As a result, I am feeling rather behind in all my work after five days of this.
This got me thinking.
First, ADHD and Autism are apparently common comorbidities, and they both are linked to dopamine deficiency. Without dopamine, it’s difficult to be motivated to anything at all. Interestingly, many of my productivity tricks appear to be compensating for low dopamine levels:
- My favorite trick of asking interesting questions about my otherwise boring work harnesses curiosity…which boosts dopamine production
- My inability to remember the first half of a sentence and generally poor working memory make me pretty paranoid about forgetting stuff, and so I use a continuity journal to provide the moment-to-moment linkage between thoughts. Forgetfulness and poor working memory are associated with low dopamine levels.
- The way I discern between true tiredness and bored tiredness is to see if I still feel tired after switching to doing something more interesting; if my tiredness goes away after engaging in “happy bubble time”, then I know it was my resistance to doing boring work. Experiencing novelty and exploring rabbit holes are also dopamine boosters.
Secondly, Autism was a surprise possible diagnosis. Maybe there are MORE SURPRISES lurking in the shadows? On Thursday evening I chased rabbits through the warrens of Wikipedia, reading about other diagnostic possibilities that shared traits with ADHD Inattentive Type and Autism and noted my gut feelings about them with respect to what I know about myself.
AUTISM – The diagnostic symptom that matches my experience is confusion with emotions and communicating, but I think that may be more attributable to the third culture experience that was for me rather traumatic. Also, I am an interactive and communication designer by training, and a requirement of this is good communication skills and a high degree of emotional intelligence; my symptoms seem more environmental than chemical in this light.
AVOLITION – From Wikipedia (emphasis mine): People with avolition often want to complete certain tasks but lack the ability to initiate behaviours necessary to complete them. Avolition is most commonly seen as a symptom of some other disorder, but might be considered a primary clinical disturbance of itself (or as a coexisting second disorder) related to disorders of diminished motivation. This I find HIGHLY RELATABLE, but the Wikipedia article gave me the impression that this is a term that describes a surface symptom, and is not a diagnosis in itself. So, gotta keep looking.
BOREDOM vs MOTIVATION – On a related note, I often glibly describe my life goal as to not be bored, but in reading about avolition I was reminded that boredom is not the same as a lack of motivation. Applying that distinction, I AM ALMOST NEVER BORED. Sometimes I feel TRAPPED or UNMOTIVATED, but by and large I am self-entertaining to the point that it’s a distraction from doing the work “I am supposed to do”.
SENSORY PROCESSING DISORDER – I was a pretty sensitive kid, worried about people not wanting me around, not knowing what I was supposed to do, and generally uncomfortable around people that became frustrated with my inability to speak Taiwanese or Chinese even though I looked like I should. As an adult introvert, I also know that social interaction are really draining; just 30 minutes of any outside interaction takes 4-8 hours to recover. Descriptions of autism mention heightened sensitivities and discomfort with them, so I looked around and found a description of sensory processing disorder (SPD). Most of the descriptions didn’t seem to fit except for sensory modulation disorder, which reminded me of how I had recently decided that I needed to consciously modulate the amount of data I am requesting/communicating from people around me; it only recently occurred to me that maybe people DON’T WANT TO USE ALL THEIR ENERGY to communicate, which was my default setting. Perhaps there was a link? Maybe those 4-8 hours of recovery time I need was related to some kind of sensory processing disorder, but I didn’t experience the debilitating effects. It was like I was looking more for…
SENSORY PROCESSING SENSITIVITY – Another way of describing a disorder is to call it an aberrance or deviation from the norm. Sensory processing sensitivity is not a clinical term but is instead a personality trait associated with being a highly sensitive person or HSP. I remember reading about this in the early 2000s when the HSP was having a moment in pop psychology, and at the time I found it highly relatable (emphasis mine): […] high SPS as a temperamental or personality trait which is present in some individuals and reflects an increased sensitivity of the central nervous system and a deeper cognitive processing of physical, social and emotional stimuli.
DEEP COGNITIVE PROCESSING – The last phrase of the previou entry reminds me of descriptions of introverts and of being a highly sensitive person. It also reminds me of the personal quirks I have that have caused people to label me as an “overthinker”. After trying not to think+worry so much about things for years, I eventually decided to embrace this characteristic and own it; while thinking is not the right tactical choice in every situation, it does have tremendous value in many others. The people who have looked at me like I had something wrong with me were (1) managers who wanted to get something done in a hurry and weren’t part of the solution, (2) people who didn’t have deep interests that they were excited to share, and (3) teachers/experts who did not like or understand the theory of what they were teaching, only knowing rote methods. One of my personal challenges is not to let that get to me and bring me down.
I think I am seeing four main lines of inquiry here, admittedly without the benefit of actual expertise in any of these areas:
- Brain Chemistry with respect to the levels of dopamine, serotonin, and norepinephrine levels. It is theorized that ADHD and AUTISM SPECTRUM are caused by imbalances in dopamine and serotonin. AVOLITION might be here as well.
- High Sensitivity is also associated with AUTISM SPECTRUM with respect to having a reaction that is “too high” or “too low”. However, I’m also thinking that between those two extremes might exist merely “high sensitivity to sensory input” as a normal variation in human traits. People who are more highly sensitive have a different experience than people whose senses are not gathering as much data. And senses are the input mechanism we interpret to relate to the people in the world.
- Deep Cognition is maybe related to AVOLITION and MOTIVATION. Combined with HIGH SENSITIVITY, the ability to think deeply about high-fidelity sensory input to process it into understanding could be described as a form of INTELLIGENCE that is based on personal traits that are above the norm. It doesn’t mean being “smart” or “genius”, I think, but certainly such people would see the world in a different way.
- Social Integration relates to the ability to interact smoothly with society, and is affected by all the disorders and traits I’ve listed. Perhaps this line of inquiry is most affected by EMOTIONAL INTELLIGENCE which might be thought of as the combination of high sensitivity in the form of reading microexpressions and deep cognition over social norms and life experience that lead to empathy and compassion.
As a layperson, perhaps my takeaway is that each of these factors are worth exploring. It may be that of the three, brain chemistry is actually not my primary barrier to being more productive and confident. I know it’s only been 5 days on generic Adderall, but it’s opposite effect on me so far has me wondering if there is more nuanced way to think about it.