Check out this article about studies done at the University of New South Wales about how you can develop stronger impulse control by getting in the habit of using your "wrong" hand more often.

I'm going to try it. I'll let you know how it works.

Ego Depletion/Decision Fatigue: Some Helpful Reading

I've mentioned the concept of decision fatigue on this blog before, and how it relates to ADHD...but as a quick refresher, ego depletion is a new idea based on evidence psychologists are observing about human nature.

Basically, the new evidence seems to suggest that what we might call "willpower" or executive function (i.e., what those of us with ADHD seem to have so much trouble with) is a real, traceable neurological phenomenon related to our brain's metabolism. What's really important about this is that it means that phrases like, "mental energy," or "emotional resources" aren't just cute turns of phrase, they're speaking to a concrete biological reality.

So what depletes our willpower? According to the research, being tired, being hungry, having to make a lot of decisions, having to exercise willpower in the face of impulses, and feeling anxiety or social rejection.

I hope to see someone with real credentials dig into the question of ego depletion in a brain that already has limited executive function, but I don't expect many surprises there. I'd be willing to bet the strength of the ego has a lot to do with a person's dopamine levels. This is the sort of science that's going to blow a lot of holes in our ability to continue being judgmental about people's "character," but you won't see me crying any crocodile tears over that fact.

Anyway...here's some good reading on the subject:

Good ol' Wikipedia

A therapist's rundown about ego depletion and some advice.

Ego Depletion on the "You Are Not So Smart" blog

I came across this article today:

Unprecedented Reliable Data Proves That ADHD Is Overdiagnosed

So, to summarize, someone decided to go out and do research about the rates of ADHD diagnosis and test the common notion that ADHD is wildly overdiagnosed. They set out to determine whether therapists diagnose ADHD according to heuristic judgements (vague stereotypes of ADHD, basically) rather than established diagnostic criteria.

I have to say, I'm grateful that the reporters included the study's methodology:

"The researchers surveyed altogether 1,000 child and adolescent psychotherapists and psychiatrists across Germany. 473 participated in the study. They received one of four available case vignettes, and were asked to give a diagnoses and a recommendation for therapy. In three out of the four case vignettes, the described symptoms and circumstances did not fulfil ADHD criteria. Only one of the cases fulfilled ADHD criteria based strictly on the valid diagnostic criteria. In addition, the gender of the child was included as a variable resulting in eight different case vignettes."

The thing is, though, what's actually contained in those four case vignettes is important to the interpretation of this study. Presumably, at least some of the three "not ADHD" vignettes were chosen for the study because they did resemble ADHD prototypes. They were red herrings, in a sense.

But what about the opposite kinds of cases? What about cases that don't look like prototypical ADHD, but do fit the diagnostic criteria? I don't see how there could have been any room in this study's methodology to test those kinds of circumstances at all. That leaves us with no data about how often it happens that someone has ADHD, but gets told that they don't. So...if you're only testing prototypical cases, you cannot possibly be proving statistics of "over" diagnosis, only statistics of wrongful diagnosis...and even then, only one particular kind of wrongful diagnosis.

The Common Ground In ADHD Treatments

I'd like to point you all in the direction of this forum post over at addforums.com.

User bof00 has put together a brief sort of thesis about how, basically, a very specific brain process called BDNF (brain-derived neurotrophic factor) is at the heart of all ADHD treatments. He (she? sorry, bof00!) then cites sources indicating how everything from exercise to omega 3 to meditation to medications have been proven to up the BDNF.

So what is BDNF?

Basically (and this is my half-assed layperson's understanding, mind), BDNF is what makes neuroplasticity happen. Neuroplasticity, of course, being the brain's ability to develop itself into something different, to grow and improve through all stages of life.

Anyway...go read it!

The dangers of the "rewards system"

How many of you folks out there in ADD land have ever tried this trick: you know you have to get X done today, you don't want to do it/know you will procrastinate on it, so you decide that you will give yourself a reward of some kind when you do.

This is a common coping strategy for ADD, and one that I see a lot of people try to employ, including myself. However, I don't know of anyone with ADD who's ever had good luck with it. If you think about it for a minute, it's easy to see why: if our neurology makes us naturally bad at delaying gratification, why would we think that another form of delayed gratification is going to somehow make us be more effective?

I think those of us who try this tactic do so because we've had some well-meaning parent, relative or teacher try to push it on us at some point in our youth. File that under "things that work for normal people," because most neurology-typical people ARE motivated by delayed gratification, so adding to the gratification adds to to the motivation.

Alas, not so for those of us with ADD. However great the gratification in the future, the future is essentially nonexistent for all that our brains can emotionally conceive of it as a reality. We are like the children in the classic experiment who can't wait five minutes to eat the marshmallow, even knowing that we will get a second if we wait it out.

The Now is real for us. The Not Now is something we can only understand as a concept because the mechanism in our brain that should make it feel real is underactive.

So...stop trying to reward yourself later. A far better solution, when you can do it, is to find a way to reward yourself during. How about a piece of chocolate to eat while you work on that boring report? Creature comforts have become a major source of strength for me when it comes to coping with my ADD. Favorite movies on my laptop while I wash the dishes, favorite music playing while I do my writing, snacks while I attend to my neglected e-mail...even something as simple as wearing a favorite shirt or sitting in a favorite chair while performing an unwanted task can have a surprisingly positive effect on my ability to motivate myself to get things done. The same simple, childlike parts of my brain that can't be motivated by something big later can be motivated by something small now.

And always remember...if it doesn't help you, don't bother with it.

Decision Fatigue

This article was shared with me by a friend of mine a little while back, and I've been wanting to share it with all you folks in ADD-land ever since. It's from the New York Times and it details an interesting phenomenon that the author dubs "decision fatigue."

Basically, the idea is this: the more decisions you have to make in a day, the more your mental energy gets sapped and, as a result, the harder it gets to make those decisions well.

Not exactly rocket science, is it? Anyone with ADD understands the problems of limited mental energy, but this article makes a solid statistical, anecdotal and scientific case for decision fatigue being a lot more than some vague, quasi-imaginary concept. Mental energy is real energy, connected with one's metabolism, which is why you can restore it by snacking

Here's the kicker for folks like us: mental energy gets sapped at much higher rates whenever the decisions you're making require forcing yourself to do things that go against your impulses - and after all, what is any task, on a mental level, but a series of intricate decisions?  Now, let's just couple that with certain facts about ADD neurology...namely, the fact that we are naturally more impulsive and driven by impulse because the mechanisms in our brains meant to control impulses are underactive.

What it comes down to, in the end, is this: if you have ADD, mental energy is a precious resource. You have to ration it out carefully in the course of a day and learn ways to replenish it as you go.

I think I'd like to do a series of personal experiments along the lines of learning to minimize decision fatigue. I'll confess that at the moment, I'm still feeling pretty high-on-life from the new medication and that's caused me to neglect a lot of my usual regimen of natural coping methods, but now's as good a time as any to get back into the swing of things. I'll keep you all filled in as I go.

ADHD And Disability Accomodation

As some of my readers may know, I worked briefly as an employment specialist for a non-profit company working with people with mental illness. One of my responsibilities was to work with employers on negotiating "reasonable accommodation" (as per the Americans With Disabilities Act) when it came to mental health disabilities.

I was no expert and frankly, was pretty well out of my league at the job, so I can't claim to have perfect advice in this area. But I still think it's a useful discussion to have and one I don't see many people with ADHD having.

What, exactly, are "reasonable" accommodations for people with ADHD on the job site?