Women and ADHD writer’s block: a crash course

From time to time, I suffer from a terrible side effect of ADHD — not of ADHD medication, but of attention-deficit hyperactivity disorder itself. It is highly destructive, perhaps especially for women, and it has a name: ADHD writer’s block.

Girl-with-pen-in-hand-writing

What is ADHD writer’s block, you ask? Well, first you have to understand the science behind ADHD. Now, full disclosure: What I am about to tell you *may* not actually be correct. You see, even though I’m confident that the cause I’m going to provide is right, so far, it’s politically correct just to say ADHD is thought to have that etiology. I know in my bones this explanation is accurate, and I’m pretty sure scientists haven’t thrown their weight behind it definitively only because they’re terrified they’ll turn out to be wrong. Still, this should not be taken as credible medical advice. Having said that, the primary source of ADHD is almost definitely, in a word, dopamine — or rather lack thereof. I think Jessica McCabe explains it best:

Dopamine is a neurotransmitter that’s part of the reward system in our brain. We do a thing; we get a hit of dopamine; we feel good. The problem is, in ADHD brains, there aren’t as many dopamine receptors as there are in the average brain. We kind of have to flood our brain with dopamine to feel the effects. You’ve heard of heat-seeking missiles? We are dopamine-seeking missiles.

The kicker is that estrogen modulates dopamine systems. According to a November 1988 article in the New York Times, “In two studies involving 200 women … the women performed better on tasks involving verbal skill or muscular coordination when estrogen levels were high than they did when the levels were low.” In other words, the higher your estrogen levels, the higher your dopamine levels; and the higher your dopamine levels, the stronger your verbal acuity. Thus, women are left experiencing heightened difficulty expressing themselves, both in conversation and in writing, during certain times in their monthly menstrual cycle and throughout their lives. 

During a bout of ADHD writer’s block, I, for one, feel tremendous amounts of frustration. I cannot overstate how aggravating it is to have half-formed brilliant ideas floating around in your head, but then be unable even to start typing when it comes time to write them down. Sometimes snatches of individual sentences will flit in and out of my mind, but when I set out to complete them and commit them to paper (well, to WordPress, anyway), they come out as gobbledygook, or worse, they don’t come out at all. This was a dangerous game for my brain to play with me back in grad school when I would need to write multiple-page papers on very imminent deadlines. And if you’re a professional writer, like me, it can actually put your career in jeopardy. Not to mention, it’s just plain annoying!

OK, great. But what are we supposed to do about it? Is there even anything to do about it? The answer, fortunately, is yes, there is:

Coffee.

As Devon Frye explains,

Caffeine is most commonly used to overcome sleepiness and increase productivity; in some people with ADHD, it’s thought to combat common symptoms like distractibility and inattention in the same way that stimulant medications do. […] Caffeine works by stimulating the autonomic nervous system — responsible for regulating heart rate and other involuntary bodily functions like digestion. In the brain, caffeine stimulates the release of certain neurotransmitters, like dopamine, and blocks the absorption of others, like adenosine — a chemical linked to sleep and relaxation.

So, there you have it. I usually am able to get my writing work done thanks to caffeine* — caffeine delivered in coffee form, that is. Personally, I get the most potent benefits from a regular coffee drink such as a Starbucks Grande Caramel Frappuccino (100 milligrams of caffeine) with an added shot of espresso (about 64 mg caffeine) thrown in. Of course, your mileage may vary. After all, I’m pretty sure I have the severest ADHD in literally (yes, literally, literally) the whole world; you may need less caffeine to achieve the same effects.

Coffee-with-pen-and-paper

In any case, after about 15 minutes of intermittent sipping, I’ll suddenly notice myself finishing incomplete thoughts and finding the language that will enable me to evoke them. Now, that’s my kind of ‘java-script!’


*For the record, coffee is not the only palliative for ADHD writer’s block. More suggestions on how to combat ADHD writer’s block can be found in Beth Harvey’s February 2016 post on her blog Smart Girls with ADHD.

It’s OK to know your own limit if you have ADHD.

I always hear people talking sympathetically about how ADHD makes it harder to do certain things. But despite that apparent understanding of my disability, the neurotypical party line seems to be that we ADHDers need to keep pushing ourselves to our “full potential,” and that we will be able to do more if we try.

The problem is, neurologically speaking, ADHD makes the very act of trying a challenge in and of itself. 

Double trouble

To quote the abstract of an article published in the journal Molecular Psychiatry in 2011, “disruption of the dopamine reward pathway is associated with motivation deficits in ADHD adults, which may contribute to attention deficits.” In other words, a hiccup in the nervous system of a person born with ADHD results in difficulty paying attention, AND trouble getting motivated to OVERCOME this challenge.

Think about this for a second: Wouldn’t it be sufficiently sucky to have impaired attention OR motivation? Wouldn’t either be enough on its own to have a deleterious impact, in both the short term and the long run for someone who, like any of us, is, after all, only human? I think we can all agree the appropriate answer would be ‘Oh my god, yes.’

Young woman in pink shirt working

Below average

And neurotypical people don’t seem to realize just how VULNERABLE being unmotivated can make you. Decades and decades after the birth of the American Dream, at least in the U.S., Western society continues to value a healthy work ethic above perhaps any other quality. So, it’s one thing to realize you lack the motivation to clean the kitchen, and decide to hold off on doing it tomorrow in the privacy of your apartment; faltering in this way in public, meanwhile, exposes you to the censure of your friends, family, colleagues, etc. It feels sort of like literally everybody else in the world is giving you side-eye.

Furthermore, this problem isn’t confined to questions of productivity; sometimes, even maintaining the ability to go about what to an outsider looks like ordinary daily life can be a significant struggle as well.

Do I speak from personal experience? You bet I do.

Reality check

Between Oct. 25 and Nov. 8, I was visiting my boyfriend in Washington, D.C., where he’s in grad school. Washington is actually a lot like Portland; it’s big on public transportation. But it and I have always had a fraught relationship; the sequencing involved in navigating transit infrastructure is a sizable challenge for me. However, in D.C., I didn’t have an alternate means of transportation, i.e., my car.

Anyway, after a week of walking whenever outside my boyfriend’s apartment, I admitted to myself it was time: I had to take the bus. Unfortunately, this happened to coincide with me discovering that my pharmacist had not given me a full 28 days’ worth of my immediate-release Focalin when I went to fill my prescription for the month. Long story short, I was undermedicated and faced with a task that would require a tremendous amount of effort on my best day, on what was, in fact, my worst.

After about two hours, I managed to work up the motivation to input the information on my iPhone necessary for Siri to guide me to the bus and tell me what to do once I got on it. But to my utter lack of surprise, I was unable to find the bus stop and realized I would have missed the bus even if I had been able to pinpoint where to get on it.

I knew what my parents and my boyfriend would tell me to do: figure out where the stop was and wait for the right bus, or walk to an entirely different stop if necessary. But at that moment, I knew making even that tiny extra effort was totally and completely beyond my abilities. So although it was far more expensive than the bus would have been, I ordered a Lyft. 

It’s inherently empowering to cease pretending to be in denial about yourself and what you’re capable of. The politically correct response to others pushing you to find more motivation within yourself is to express appreciation for their confidence and a plucky resolve to prove them right. However, I’ve had ADHD all my life, so the extent of my neurological stamina has long since revealed itself to me. I know what I can and can’t do. More importantly, I’m AWARE that I can’t do what I can’t do, and I understand WHY I can’t, as well. I and all people with ADHD deserve to live life authentically, limitations and all.

And that is just what I intend, from now on, to do.

 

7 reasons people with ADHD should work from home (ADHD Awareness Month post #3)

Owner of independent startup networking casual comfortable lifestyle at home blue rustic

People with ADHD who work from home get to sit wherever and in whatever position is most conducive to their productivity. (Photo source: Adobe Stock)

When I think about the best choices I have ever made in my life, two come to mind. First and foremost was my decision, three years ago, to quit my steady job at a newspaper and apply to the graduate program in WGSS at Oregon State University. But a close second was deciding not to go back to work after I graduated. 

Don’t get me wrong — I still work; just not in an office, and not for someone else: I’ve chosen instead to work as a freelance writer and editor to support myself as a feminist blogger. This is self-employment. And you know what? It is fan-freaking-tastic. Why? Well…

1. You make your schedule. 

One of my greatest downfalls as a ‘traditional’ employee was my schedule. If you have ADHD, you know what I’m talking about: ascertaining when your medications would be in effect and having to plan — or at least trying to plan — your working time around that. Unfortunately, my pill breaks very rarely coincided with my lunch breaks, because I would always unintentionally wake up very early in the morning — We’re talking 5:30, daily — and my morning medications only lasted four hours, maximum. But when you work at home and are self-employed, you don’t have to contend with human resources forbidding you from starting your workday before 9 a.m.; this is especially useful if, like me, you concentrate best in the morning. Also, this builds flexibility into your schedule for the doctor appointments and monthly (and, inevitably, often more than monthly) visits to the pharmacy that come with the territory of having ADHD and taking medication for it. 

2. You choose your position — your sitting position, that is.

Less noticeable to others, but still highly impactful to me, was the unspoken expectation that I would, you know, sit in a chair. When I was working at the newspaper offices, I often interviewed sources over the phone, and apparently, I — entirely unconsciously — used to lean back and twirl around in my swivel chair while doing so. It drove my boss CRAZY. What he didn’t realize, though, is that people with ADHD have the symptomatic tendency to sit in odd positions; that’s how we help ourselves concentrate. (I’m not entirely convinced that it would have made a difference to him had he known, though, to be honest.) At home, I can work sitting on a couch or lying face-forward on my bed under my weighted blanket, and no one can say boo.

3. You have fewer stimuli to filter out.

Newsrooms are obviously an extreme example of this, but traditional, brick-and-mortar offices are hotbeds of cacophony. That’s just the way it is. Ringing phones; copy machines; water cooler talk — you get the idea. Suffice it to say that such an environment is anathema to the ADHD brain. When working from home, by contrast, the only sounds you have to grapple with are the ones you make (see below), which is essential, because “Problems with external distractibility (noises and movement in the surrounding environment) … can be the biggest challenge for adults with ADHD.”

4. You have more freedom to listen to music/use alarms.

A weird thing about ADHD is that dealing with multiple stimuli of external sources, filtering them out and concentrating on your work, is virtually impossible; however, you can enhance your productivity through the use of one, single stimulus: music, of your choosing. I know from personal experience that listening to classical music can have a tangible positive impact on focus; I prefer baroque musicians, including Bach and Albinoni:


On a related note, while phone notifications and computer alert tones are distracting for EVERYBODY, for an ADHD people, such distractions are actually welcome when we have pre-set them to remind us of appointments and upcoming responsibilities. (Additional pro tip: I set my computer preferences to have my MacBook announce the time every half-hour. Try it! You’ll be amazed at your newfound punctuality and time-management.)

5. You aren’t required to sit through seemingly endless meetings.

Raise your hand if you have ADHD and have ever honestly thought you might die while being forced to sit through a long meeting. … Ha! I knew I wasn’t the only one. As I mentioned above, people with ADHD have a propensity to sit in odd positions and to move around if they are required to have sustained attention and direct it to one specific, often profoundly dull thing. Working at home, however, circumvents the requirement to remain stationary of that trope of brick-and-mortar skilled employment, the sit-down meeting. And it’s a good thing, too, because “Adults with the hyperactive presentation of ADHD often do better in jobs that allow a great deal of movement.”

6. You don’t have to contend with rush-hour traffic on your way to and from work.

This reason is pretty self-explanatory. Goodness knows we were driving distracted before ‘distracted driving’ was a thing. Luckily for us, no workplace outside the home means no driving to work, which means no risk of getting in a collision while driving to work — or exhausting all of our remaining focus trying to avoid it. 

7. You get more time with your pets.

This reason is relatively straightforward, as well. Not all of us have officially designated service animals, but pets regardless provide a genuinely crucial service. First of all, people with ADHD, including and perhaps especially young women, often have comorbid depression (I know I do), on which dogs have a proven ameliorating effect. And the petting of furry animals, such as cats and rabbits, has been shown to slow one’s heart rate and reduce anxiety. Free of the distractions of feeling depressed and anxious, it is much easier to get your work done! Don’t already have a pet? Adopt one from your local animal shelter. Easy!

woman working on tablet / laptop at home. Dog helps her

ADHD people who work from home get more time with their pets, reducing depression and anxiety and thereby improving concentration. (Photo source: Adobe Stock)

My love-hate relationship with Big Pharma

As almost every single person I have ever met knows (because you better believe I tell them!), I have chronic attention-deficit/hyperactivity disorder, better known as ADHD. Usually, those who are assigned the sex “female” at birth are diagnosed much later than their male peers, if at all. Boys with ADHD tend to be hyperactive, while girls often exhibit symptoms of inattention, which are less noticeable to an elementary school teacher or parent with no formal training in psychiatry or neuroscience. I, however, was both hyperactive and inattentive.

Getting diagnosed at age 5 enabled me to start receiving treatment for my disorder even before I started kindergarten. That treatment came in the form of Ritalin, a central nervous system (CNS) stimulant medication. I am not going to attempt to convince you that my parents and pediatrician opting to medicate me was healthy, moral, or necessary. No, I am going to skip that full-disclosure part of most ADHD narratives and get right to the point.

Big Pharma is not doing too much; it is not doing enough. The longest-acting stimulant medications — stimulants being the first-line pharmaceutical treatment for ADHD — last about 12 hours.

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That is all: Twelve hours a day.

I, for one, am hard pressed to function as a productive member of this (capitalist) society in 12 hours a day. Moreover, in fact, that whole 12-hours-of-effectiveness thing is not entirely accurate; generally speaking, these drugs take effect after 30 minutes or more (in my case, 40 minutes on the dot). Bearing in mind that many people with ADHD take short-acting, immediate-release versions of these stimulant medications as “booster dosages,” as well, we are talking one missed hour a day.

It may seem that as long you are motivated, 11 hours is plenty of time to do all the activities that comprise one’s day. I hate to say it, but frankly, that is wrong on multiple levels: First of all, one need only consult the latest data from the U.S. Bureau of Labor Statistics to see the average length of time spent doing things such as eating, working, shopping, and cleaning exceeds 11 hours. Additionally, one of the quintessential realities of ADHD is that people with it symptomatically experience a lack of motivation. In my case, that lack of motivation is a frequent guest-star — this, despite the fact that I never, deliberately or otherwise, refrain from taking my prescribed treatment regimen in its entirety.

I challenge Big Pharma to step up its game, because amid all the accusations that it is contributing to the overmedication of children, the fruits of its labor — the major CNS ADHD medications — aren’t even close to consistently, sufficiently medicating us, adults.

 

ADHD is a Battlefield; Meli is an Ally.

If you’ve ever heard of ADHD (or, more likely, ADD), you’ve probably also heard that people usually get over the disorder when they grow up. But I’m going to let you in a little (horrifying) secret: Many people don’t get over ADHD, but get more ADHD when they enter adulthood. And there is a name for these people: women.

Members of the ADHD medical community have observed for decades that women seem to experience an amelioration of ADHD symptomology during pregnancy. (This is great, because physicians will tell you that you should only continue taking ADHD stimulant medication while pregnant if you feel that the benefit to you, the mother, outweighs the risk of harming your baby in utero; basically, the implication is that you’d have to be a sociopath to continue your treatment regimen if you have a bun in the oven.) However, it has also been observed that women seem to experience an exacerbation of their symptoms during menopause, and as young adults every few weeks or so.

As it turns out, studies in recent years have shown, an average woman’s mental acuity is proportional to her estrogen levels. An ADHD woman, of course, struggles with inattentiveness and lack of focus just as a baseline. Thus, she may be able to get by and even thrive during the first half of her menstrual cycle each month, thanks to medication and/or therapy of some kind. But when she hits her PMS week, her hormone levels deplete, and stay low until the end of her period, leaving her feeling out of it for virtually half of every month.

I mentioned in my last post that I’ve been empowered by acknowledging how real — and how limiting — my ADHD has always been. It became particularly acute starting around age 18, and now we know why: In a word, hormones. If I weren’t aware, or didn’t believe, that my disability has a biological foundation, I would inevitably suffer even more, because I would be left believing that the cause of my troubles were some flaw in my character, my quality as a person. I can’t adequately express how significantly my mental health has improved since I’ve learned to acknowledge my own limitations (and their neurological basis) and forgive myself for not always being able to exceed everyone’s expectations.

But that’s only half the battle. To win that battle, you need allies. I have at least 20. Let me tell you about one of them.

Me and Meli, May 8, 2015

Me and Meli, May 8, 2015

This is Meli. She and I were roommates at the University of Oregon’s Living-Learning Center residence hall during my freshman year of college. We definitely did not have a perfect roomie-roomie relationship back in 2009, but with every passing year she and I have grown closer and closer, so much so that today each of us considers the other one of her best friends. There is a lot to love about Meli: She is adorably small in stature and unabashedly nerdy; I can’t do justice to her particular syntax, but trust me, it’s completely unique and utterly hilarious. Above all, though, I love Meli because she loves — and supports — me, ADHD and all.

About two months ago, on the second Friday in May, Meli accompanied me on a trip to Newport (one of Oregon’s coastal towns) for the wedding of my friend Dana to her longtime boyfriend, Nick (Dana and Meli get along really well, which isn’t surprising, because they are both awesome), in which I was to be a bridesmaid. The members of the wedding party had all chipped in to rent a beach house for two nights. Around 10:30 p.m., after everyone had returned from the rehearsal dinner and a complimentary boat ride around Newport Bay, Dana knocked on the door of the bedroom Meli and I were sharing to inform me that in about 10 minutes we were all to congregate to go over the logistics of the wedding day. “Is that okay?” she asked. “Yes,” I deadpanned. “As long as you understand that I am heavily unmedicated and will not retain any of what you say.” Dana, of course, gracefully accepted this, she being an ADHD ally herself, though we were left wondering what to do in light of the current situation. But then, Meli chimed in and gamely offered to attend the confab as my proxy and take notes on the scheduling and my responsibilities for me to read the next day when I was medicated once again.

Now, granted, I was pretty emotional already, seeing as how I was about 15 hours away from witnessing the nuptials of two incredible people, but I almost burst into tears because of what had just happened: Rather than chiding me for being lazy, or even encouraging me to have some faith in myself, Meli simply accepted that I couldn’t handle the task at hand, and offered to do it in my stead. Why? Because she could. It was a far cry from my senior year of high school, when a girl who at the time I counted as one of my closest friends told me that I had done a good job “not saying anything stupid yesterday.”

A true ADHD ally embraces an ADHD woman for all that she endures, and for all that she is unable to endure. My friends support me when I push myself, and support me when I don’t. Meli is the epitome of an ADHD ally. I’m hanging out with her tonight, in fact.

I can’t wait.