Thursday, 5 June 2014

Personal Experiences of The First Steps to Diagnosis

The first stage to solving a problem, is admitting there is one.

In our recent spouse sub group meeting, the discussion focused on experiences and memories of how the long trail to diagnosis and help began.

In adult diagnosis it seems that the symptoms lead to a viscious circle of the relation between a disturbed lifestyle and carrier, fuelling further poor decision making, leading to a higher level of stress which then exacerbates the individual's, in this case mostly husband's, summation of their life situation and makes their decision-making yet worse.

Under the ongoing higher stress level, it often becomes clear to those around at home and colleagues at work that the person has impaired judgment or lacks a certain mature objectivity in dealing with everyday challenges. Behaviour can become more erratic as the combination of stress and underlying psychological challenge (read illness!) fuel this viscious circle.

Generally in our group, the effects lead to either a slow but certain deterioation in family relations, a career impass or failure, or a combination of the two precipitated from either pole , family or workplace.

Other eventual realisations that there were serious issues to address were more subtle, but stilleither from family or work as a source which either precipitated or amplified the situation. As in this account-

" My Husband first noticed that he had real concentration problems when he was accessing interrnet banking using a digital key code dongle. In the two seconds from reading to code to typing it in on the laptop he would simply forget the code, and had to fumble with the key in one hand and the other on the keyboard so he could type the number's in from right infront of his eyes.  At work he had landed a pretty appropriate sounding job, but I felt he was getting used and the type of run around I had known him go through, and could guess had happened before from his CV which was littered with short term contracts, erratic changes of jobs and outright failure with dismissals.

This job was in market research using internet tools, both of which my husband has education in, but it showed a weakness apparently in that he was not getting past the "foot soldier" stage in many jobs, while being able to cope with some situations as a real professional, he often failed to be able to deliver on boring, repetitive tasks or work that demanded a high degree of precision or concentration.  

Previously I had blamed his fiery temperament, a degree of social angst he always had for authority personailities,  and often the situation he allowed himself to get into, but it became apparent after he lost this latest job that he needed help with his concentration , aged over 40 by now.

It seemed to me initially that he had run out of steam in his career, and was sufffering from quite severe stress which was destroying his concentration, and this is probably partly true. However he confided in me that in fact he had always suffered some degree of concentration problems in relation to summative tasks, wrtiting prose or essays and even in writing e/mails he often wondered how on earth he had managed to concoct some of the e/mails he read later or was confronted with from managers and colleagues who were rather frustrated with him at times I hear.

He sought help, and the first pyschologist was really pretty useless,. prefering some obtuse methods and taking a "go slow" approach to getting to know the patient. He traced the history back to an impasse aged 15 to 16 when my husband had unexpectedly had a major set back in his academic progression and had to resit just about all subjects in order to gain university entrance, which from his previous year's straight A in 7 subjects was a surprise.

Luckily the psychologist towards the last of the sessions decided that a referral to a neuropyschologist was worth the trouble, and agreed with my husband that a more structured type of work such as book keeping or purchasing would suiit him better than his previous arena of marketing which is very personality driven.   Had the psychologist not done this, my husband would be to this day probably none the wiser.

The Neuropsychologist ran several basic concentration tests and to my husband's and my own astonishment, proposed that the diagnosis was moderate to severe ADHD.

All the years my husband had been able to compensate for  this ailment when able to work at his own pace, such as in academia but was then hindered later in his career.To me it became also very apparent  also this ADHD was the route for his social angst and often crass if amusing behaviour, jokes and social interactions which many tired of as he grew out of the 20 something set up and tried to get on with adults now his own age and older at work and sports.

  So when he came to the working world, jobs which required him to summate information for example, from  less concrete or more complex sets of data or information, and thosse which demanded a high level og social skills and a thick skin, were an obvious route to failure. Intellectually he was attracted to marketing, but his personality I must say and then his ADHD made it a terrible choice of career.

The story has a happy ending to some extent> he went on a course of ritalin and eventually tolerated the slow release, tarmic absorbed preparation. He made a couple of very logical choices in career followed by a very emotionally driven choice which was coloured by "not having looked a gift horse in the mouth" and allowing himself to be placed in a poor situation having accepted a new seemingly much better aligned job in terms of the family. This he however managed to grasp very quickly, but he did make a misjudgement in terms of the local labour market in terms of negotiating a contact as a way out, rather than bending with the wind and finding a new job.

On the down side I feel myself exhuasted by him. He still lacks some empathy and a level of self control I really want in a partner and father to our children. So much of his personaility is obviously influenced by this disease it is difficult to see what is him and what is disease, and to consider why he reacts unpredicatbly either quite laid back, or very engaged or with emotion and often that is anger.  It is just the lack of an even keel that we experience and we have agreed a "T" time out where he can live away and build his career a bit coming home just on weekends and school holidays, so tiring I feel it has been and so much he needs to get his medication sorted to a level of benefit versus the "speed" side effects he hates.

Right now he is in a bit of a malaise with jobs, being a practical house father while I work and study part time, but his reasoning and ability to present himself and think through applications and the process seem to be much better judging by the letters he asks me to proof read, or the suggestions he makes for family logistics if he is to live away during the week.

Emotionally he has grown a lot but also he has come off ritalin due to him feeling too "geared" by it in his current situaiion as  a laid back house father life style. We see very much that his anger management is impaired, and although he is a little less irritable maybe, he seems more prone to sudden unexpected over reaction and anger. Now we all can confront him more, and realise that this is a diseased part of him, like a boil needing burst and soutred.

However, I am fairly convinced that we can thank the day he couldn't log into his internet banking, a passing remark and resulting appointment for the Neuropsy' and his own interest in getting better for the progress he has made and the building blocks of a longer lasting career he is making so as to prepare for the second half of his working life and take us forward to more financial security and well being."

Other group members offered both even more subtle events that lead to a realisation that there was an illness, while others had far more alarming stories of stormy mood swings, substance abuse and minor violence. All lead to the following two family or individual realisation

1) the afflicted house member had a comparitively immature way of tackeling some sources of stress, some social circumstances > this became more apparent as they grew older, rather contra to the perception of ADHD as peaking in teenagers. In fact it usually appeared to get worse with age to the point diagnosis was perhaps inevitable.

In most all cases the seeds could be traced back to adolesence.

In some of our group of 20 or so participant afflicted, the person seemed to never grow up, but sustained a long term relationship with their spouse. THey could see that their earlier crassness and youthful energy was somethign they didn'grow out of.

2) In others as above citation, the disease showed its head by a pattern of relationship or career turmoil while the diagnosis was sought after a particularily stressful period of the afflicted or their family.

In both types of case, there had been a history of the erratic behaviour and poor tackeling strategies from the sufferer, which "came  to a head" as many agreed was a good way of putting it, rather than perhaps a contrasting pathology whereby a traumatic or stressful event leads to a proximal stress related neurosis. It can then be difficult for the psychologist or physician to see the wood for the trees, when confronted with a post traumatic situation. The long term lack of an "even keel" in life is overlooked as a group of trivial and unrelated personaility quirks, rather than the actual root cause or exacerbating factor of the symptoms the patient presents with.

It is our family help group and indeed clinical contention,  that ADHD in adults is vastly under diagnosed, whereas the exact reverse is true in the medical establishment's approach to teenagers in many western countries now, where disruptive behaviour, lack of self discipline and willfull mischief are often wrongly labelled as having ADHD as the source.

ADHD indeed renders many of life's more challenging situations worse, and can of course help to create very negative situations, while then also hindering the sufferer from tackeling those. Neagtive Stress probably excaserbates the whole cloud of symptoms that really the world around the individual experience far more than the afflicted themselves, and this seems to be characteristic of the ailment in teenagers too, where often they do not have a rational explanation for their behaviour or cannot summate why they acted as they did.

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