Predominantly Inattentive

January 12th, 2009  |  Published in adhd, ruby  |  2 Comments

So, the purpose of the whole NetNewsWire feed graphing thing was to give me a handle on something that claims a lot of my attentional resources. Having information like that is important to me because I’m, as my old boss at the high school might have said, “ADHD as hell.”

Before going much further, and so the terms are established, when I say “ADHD” I’m going by the DSM-IV’s definition, which does not distinguish between “ADHD,” “ADD,” and “Adult ADD,” but rather puts everything under “ADHD” then breaks that down into three classes:

  1. Combined Type: symptoms related to both inattention and impulsivity are present

  2. Predominantly Inattentive Type

  3. Predominantly Hyperactive-Impulsive Type

I’ve never manifested symptoms of hyperactivity, I’ve periodically manifested impulsivity, and I’ve always–for as long as I can remember–consistently displayed most of the nine symptoms of inattentiveness. I’m clarifying terms because people have conflicting ideas about ADHD, who can have it and what people who have ADHD act like. It’s entirely possible to be externally placid and have ADHD. It’s also entirely possible to demonstrate a capacity for extended periods of intense concentration and have ADHD. I also think it’s worth noting that I don’t look at ADHD as some sort of sickness I need to “cure.” It does create its share of issues which have to be addressed, but it also confers some advantages I wouldn’t trade away. My experiences with ADHD medication helped me realize the ways in which I’ve benefitted from being out on my end of the attentional spectrum.

That’s my way of hinting that I don’t need to be encouraged or reassured, thanks.

Adaptation

People with ADHD learn all sorts of ways to cope with their inattentiveness or impulsivity.

Depending on the type of impulsivity you’re talking about, I’ve been pretty successful in cultivating habits to curb that. They aren’t always the most socially adaptive, because they involve a sort of delaying check loop that can come off as reticence. They can also be sort of off-putting, because I tend to hold my fire in impersonal communications–e-mail, IM, bulletin boards, talkbacks–until I feel like I’ve checked my initial assumptions adequately. That can result in a barrage of fact-checked data out of proportion to the rest of the conversation. nerdmeyr once referred to me fixing my “Sauron-like gaze” on problems I’m out to solve, and I think she was picking up on a combination of that check loop and hyperfocus–another adaptation people with ADHD tend to come up with. An imperative to make sure I’m about to say or do the right thing in combination with a need to turn off big chunks of my external awareness to get through the process of thinking something through can make for some seemingly monomaniacal excess sometimes.

Another way to cope is, of course, medication, which I tried for a while. The meds I was on were spiking my blood pressure, ruining my sleep and making me feel depressed. I don’t want better focus because it’ll make me a better worker … I want better focus because the quality of what happens in my head matters to me, and I want it to continue to matter to me until I’m dead. I do not, however, want to drag a hand-written prescription down to the pharmacist once a month until I am dead, and I suspect that something that pushes my systolic blood pressure from its unmedicated 95-100 up to 135-140 will probably make me dead that much faster. (If you’re curious, the medication in question was Adderall, which is tightly regulated because it’s a time-release amphetamine.)

The thing is, if I’ve cultivated habits of thought and behavior that have helped me curb the impulsive elements of ADHD, it stands to reason that I can curb the inattentive elements, too. In the absence of medication, personal research and professional opinion suggest a few categories I can improve on to rein in my brain:

  • Diet: Studies have shown improvement in people with ADHD who avoid carbohyrdates and take in more protein.

  • Supplements: Fish oil and iron are supposed to help. There are a number of other recommended vitamin supplements, depending on the type of ADHD one has.

  • Sleep: Consistent and adequate

  • Exercise: Vigorous and often

Life coaches who work with people who have ADHD also recommend establishing a routine for all sorts of things, ranging from when the work day starts and stops to where keys, watch and wallet are deposited at the end of the day. But because I’ve spent years approaching most activity as a matter of spontaneous interest, the focus on diet, exercise and routine changes the way time works.

Time Is Different in Here

ADHD can manifest as serious procrastination–islands of intense activity in a sea of unstructured, unmarked time. Procrastination is o.k. in some contexts and for some people, but it becomes less adaptive as complexity is introduced. If all you do is get up at the last minute, rush through the morning, sprint off to work then sit around reading MetaFilter until 3 p.m. then guiltily sprint through work before calling it quits and going home to do whatever seems shiniest until you’re too tired to stay awake, procrastination works. Add exercise first thing in the morning, adequate time to prepare good meals, planning to get the groceries and supplements, care to go to bed early enough to rest well before getting up in time to exercise, and procrastination becomes problematic. Especially if you’re inattentive enough to miss details as you rush through whatever.

To people who do not have ADHD, all of that must seem like the commonest of common sense, but to someone used to living in a kind of time flow that’s not reflective or regulated–where there’s a seemingly limitless pool of unstructured time–it requires some shifts in thinking and behavior. Time has to become finite and each activity has to evaluated in the context of a matrix of activities. These patterns of thinking have to be learned by everybody, but some people are cognitively equipped to learn them passively, while some of us have to learn them actively, and maybe after years of frustration that we don’t share some common understanding other people have.

The process of evaluating how time gets spent looms large in a lot of ADHD literature. ADHD coaches encourage their charges to make sure they keep lists, engage in daily planning sessions, be more mindful of the passage of time and find ways to break out of extended periods of hyperfocus before a single task consumes all their time. Having dabbled with self-hypnosis and having been through a course of cognitive behavioral therapy, I perceive two levels of purpose with all that time tracking and focus marshaling:

  1. People with ADHD need the help timers, lists and reminders provide on a practical level.

  2. There’s value in constant, syllogistic repetition of a goal.

My experience with ADHD medication showed me that the issue isn’t one of a “medicine” somehow “curing” a condition. What it did do was provide a way to hold a thought just a bit longer. When my thoughts centered around ways to self-organize, the medication was beneficial. When they didn’t, the medication generally seemed to intensify the sort of hyperfocus ADHD people cultivate. So a big part of dealing with ADHD’s harmful symptoms involves cultivation of a second, persistent level of awareness; a soundtrack that more or less continuously says things like “I’m putting this off because I want to move on to something else, but that’s something I do because I have ADHD. I should stop putting it off or I won’t have time to do it well,” or “I know I promised to do that chore, but I’m rationalizing not doing it for a while longer. I know I don’t often make very realistic estimates of how I use my time, so I should stop and reassess my estimate in this case,” and on and on.

I don’t think about this stuff because I’m desperate to fit in with all the monochrons, but because there are only so many hours in the day, and unwise use of them leads to lots of things being done poorly instead of perhaps fewer things being done well. As I noted earlier, this isn’t just about housework or chores. It’s about sustaining all sorts of endeavors — creative, interpersonal, cognitive, physical and spiritual endeavors.

Self-Coaching

On the workaday level, I’ve used a small inventory of things to help me rein in my attention:

Timers

I have a digital egg timer, but I’ve been using the Mac application Minuteur for several years. It used to be free, but it now costs 8€, Its advantage over an egg timer is that it can be set to blank the display when it goes off, providing +5 or +10 snooze buttons. It can also save a list of common time periods, so it’s easy to set up labeled time lists.

Another timer app I own and use sporadically is Red Sweater’s FlexTime, which makes it easy to create timed routines. Each block of a routine can start or end by playing a sound, displaying a message on screen or running a script. I’ve set up routines for things like “an hour of work,” so I can get prompts to do ten or fifteen minute bursts before cooling down for a few minutes. My initial temptation was to program my entire workday routine, but that sort of rigidity makes it hard to get back on track when the inevitable disruption comes along, and then the whole thing falls apart.

I use timers for a few things:

  • to break up time during the work day. It’s easier to stop procrastination when work is broken up into chunks then interrupted by design for small periods of time.

  • if I absolutely cannot abide the thought of keeping at what I’m doing, a timer helps me put limits on off-task time.

  • to remind me of things I’d otherwise forget about: stuff like the time my tea has been steeping or my coffee has been sitting in the french press. I also set timers for the tea pot, even though my tea pot whistles. Sometimes its whistle doesn’t get through the perceptual wall.

Right now my most used fixed time alarm is one I’ve set for 10:15 each night. It reminds me to wrap up what I’m doing and start winding down. I use my iPhone for alarms, since it allows me to save alarms for repeat use.

Note Cards & Sticky Notes, Lists

Keeping a pad of these handy helps me deal with external interruptions. Stuff that happens when I’m absorbed in a task is easy to forget despite my best intentions. I’ve found myself using the Mac’s “Stickies” app the most, just because it’s right there and it’s persistent between restarts. Paper often disappears in the clutter or stacks up.

I also keep beginning- and end-of-the-day inventories: Keeping a simple log or journal that’s distinct from my calendar or main to-do list helps me reinforce what I hope to accomplish or need to remember for the day.

Observation and Reflection

Which brings me partially back to the matter of charting what I’m reading.

Before I started reflecting on what it meant to have ADHD, my feed reader was pretty busy. At the peak of things, I was tracking close to 200 feeds along with a few mailing lists, whatever books I was reading at the moment and a pretty healthy movie-watching jones. A lot of factors combined to slow me down–having a kid makes for less ambivalence about holding a job, or willingness to suck at it. I still wasn’t being very selective. I had a giant pool of inputs, and even if I couldn’t absorb quite as much of it I was still approaching it as an undifferentiated mass of interesting things.

Medicated, I still didn’t do much thinking about what I was taking in. My thinking wasn’t really centered on behavioral optimization so much as it was about doing everything I was supposed to then luxuriating in unstructured time as I earned it.

A few months ago I made it a point to drastically scale back commitments so I could free up the space to contemplate what I was doing and why I was doing it. The whole apple run-in was sort of helpful, because it further wrecked my routine and caused me to forget about my medication for a few days, which is how I learned just how high my blood pressure was running.

I was pretty nervous going into the holidays. All the things that must be done combined with a lot of socializing makes for a pretty enervating time of year. I dropped the medication, though, and decided to see what happened.

Curiously, my mood got a lot better. I was half-fearing some sort of Flowers for Algernon-like descent into fog, but that isn’t the first thing I noticed. Rather, I noticed it was easier to get to sleep at night and I felt a lot more loose in social contexts. It was noticing that the medication had seemingly buttoned me down further than I was comfortable with that encouraged me to think about adaptive behaviors I’d already cultivated before medication, and how if I had self-corrected issues of impulsivity, it was probably in my power to self-correct issues of inattentiveness.

It’s Not an Affliction: It’s an Excuse to Hack

As I noted earlier, a big part of dealing with the bad parts of ADHD involves cultivating a habit of thinking about having ADHD. The lists and timers help with that, but they don’t deal with the quality of activity … they just act as reminders to do activities at appropriate times. Part of the reason I hate drifting off on tangents is the way I leave a trail of half-finished projects and ideas in my attentional wake because I’m wasting time on things I realize I will not, ultimately, be happy I bothered with.

Last week I noticed a piece of software that gave me a few notions:

Optimism seems to be aimed at people who suffer from depression, providing a daily log of things like how well one ate, how much sleep one got, negative behaviors one might have engaged in that exacerbate depressive symptoms, etc. etc. It got me to thinking about how useful it would be to track attentional demands.

This evening I scaffolded a Rails app to help me do that. Right now, it’s built around tables for:

  • interests

  • Web domains:

    • Web pages visited

    • feeds read

  • projects

I’m using habtm relationships between the tables to reflect the way projects can involve multiple interests.

The core functionality will involve:

  1. Listing interests — things I want to learn about, think about, read about

  2. Listing projects — the practical manifestation of my interests

  3. Tracking reading — the raw material I feed my attentional resources

I’ve got the code to track my reading both on Safari and in NetNewsWire, with Safari history going into a sqlite database for processing … it just needs to be plugged into Rails. There’s also Google’s search history RSS, which provides an overview of topics searched as well as links from results visited. Considering the bulk of time I spend somewhere in Google:

Top 15 Domains in Safari History

… it seems like something worth keeping an eye on.

“1.0” functionality will involve setting priorities on my interests and projects, then making tools to easily compare how those interests stack up against my reading habits. I’ll keep it in the domain of online activity initially, but I can see eventually adding logging for reading away from the computer.

That’s what I’ve got for now.

Responses

  1. gl. says:

    January 14th, 2009 at 7:58 pm (#)

    this is -so- awesome. thanks for being willing to share such a personal analysis.

  2. Patrick says:

    January 23rd, 2009 at 7:38 am (#)

    Hi,

    could you elaborate a little bit more on the process of storing Safari’s history into a database and graphing it with Google Charts?

    Thanks in advance

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