So You Have, or Suspect You Have, ADHD

I recently earned the dubious honor of being named a Quora Most Viewed Writer in the topics “ADHD” and “Adult ADHD.” As I understand it, that has more to do with the fact that I write about these topics a lot than it does with the actual quality of my answers.

As one might expect, the most commonly-asked questions in these topics can be grouped into a few basic categories. There are the medication questions. There are the closely-related “alternatives to medication” questions. There are the “is this a symptom/is so and so ADHD” questions. And so on.

The biggest category of questions, by far, is the “I’ve just been diagnosed with, or suspect that I have, ADHD” category.

I find myself fielding answer requests to questions in this category over and over. Since my answers to the most common iterations are always the same, it made sense to list them somewhere for posterity. Think of this as a FAQ for Folks Who Have, Or May Have, ADHD and Holy Crap What Does That Even Mean.

I took an online test and it said I probably have ADHD. What do I do?

First: No online test is sufficient to diagnose you with ADHD. For that, you need a doctor, psychologist, or similar professional with experiencing in diagnosing ADHD – and you’ll probably need to take one or more tests that can’t be administered online. So take that online result with a grain of salt. (After all, you can just as easily find an online test that will “diagnose” you as an Idaho potato or as Dorothy Szbornak.)

If you took the test because you suspect something is up with your brain and you wonder if ADHD is its name, schedule an appointment with your primary care doctor (or your psychologist if you happen to have one already). Bring along the results of your online test. They’re not official, but they can serve as a good conversation-starter.

Talking to a doctor is optional. If you don’t feel like the answers you gave on the test or its results are any big deal, you don’t have to make an appointment.

If you think the results are a big deal but you cannot talk to a doctor for any reason, Googling “non-medication treatments for ADHD” may give you some ideas about how to rearrange your life to better accommodate your brain. The good part of these interventions is that they often help people stay more organized and focused whether or not they have ADHD. So even if you don’t qualify for an official diagnosis, you’ll still be doing something good for yourself.

How did this happen? Did I give myself ADHD? What did I do to deserve ADHD?

ADHD is a neurodevelopmental difference: It is a specific type of way the brain forms in utero that is different from the way most brains form. Your brain was structured for ADHD before you were even born.

ADHD doesn’t happen “to” people, any more than having blue eyes or particularly small hands happens “to” people. You can’t give yourself (or your baby) ADHD, nor can you “catch” ADHD from some outside source.

There’s a lot we don’t know about how or why, exactly, ADHD forms. There does appear to be a genetic component – namely, if you have one or more relatives with the same symptoms you have (whether or not they were ever diagnosed), there’s a higher chance that you’ll have ADHD too. But some cases of ADHD appear even when there’s no obvious genetic link.

What we do know is that ADHD is not a punishment. You didn’t do anything to “deserve” it, and you can’t do anything to “deserve” not having it. ADHD is not a statement on your worth or value as a human being.

Does this mean I have a mental illness?

No. ADHD is not a mental illness.

As mentioned above, ADHD is a neurodevelopmental difference. It is a difference in the structure and function of your brain as compared to most other brains. It’s a very specific difference, once we can study and measure and identify pretty clearly through various tests. Most importantly, ADHD’s status as a neurodevelopmental difference doesn’t change based on how you feel about having it.

Why do your feelings matter? Because mental illnesses are typically defined as conditions that cause “clinically significant distress” to the person who has them.

In fact, this is how psychiatrists and psychologists draw the line between a “personal quirk” and a “mental illness.” If the person isn’t distressed by the symptom, they aren’t likely to be diagnosed with a mental illness. The “illness” part happens when the symptom or quirk starts to interfere with your daily life, even when you don’t want it to.

ADHD can certainly feel like a mental illness, especially if it’s not treated. After all, if you could sit still or concentrate on demand, you probably wouldn’t be looking for answers about why you can’t do that. But even when your distress is managed – usually by managing symptoms – your brain structure will still be different in ADHD’s unique ways. You will still have ADHD; you’ll just have managed ADHD.

Untreated ADHD can also cause or contribute to a number of other mental and emotional conditions, like depression and anxiety. Some of the symptoms of ADHD, like the inability to concentrate or to get started on a task even when you want to do it, also appear in conditions like PTSD for some people. Some people find that they can’t get a reliable ADHD diagnosis until they deal with other conditions first.

What if the doctors want to put me on medication? Aren’t ADHD meds basically meth?

First: Whether or not you try medication for ADHD, and which medications you try, is between you and your doctor. Your doctor will not follow you around and shove pills down your throat.

That said, ADHD meds come in two basic forms: stimulant and non-stimulant. Stimulant medications for ADHD are generally Schedule II controlled substances, which means they’re subject to a lot of rules and restrictions in the United States. (Medications on Schedule II are understood to be addictive, but also to have useful medical properties, so they’re not banned for all uses like those on Schedule I.)

ADHD meds and methampetamine are both potentially addictive stimulants, but the similarity ends there. Meth is a Schedule I substance with no recognized medical value. It is also notorious for doing significant damage to the human body and brain.

In addition, the risks of addiction to stimulant medications appear to be somewhat lower for ADHDers than for people without ADHD. They’re not zero, but if you have ADHD, your chances of being able to use a stimulant medication without developing an addiction are higher.

Stimulant medications treat ADHD, generally speaking, by increasing the amount of dopamine circulating in key areas of the brain, like the anterior cingulate cortex – the part responsible for impulse control, focus, planning, and response to reward and punishment. (Sound familiar?) By increasing dopamine circulation, the meds help ensure that these parts of the brain have the dopamine they need to function – but not more.

Extra dopamine, beyond what your brain needs to function, is what causes the feeling of a drug “high.” It also leads to greater tolerance and dependence over time, as your brain adjusts to the extra dopamine.

But since ADHDers don’t get extra dopamine from stimulant meds, their brains never make the adjustments that result in tolerance and dependence. Their brains just work like they’re supposed to, because they finally have the right amount of fuel.

Non-stimulant meds for ADHD are generally not controlled substances, but they also tend to be less effective for many people. The only way to know if any ADHD medication will work for you is to try it yourself under your doctor’s supervision.

Am I stupid? Am I retarded? Am I a freak? Does this mean my life is over?

No, no, no (or maybe but in the good way), and only if you let it.

Sadly, these are the questions about new ADHD diagnoses that I field the most. As the choice of derogatory language indicates, they’re very often asked by people who still have a very particular idea of what is “good” or “bad” in the human brain – and they fear ending up on the “bad” side of that fence.

However, ADHD doesn’t mean you are an [insert slur here], because no insult or slur can capture who any person really is. That’s where their power to hurt comes from – the fact that they reduce a glorious complex living human to a single point of derision or hate.

ADHD means nothing about who you are as a person. It means that you think differently and respond to some stimuli differently from most people. It means that ways to accommodate your style of thinking and approach to the world probably weren’t ever taught to you by your parents or in school.

But, if you’ve gone undiagnosed for many years or decades, you’ve probably heard a lot of messages that feed the idea that there’s something irredeemably “wrong” with you. A lot of people with ADHD – even those who were diagnosed and treated as kids – grew up hearing things like “You just need to focus more,” “I can’t believe you’re so lazy,” and “If you’re so smart, how are you so dumb?”

When you first get an official diagnosis and start treatment, you may also benefit from talking to a therapist about your childhood and life pre-diagnosis. An ADHD diagnosis, especially for older teens and adults, tends to stir up a lot of painful memories of being punished or harassed for things that you didn’t know were ADHD symptoms at the time. It’s important to be kind to yourself and to take those stirred-up pains, if any, seriously.

Finally: ADHD doesn’t mean you’re doomed to a life of failure. In fact, getting ADHD properly diagnosed and treated can help you unlock levels of success you always wanted to reach but never could figure out how. Many highly successful people have ADHD; some even use their ADHD to their advantage.

If an Internet quiz told you you have ADHD, you might have ADHD – or you might not. It’s up to you to decide what to do next. ADHD or no ADHD, you remain in charge of your own life.


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What It’s Like to Have Auditory Processing Disorder, As Illustrated By Auto-Generated YouTube Captions

Like a lot of people with ADHD, I also have central auditory processing disorder.

CAPD manifests as a problem understanding speech and other sounds. It isn’t a hearing problem per se: The structures of the ear work just fine to capture sound waves and transmit them as electrical impulses to the brain. The brain, however, struggles to interpret these electrical impulses effectively.

People with CAPD frequently have trouble understanding what’s being said to them, especially if the sound of the speaker is in any way distorted (phone lines, VoIP), interrupted (conversations in noisy restaurants), or intruding upon a preexisting focus (someone trying to talk to you while you’re concentrating).

Most folks with CAPD identify heavily with this exchange:

Them: Can you hand me the remote?
You: What?
Them: Can you hand m-
You: Oh, sure. *passes remote*

It’s not that we didn’t hear the first “can you hand me the remote?”, per se. It’s that our brains lag translate it into a comprehensible statement. We know we were asked something (hence “What?”), but it takes extra time for us to realize what the something was.

And we very often get it wrong. “Can you hand me the remote?” could just as easily be interpreted by our brains as “Canoe slappy boat,” or as sounds that don’t register as language at all. (“Canoe slappy boat” is very likely because our brains will try to make sense of the sound input we just got, and “canoe” and “boat” are related words.)

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When Captions Fail

Like a lot of people with CAPD, I watch television with the captions on. Captions help my brain keep up with what’s being said by giving me an insta-check on what I thought I heard.

Usually.

Auto-generated captions, created by algorithm, are increasingly popular – particularly on sites like YouTube, where captioning everything uploaded in one minute would take over 300 years if done by humans.

The accuracy of YouTube’s auto-generated caption algorithm appears to depend on many of the same factors that affect the accuracy of comprehension in CAPD. For instance, auto-generated captions over a single speaker enunciating clearly into a microphone in an otherwise silent space are generally accurate. Auto-generated captions over a musical track or with significant background noise are often not.

Sometimes, however, the speech seems clear but the auto-generated captions really fail. And in one particular instance, the failures looked almost exactly like what my brain “hears” through the filter of CAPD.

Strength of the Algorithm: Auto-Captioning Fails in BraveStarr

BraveStarr ran for one season, in 1987-88. The show was Filmation’s last animated series (He-Man and She-Ra having both been pulled the year before). It has a lot of the hallmarkes of a Filmation piece – especially the presence of nearly-incomprehensible characters and the use of the same five voice actors for nearly every character.

Here’s what it’s like to hear through CAPD. (The first two examples are from the episode “Unsung Hero.” The rest are from “An Older Hand.”)

Unsung Hero

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YouTube/My Brain: “…interested in in mining carrion no one wants to be a pot farmer imprudent….”

The Actual Line: “…interested in mining Keriam. No one wants to be a pod farmer, including [my son].”

This was the first screenshot I grabbed. At the time, I was merely amused at the “pot farmer” part of the joke.

Then things got even more inappropriate:

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YouTube/My Brain: “you all right I think so oh but your whoreson stolen”

The Actual Line: “You all right? I think so. Oh, but your horse was stolen!”

CAPD makes my brain translate ordinary sentences into potentially offensive ones all the time. I don’t even comment on it anymore.

(Given that the brain tries to fit sound into a pattern with which it’s already familiar, this might say more about the frequency with which I hear and use profanity than it does about CAPD.)

Typically, YouTube’s auto-caption generator doesn’t trip much on human characters’ lines. The humans characters’ voice actors tend to deliver these lines straight; they save accents, funny voices, etc. for non-human characters. The algorithms’ ability to handle non-human characters’ lines ranges from “bad” to “nonexistent.”

An Older Hand

All of these examples contain lines delivered by various Prairie People.

Normally, YouTube’s auto-generated captions don’t interpret the Prairie People’s voices as speech at all. Captions simply aren’t generated when Prairie People are speaking.

In this episode, however, the algorithm recognized when Prairie People characters were speaking most of the time. But it struggled with what they were saying – in a way very similar to my own brain’s struggles.

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My Brain/YouTube: “bigger you might be you maybe not Maggie what’s your work being a good screen”

The Actual Line: “Whoa. Maybe not magic, but still work pretty good.” [scene change] “BraveStarr….”

Like a lot of things I hear with CAPD, this caption makes no literal sense. Those are words, but they cannot possibly be the words the speaker actually said – can they?

This caption also carries over lines from a previous character/scene into the new one, where it mashes them together with the start of a line delivered by a character in this scene. It’s not unlike having to listen to someone speak in a noisy restaurant or bar: My brain doesn’t always distinguish between “what this person is saying” and “what someone else in the room said.”

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YouTube/My Brain: “real that really be young bad guy a riot you’ll never did stop believin”

The Actual Line: “Well, that’s where it belong, by golly wollies.” “You never did stop believing….”

I didn’t expect YouTube to get “by golly wollies” on the first try (or ever). But idiolectic details like “by golly wollies” can make the comprehension process even harder. Until I’m aware that the person will frequently do things like interject “by golly wollies” or pronounce “washing” with an “r,” my brain won’t account for them in processing – so I’ll struggle even more to understand the speaker.

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YouTube/My Brain: “you know you lose your hoop boys always believing you but it more potent”

The Actual Line: “No sir, Fuzz always believe in you. But it more important….”

This line almost made me wish YouTube had not started picking up on the Prairie People’s speech as speech. I’ve watched enough Fuzz episodes to understand him (on a 2-3 second delay), but the captions here actually made matters a lot worse.

This is also a good example of how non-spoken sounds will get interpreted by a CAPD brain as speech. “No sir, Fuzz” became “you know you lose your hoop boys” due to background non-speech noises in the actual scene.

It’s not that people with CAPD aren’t listening to you. It’s that what you said + all the sounds around it = “you know you lose your hoop boys.” You’d say “What?!” too.

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YouTube/My Brain: “karyam I’m as powerful as she wore brave stars under stick”

The Actual Line: “…Keriam. I’m as powerful as you are, BraveStarr! ThunderStick….”

YouTube’s lack of punctuation in auto-generated captions illustrates another common pitfall for those of us with CAPD: We don’t always “hear” where punctuation fits into spoken language.

For instance, this joke is typically presented in written form:

Let’s eat grandma!

Let’s eat, grandma!

Commas save lives.

When spoken, there’s typically a change in pace and pitch that indicates the relationship between “eat” and “grandma” that the comma encodes in writing. Here’s a bad attempt to draw it:

lets eat grandma

People without CAPD can hear the change in pace and pitch that indicates whether “let’s eat” is a comment made to grandma (let’s eat, grandma!) or if grandma is the object to be eaten (let’s eat grandma).

With CAPD, the brain doesn’t always process pace and pitch, either. So even if we understand the words “let’s,” “eat,” and “grandma,” we may not know whether the speaker is proposing to grandma that we eat… or proposing we eat grandma.

This auto-generated caption mistake crams together parts of three separate sentences, each of which include one name (“Keriam,” “BraveStarr,” “ThunderStick”). The combination of proper names and lack of punctuation further confuses the meaning, both in the caption and in hearing with CAPD.

What’s the Point of All This?

I started collecting auto-caption BraveStarr mishaps because they were funny. I still giggle at “no one wants to be a pot farmer.”

But they also turn out to be great examples of how my brain mishears things.

Living with CAPD can be tough, especially when you go undiagnosed for decades (as I did). With CAPD, people assuming you’re deaf or hard of hearing is the good outcome. They’re more likely to assume you’re rude or lazy, especially if they know you well enough to know you can hear.

To complicate matters, CAPD often rides along with neurodivergences that make people more sensitive to sound, like autism and ADHD. It’s not uncommon for children with CAPD to get hearing tests that report their hearing is, if anything, too good. It’s not enough to test hearing – you also need to test processing, or what happens once the sound gets from the ear into the brain.

Normally, I’m not a fan of disability simulations. These auto-generated captions, however, failed in a way so completely similar to what I hear, and for so many of the same reasons, that they offer the closest thing I’ve yet found to actually having CAPD.

So the next time someone who seems to hear perfectly well asks “What?”, just assume they heard you say “you know you lose your hoop boys” – and that they respect you enough not to write you off as really spouting gibberish.


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How I Wrote a Novel in 10 Months With Untreated ADHD, Part 3: The Notebook

Part 1, I talked about how I organize my schedule, or when I write. In Part 2, I talked about my workspace, or where I write.

Now let’s talk about how.

ADHD III

Part 3 is the story of the heart of this entire operation: The Notebook.

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“The Notebook” makes it sound portentous, like I spend hours searching for just the perfect vessel to hold my Great American Novel(TM) and I might die without it.

Not going to lie: I went through that phase, in my late teens. I still have the two Moleskines I filled back then. But it was only about eight months before I realized that putting The Notebook on that kind of shrine was actually making it harder for me to write.

These days, I use single-subject college-ruled notebooks I pick up during the back-to-school sale at my local big-box store for about $0.25 apiece. I buy at least a dozen every year, and I keep the unused ones within easy reach:

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Back in the days before I published the vast majority of my work on the Internets, I filled a notebook a month. These days, it takes 1-3 months for the same amount of handwriting.

The used ones occupy several different shelves. This photo is the central repository but by no means the only one:

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Once, in 2009, I went through all the notebooks I’d filled since 1998 and broke them down, discarded everything I thought wasn’t “useful,” and put the rest in a giant three-ring binder. I have regretted it ever since, which is why I will not be repeating the process anytime soon.

It took me quite a while to make the notebook work for me. I loved it from the start as a writing tool, but like a lot of folks with ADHD, I really didn’t grasp how to make it work as a planner and an extension of my memory. For years, I juggled The Notebook, notebooks for work, notebooks for school, a day planner, a to-do list, you name it.

I tried a Franklin planner. I tried OneNote. I tried bullet journaling. And it all made me even more confused.

Then, while browsing the Intertubes one day late in 2015, I stumbled across a system that was far simpler than keeping a bullet journal. The blogger I read this from claims to have learned it from a Japanese businessman he was sitting beside on a flight once.

I just know it works for me. Here’s how:

The very first thing I do with any new notebook is flip to the back side of the final page.

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Here, I write the major categories of stuff in the notebook, and make a little “tab” by blacking in the edge. I like to space my categories widely because it makes the tabs easier for me to find.

Often, I’ll start with the first thing going in that particular notebook. This one, for instance, has outlines for Nahara and The Ambassador on the first few pages, so the top tab is “novel.” The first not-novel page I used had a to-do list on it, so that went under “personal and journal.”

You can tab as many things as you like, or as many as you have lines for. In theory, you could also flip to the second to last page and tab again in different colors, too. I rarely have more than five tabs in any notebook, and these four are always on the list.

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Each page then gets a corresponding tab. Here are the first three pages in this notebook, all of which are outlines.

(I am sorry to report that the rumors are true: Nahara does not feature fully automated luxury gay space communism.)

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Every time I start a new page, it gets a new tab. This is the page I started for the outline for this blog post series.

I love this system for two ADHD-y reasons:

  1. It cut me down to one notebook. Much harder to lose, especially since it lives with my wallet and keys on my desk. (Not impossible to lose, though, which is why my name and email address are always on the inside of the front cover.)
  2. I don’t have to care what order the pages are in anymore. I used to juggle two notebooks because I cared about page order. A lot. I hated having a to-do list pop up halfway through a chapter I was drafting, for instance. I found it super distracting.

Now I don’t have to care, because every page has its tab:

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I also appreciate how the tabs help me see where my time went over the past month or two. This notebook, for instance, makes it obvious that I spent a huge chunk of time on marketing and “outside” writing smack in the middle of it, taking a pretty obvious hiatus from the novel to do so.

Those chunks, btw, include both the pieces I submitted to Spoon Knife 3: Incursions, which you’ll all get to see in a few months.

Here are two pages from the draft of Nantais:

 

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When I sit down to write, I date the margin, just because I like to see my own progress. I tab each page as I start it. Notes about things I need to go back and fix, scenes that are relevant to this scene, or character background I don’t want to dig into here but that I’ll need for consistency later on all goes in the margin as well.

My goal, in my nightly two hour writing slot, is 350 words. That’s it.

They don’t even have to be story. If I’m particularly stuck on the story, I’ll spend time sketching what could happen next, or working out character motivation, or detailing someone’s history or mythology. As long as it’s related to the novel and written with the intent of helping me get unstuck, it counts.

After the Notebook But Before Editing: The Typing Stage

Approximately every ten pages, every chapter, or just when I’m starting to get a little lost as to what the heck happened to get me to this point, I’ll take the handwritten draft and type it up. But the first draft of all my fiction is always written longhand.

 

The reasons are a mix of practical points and straight-up “I like doing it this way so there”:

  • I find the Intertubes distracting as heck. “I went to look up one thing and eight hours later I realized I had 422 Wikipedia tabs open and also it was Tuesday” isn’t a meme; it’s literally my life. If I drafted on the screen, nothing would ever get done.
  • I revise as I type. The first typed draft is always my second draft. Rewriting the entire draft this way allows me to address a lot of mistakes and clunky text. It also lets me do things like write “[nearby star with habitable zone]” in the draft, then Google that when I get to the typing phase, saving me from the Wikipedia hole.
  • I feel free to screw up. Since I know no one will ever see the handwritten draft, I can cross things out, rewrite entire sentences mid-draft, draw giant arrows to move pieces from one place to another, and write things like “FIGHT PIRATES, DO A SCIENCE” or “THIS BOOK DOESN’T EXIST WTF IS HE READING” in the margins (two comments that actually exist in the margins of the handwritten draft of Nantais).

…And, perhaps most selfishly but also most importantly, I just like the way it feels. I like the feel of writing and the look of my own handwriting covering pages and pages of notebooks.

Writing longhand greatly increases my joy in the process. It feels like making something. And that’s really the only reason I need to do it – and the reason I never insist other people do it the way I do.

The whole point of the entire system is to move the crap out of the way in order to find the joy in the work.

Ironic twist: While starting Ritalin has changed my life with regards to my work, my relationships, my ability to eat and sleep, and the general orderliness of my house, it has actually made fiction writing harder. I don’t write on Ritalin. I wait till it wears off first.

Why? I’m still trying to pinpoint the reasons, but the biggest one appears to be that having everything on the whiteboard of my brain at once, while a major challenge in ordinary life, is actually exactly what I need in order to keep track of all the moving parts of a story as it unfolds.

I wrote Nantais before I ever started Ritalin, and now that I have, I only write fiction after it wears off. Go brain!

Part 2: The Workspace
Part 1: The System


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