Category: executive dysfunction

ADHD & Rubifen

In the last couple of weeks there’s been some discussion with my psychiatrist about whether I might have ADHD. I have always struggled with memory, concentration and attention span, and my executive function issues are documented in my ASD diagnosis. My normal case manager was sick and then away, and during that time I happened to have an appointment with my psychiatrist which he accompanied me to (virtually via zoom because we were in another COVID lockdown). During that appointment I mentioned my ongoing struggles with staying on task, concentrating etc and he asked if anyone had mentioned ADHD to me. It had vaguely come up, and I’ve always known I have trouble staying on task and I have various other issues around inattentiveness, working memory and executive function. I talked to them and filled in the screener and that was an incredible eye opener. Suddenly I was looking at things I struggle with in my daily life in a whole new light and wondering if ADHD could be the missing piece of the puzzle for me.

On the screener tool I found myself answering yes to so many of the questions that I was forced to question whether I was looking at my life with an objective eye or not. Many of the questions were things I knew about myself, but thought there was something wrong with me and I was being lazy. For example:

  • I hate anything boring (though I do love routine, but I get bored easily and change it up all the time which makes me anxious – my tendency to do this has always puzzled me)
  • I make careless mistakes, even though I try to check my work
  • My desk and workspace are so messy I spend large amounts of time searching for things, only to lose them the minute I put them down again,
  • I drift off in the middle of conversations all the time and miss important parts of what I’m supposed to do (or know),
  • I can’t figure out the steps to day to day things like returning a library book
  • I’m often paralysed by indecision – even simple things like going to the supermarket involve deciding what day to go, what time to go, what route to take to get there etc and there are so many variations on each item that I get overwhelmed.
  • I’m constantly losing things. I have many multiples of sunglasses, hats, headphones, masks etc etc because I’m forever putting things down and never remembering where I put them.
  • I’m constantly distracted and it’s rare for me to concentrate for longer than 5 minutes at a time. Though I can hyperfocus if I’m challenged or really interested in something, and then I lose track of time completely. Unfortunately I can’t control what will take my interest.
  • I forget so much and so regularly that I have a name for my brain – the sieve! My brain only remembers the biggest most important thing/s so all the other stuff falls through. I can’t rely on my memory, and even if I write myself notes & have calendar reminders and alarms, the chances of me looking at the note or reminder and forgetting immediately are pretty high.
  • I procrastinate! Everything involves decision making – when to do something, how to do it, figuring out the steps involved, organising what is needed. Even things I do every day like my sleep routine are difficult for me to remember and follow the steps. So I procrastinate. I even procrastinate about going to the toilet when I need to go…. (oversharing a bit there!).

This is only a sample of the things the screener brought up for me. There is so much else that not only did I answer the two pages of questions but I wrote notes and examples all over it and I still have more just off the top of my head. 

I have known for so long that my brain doesn’t work like other people’s. I’ve always assumed my brain wasn’t working properly because I wasn’t trying hard enough, that I am lazy and so screwed up that I somehow create drama for myself so I could feel bad. Though why anyone would want to feel bad I don’t know, but I assumed that deep down I was sabotaging myself because I am an awful person. When I got my ASD diagnosis and I learnt about executive function that provided a partial answer as to why I am like I am, but I never felt it explained the whole picture. But I’ve got so much else going on (sensory & auditory processing issues, mental illness) that I figured that’s why I didn’t quite fit any profiles I saw online.

Day to day life is a struggle for me. Ordinary things that most people can get done, like buying food, are massive issues for me. My brain does this thing where I think ok, if I go today (to the supermarket) then I can get bread and milk for the week but I won’t need lunch meat for G until Tuesday so maybe I should wait until Monday but do I have enough bread, milk, cereal etc to last till then? Maybe I have enough milk but I’m not sure about anything else. Should I go before work when it’s quieter and I’m nearly driving past, but then I have to go to physio so will I have things that need to be kept cold and how warm might it be and how long will I be at that appointment and will the cold stuff stay cold long enough. And there are roadworks if I try and go back towards the supermarket but no roadworks on the other side of the road heading into town. So I’ll be forced to go round the long way home which takes me past the other supermarket which is smaller and busier. Can I be bothered going to that one as it’s slightly more expensive and I’m unfamiliar with the layout, but otherwise I will have to drive the long way round and take a detour to get back to the other supermarket and what will the traffic be like….. And that’s just me thinking about when to go! Choosing what to buy is a whole other issue, and dealing with various sensory sensitivies is another. You can see why I regularly run out of food in the house I have trouble planning and executing a simple thing like a trip to the supermarket.

I think if you asked people about me they would tell you I am a capable mature adult. How I project that image when I am such an enormous mess inside I’m not sure. But the strain of trying to keep things (household, job, life) going is immensely stressful. And I think one of the major contributors to my anxiety and depression. A large part of my depression is self-hate, and the things I keep telling myself about how useless I am because I am so forgetful, distracted, agitated, unable to concentrate etc are making me sad, and also angry at myself.

So when it was suggested that I try rubifen (generic ritalin) I decided it was worth a shot.

What a revelation!!! Within half a day I felt clearer and my ability to ‘do a thing’ had improved. The best way to describe it is that I feel capable. I can make a decision like buying lunch and then just go and do it without analysing 10 different options and the timing and costs and traffic patterns of various shops..! The first afternoon I managed to remember to buy grocery basics, put the rubbish bin out for collection, remember it was garden waste collection week and put that bin out, take bottles of coke I’d brought to my parents, reply to several texts and facebook messages,and get to a place on time. I would never normally remember even half that stuff till it was too late, I normally procrastinate over messages and reply in my head and forget to reply in real life and I’m chronically late.

While the rubifen doesn’t magically make me remember every little thing, what it’s done for me is allow me to keep something in my working memory without constantly reminding myself and feeling anxious all the time that I’m forgetting important things. Today I was in the supermarket when I noticed a note I’d written for myself about picking meds up. I had forgotten to do that earlier, but I straight away decided (another improvement) to go to the pharmacy after the supermarket, and managed to keep the thought in my head till I got to the car after paying without constantly prompting myself. No anxiety about forgetting, no procrastinating about doing it, just saw the note and realised I needed to do it that afternoon, then went and did it.

I also ‘lost’ my ipad by which I mean it wasn’t in it’s normal place on the charging station, but I pictured it in my head and immediately knew it was in my backpack in my room. I remembered noticing it was there when I took some things out of my backpack a few days ago. This is something that last week I would have looked for days for, and probably given up until finding it the next time I used that backpack. Causing myself to waste time and feel anxious and upset in the process.

One of the other things I’ve noticed with rubifen is that my perception of time seems to have improved. Prior to taking it I could lose whole hours and really have no idea how that much time slipped by. I’d intend to go to bed at 10.30pm, get off the couch and then suddenly it’d be midnight and I’d have no idea what I’d been doing for that long or why I wasn’t in bed yet, and I still wouldn’t have my pjs on or have brushed my teeth. Tonight I have been very aware of what the time is and how long it’s taken me so far to type this. I know what I’ve been doing for the past half hour and bonus, I also know what I need to do after this to get to bed.

I am now aware of how much checking and double checking I was doing. How I would need to double back all the time to get something I forgot – and this could be many times if I was going out and needed to put many things in the car like handbag, book, drinkbottle, hat, sunglasses, mask etc. How much time I was losing by forgetting and then remembering and going back to do something, then getting off track and forgetting, then trying to remember. How much effort I was expending to stay on task, or start the task in the first place. How anxious I am that I will forget something or lose something. How paralysed by indecision I was that I was overwhelmed by planning even the simplest of tasks. How the minutiae of life would constantly build up and I felt unable to deal with any of it.

I’m not saying medication is 100% the solution. But for me it’s like throwing a life ring buoy  to a drowning person. It’s holding me up but I’m still the one doing the swimming. My case manager said to me on Friday (we were talking about medication in general but this applies in this situation too), medication is liking the running shoes. You still have to run the marathon but it’s a hell of a lot easier with shoes on!!

I’m seeing my psychiatrist on Tuesday to review the medication trial. I am so pleased that the trial has been a success so far, and I’m interested to see what she has to say. I have been having a really hard time recently (more to come on that) and I now feel like I have some hope for the future.

Take care

Executive dysfunction: Part 1

Part of my ASD diagnosis is problems with executive function. Executive function is kind of hard to define but basically it’s the cognitive processes that help us regulate, control and manage our thoughts and actions. It includes planning, working memory, attention, problem solving, verbal reasoning, inhibition, cognitive flexibility, initiation of actions and monitoring of actions. People with executive function problems often have some areas which are worse than others, and the level of competency can vary from day to day depending on sensory and cognitive load from other things.

Executive function encompasses nearly every area of our lives. Work, managing a household, socialising, parenting, self care. So having executive function problems translates into problems with the tasks of daily living.

For me executive function looks like: I know the dishes need to be done. I want to do them. I want the kitchen to be clean and I don’t mind doing the task but I have trouble with task initiation. When I manage to stop what ever else I am doing and walk into the kitchen I notice the bench has a whole lot of things that don’t belong in the kitchen and some things need to be put away. I pick up Miss G’s hair ties and bobby pins from the bench and walk to the bathroom. I remember I haven’t brushed my teeth so I do that. I look out the window and think about what we are doing today and realise I need to put sunscreen on. I open the cupboard and it’s messy. I sort a few things and can’t find the sunscreen. I go off to ask G where it is and she doesn’t know either. The two of us look for the sunscreen and she finds wet togs. I take them to the laundry and decide to put washing on. While I’m there I notice there’s cardboard that needs to go in the recycling. I take that outside and notice the grass needs mowing. I open the shed to check on the petrol for the mower and there’s some seeds we were going to put in pots. I take out the seed packets and go inside to talk to G about planting the seeds….

Several hours can go past like this and not only have I not done the dishes but I didn’t find the sunscreen (usually that means I’ll have forgotten about it and we’ll go out, only for me to remember I was looking for it and never found it and neither of us have any on), or actually get anything achieved. The bench is still messy, the bathroom cupboard is still messy, the lawns aren’t done, I didn’t check on the petrol etc etc

This is incredibly frustrating for me. I have to put so much effort into focusing on one task at a time and holding that one task upper most in my mind. Not only do I have to ignore all the other things I come across that need doing, but I either need to write them down which often creates a massive overwhelming list, or be content with them not being done. Because the minute I walk away the chances of me forgetting the next thing to do are about 85%. And putting all the things on a list makes me so overwhelmed that I have trouble planning which task to do first and I feel overloaded by how much needs to be done and how much effort that takes.

Executive dysfunction for me can also look like:
– lack of awareness of one’s surroundings (it can get cold/dark and I will not notice if I am focused on doing something)
– easily distracted
– easily bored
– starting a lot of projects but never finishing them
– difficulty stopping one task and starting another
– difficulty changing routine
– forgetting verbal instructions
– losing objects frequently
– needing things repeated frequently
– interrupting others
– impulsive behaviour
– difficulty controling emotions
– easily frustrated and overwhelmed
– difficulty with planning and problem solving
– disorganisation
– poor time management
– procrastination
(credit to Lilo the Austistic Queer for a series of tweets this list is based on)

Miss G (who also has an ASD diagnosis) has executive dysfunction as well. We have slightly different areas where we are better or worse but both of us are terrible with organisation and planning. With school stuff this might look like her leaving notices at school, or her forgetting to give me school notices, me forgetting to ask or check her bag, me receiving them and then losing them, or forgetting to fill them out, pay and or send them back with her, her forgetting to take the notice back, or give me any reminders. And that’s only school notices!

Even this morning’s post is a perfect example of my poor executive function skills. I got up early to put washing on and do housework before being picked up by a friend. I put the washing on and got in the shower. In the shower I started thinking about executive dysfunction and when I got out I looked for two facebook posts I’d seen previously about it. I sat down and started writing. The washing finished but I haven’t got up to hang it out and put the next lot in. Nor have I stopped to eat breakfast (and it’s now 2 hours since I got up). I have been hyper focusing on executive function and writing for over an hour. My friend will be here soon and I’m not ready, nor have I done any of the housework I planned to do. This is what happens to me on a regular basis.

My life is chaotic. Partly because I am a solo parent who works full time, who happens to have both a developmental diagnosis and two mental illnesses, with a child who has multiple diagnoses. Partly because I struggle with executive function as part of my ASD diagnosis which means I am often forgetful, disorganised, and struggle with daily tasks. And partly because I am one of those people who if something can go wrong it will happen to me. I just don’t seem to be able to keep a handle on everything that’s happening in my life. This makes the tasks of daily living a real challenge for me, and I live in a near constant state of overwhelm, meaning the next little thing that happens can push me into full ASD/BPD meltdown.

I have more to say on this topic but I’ve run out of coherent thought so until next time.

Ka Kite