ADHD; Embracing the Alien Brain

It was a fourth grade classroom and my mentor, the fourth grade team lead was sitting in front of me with a stern expression telling me some difficult things.  It was her job to tell me the concerns that parents had about a first year teacher, but I loved this woman!  She would take a bullet for me and I needed her to like me.  I had done everything I could do to be the person she would accept and here was the inevitable unfolding before my eyes.  Rejection.  I knew it would happen because it always does.  Eventually, no matter how hard I try, I would be rejected because I am all wrong and I can never hide it forever.  The familiar tidal wave of emotion came over me.  “Don’t do this…..” she said.  I couldn’t help myself.  I slipped into a meltdown.  An ADHD emotional meltdown.  

Think ADHD is only about attention and hyper little boys?  It’s not.  It is a biological reality that you never grow out of.  It is slippery disorder that is often confused for something else.  My son Layne is one of the most extreme cases of ADHD I have ever seen.  He has been very tricky to diagnose.  I took him in to a speech pathologist when he was three and she suspected severe developmental delays.  I took him into the district for an evaluation and they gave him much higher scores.  The difference was that they engaged with him and observed him much better than the other diagnostician who only asked questions which he disregarded, behaving much like a young autistic child.  Even so, the district found him to be autistic.  I took him to the Child Study Center in Ft. Worth to see a child psychiatrist that works extensively with autistic children, and she said it was clearly ADHD.  After observing Layne and learning as much as I can about the disorder, he is a classic case.

We started treating him with stimulant medication starting at age four just before he started a special preschool class for language delayed children.  The medication made a huge impact on his ability to perform in the classroom.  He made enormous strides that surprised everyone.  years passed and he was showing himself to be an excellent student.  Unfortunately, he had a hair trigger temper and was extremely sensitive to criticism and teasing.  He would regularly, almost daily, have major meltdowns that would end up with both of us sitting on his bed while I spoke softly and soothingly, trying patiently to keep his mind from endlessly ruminating on his painful emotions by distracting him.  Sometimes it would take him hours to calm down.  His distress was so great, that he starting having suicidal thoughts.  At school he never had a single meltdown.  He was six.

My Momma heart was in tatters.  My baby was having the same problems I had and there was nothing I could do for him.  All my life, for as long as I can remember, I have had an explosive temper that has eluded every effort to manage.  Telling me to control my temper is like telling someone not to pull their hand back when they touch a hot stove.  You don’t decide, it just happens.  I knew that Layne would need more than just lectures about self control.

Thanks to God’s intervention, I happened upon an incredibly competent pediatrician for my boys.  He is stooped and gray and full of an indomitable energy.  He never tires of playing silly games with his little patients and they adore him.  Austin calls him Dr. Strange.  “Very fierce!”  He knew just what to do when I called him about Layne’s tantrums.  He prescribed guanfacine.  How did he know?  Perhaps because he is unusually perceptive about treating ADHD patients because he has it himself.  How he managed to become a doctor with his ADHD, I don’t know.  I’m just glad he did.  He told me that his treatment was black coffee and a leather strap when he was a boy.  (Winking and smiling with a twinkle in his eye)  

Last night I came across a new theory about the emotional component of ADHD.  It is called RSD or rejection sensitivity dismorphia.  It literally means you can’t bare rejection.  The very thought that maybe somehow some way someone you care about is rejecting you, is so acutely painful, it can result in suicidal ideation in those whose anger is directed at themselves, or impressively explosive rage at another person if it is externalized.  This pain is so much greater than what is called the “neurotypical brain” that people that have never experienced it, can’t really understand it.  It comes on very suddenly and can be gone just as quickly.  It is like a supercell Texas thunderstorm.  Wait an hour and its gone.  The roof might be gone as well, but the storm is over.  Like it never happened.  This RSD is highly correlated with ADHD.  Some people, like Layne and me, it can be one of the most problematic aspects of the condition.  It is extremely difficult to manage as it is difficult to anticipate a trigger.  It can wreak havok on relationships and jobs.

Layne now takes Clonadine which is helpful to control the RSD aspect of his condition as well as helps him to sleep.  The ADHD brain continues to surprise me as new information about the many facets of this remarkable subset of the population are revealed.  Of course, viewing ADHD as only a disorder is insultingly simplistic.  ADHD brains are no better or worse than other brains, just different.  As we  understand and learn to treat ADHD, we can have more compassion for those who are neurologically atypical.  I dream of a day when the human environment can be adapted to embrace these differences in our brains and accommodate them rather than medicate them.  In the meantime, we will soldier on with our stimulant in one hand, our mood medications in the other.  We will speak out.  We will learn from one another.  And together we can find ways to survive and thrive in an alien world full of “normal” people.

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