The Silent Struggle- Adult Women with ADD by Shalvi Weissman M.Sc. -recently published in The English Update
September 30, 2014
"For years I was told, 'get with the picture,' 'get organized,' and 'pull your own weight.' I internalized the message that I am defective. If only someone had realized that I was suffering from ADD and gotten me some help, I would not be buried under layers of shame and self-hatred today. I know that there are many girls and women out there who are suffering like me, and nobody understands the problem. I wish I could do something to change that. I wish that more people were aware of the problem. It would mean the world to me to know that sharing my story helped even one girl get the help that she needs while she is still young."
I have met a number of women like Chana* who suffer from ADD and were never diagnosed as children, and I too would like to see more awareness in our community. While ADD can't be 'cured,' with proper diagnosis and treatment it can be transformed from an obstacle to a stepping stone.
There are two types of Attention Deficit Disorder: hyperactive type (ADHD) and inattentive type (ADHD-PI or ADD). The term hyperactive is used to describe kids with ADHD, but many kids with ADD are not hyperactive; rather, they have a hard time staying focused, can be easily distracted and have other symptoms. (For the list of criteria see text box below.) The hyperactive type of ADHD is more common in boys, whereas inattentive ADD is more common in girls. A boy with ADHD who has hyperactivity will give his parents and teachers a run for their money with his high activity level, but a girl is more likely to be considered dreamy or ditsy. She may be stuggling terribly with distraction and disorganization, but only a very perceptive and informed parent or teacher will notice the problem. Girls with ADD without the hyperactivity get easily distracted, have a hard time completing tasks with multiple steps, and despite their best efforts, can’t seem to organize themselves as well as their peers. The bottom line is that a girl with ADD is much less likely to be properly diagnosed and treated, and women over 25 who were in grade school at a time when there was much less awareness of ADD were even less likely to have gotten the help that they needed.
"Each year before the first day of school I would hope that this year would be different. This year I would be able to keep track of all of te different notebooks and homework assignements. This year I would try harder and somehow I would keep up. The dread that I wouldn't suceed, and that I'd fall back into my old pattern would literally keep me up all night. Of course, two weeks later I had failed at all of my resolutions. I had no explanation except that I must be a failure.
" I suffered socially as well. Other girls seemed to pick up on social cues that eluded me. I was afraid to get too close, because I knew that if I did, they would see that I'm really defective and they would reject me. My parents had their hands full with my other siblings who were acting out in ways that couldn’t be ignored. I was in a lot of pain, but I wasn't a trouble-maker, so I never got the help that I needed."
When Chana was finally diagnosed with ADHD she was overwhelmed with relief. "Finally there was a word that described me that wasn't overwhelmingly negative. I found out that I'm not lazy or defective - my mind just functions differently than some other people's. I just wish that someone had picked up on it when I was a kid. It could have prevented the many layers of guilt, frustration and shame that accumulated over the years."
It is not unusual for women who suffered throughout childhood and adolesence to get diagnosed and helped only as adults. Some women read a description of a struggle similar to their own; others have a child who is diagnosed, and only then realize that they have been suffering from the same symptoms their whole lives.
Shayna* describes her struggle: "Before I got married my mother would constantly berate me for being a slob. She was super organized and she kept the house clean with minimal help from me. When I got married I was on my own. If I spent the morning doing laundry, the hours would pass without me getting anything else done. I would decide to clean the kitchen, and get fixated on little details for so long that hours later I was still surrounded by mess. Each time I stepped into my messy kitchen I was reminded that I am a disorganized slob. My mother would buy me books about getting organized and running a home efficiently. I read them and promised myself that I would do as they said, but the systems never seemed to work for me. I would visit the homes of friends and neighbors, and I just didn't understand why they could do things so effortlessly while I floundered. It wasn't just my home that was messy - my whole life was disorganized. I missed a dentist appointment for one of the kids despite writing it on the calendar and putting a sticky note on the door. Each time I was asked to cook for a neighbor who had a baby I would promise myself that this time it would be different; I would have the food ready on time, and have enough for my family as well. Of course that never happened, causing me and others embarrasment and frustration. Such experiences were humilating. When my seven-year-old daughter was struggling with organization, her teacher asked me if we had checked for ADD. I didn’t want her to suffer as I had, so I made an appointment right away. When she was diagnosed by the pediatric psychiatrist he mentioned that ADD runs in families. I realized that I may be suffering from the same thing, and I made another appointment, this time for myself."
Hope after the Diagnosis
For many women, just identifying the problem is a big step in recovery, but it is only the beginning. The latest neuroscience research shows that while the stucture of the ADHD brain is the same as that of a non-ADHD brain, the brain chemicals called neurotransmitters work differently. Messages that transmit seamlessly for some people come through poorly in the ADHD brain, sort of like a cellphone call with poor reception. All of the equipment is in place, but the transmission is not getting through, so the ability to create organization and structure is inhibited. Treating ADD is a process of finding other ways to create structure and to insure that the transmissions get through. Such structures can be created by religiously using a planner, making lists, setting timers and reminders, breaking down projects into small tasks, and getting help from a therapist or coach. In order to live sucessfully with ADD, it is essential to develop new habits that create an external framework of structure and organization. ADD coaches specialize in helping people strategize and plan time, task and space management, build a deeper understanding and love of themselves, and learn how to make wise and conscious choices about how to stay motivated and follow through on things, while honestly taking into account their strengths and weaknesses.
Some women find tremendous relief with stimulant medications such as Ritalin, Concerta and Adderall. "It's amazing! I feel like my mind is clearing. For the first time I find myself completing tasks that I wasn't able to complete before. My davening has been transformed. Before, the minute I picked up the siddur my mind would go on a safari. I felt terrible that I wasn't able to concerntate and connect with HaShem. For the first time in my life I am enjoying davening."
Other women prefer not to turn to medication, and find alternative options that are helpful to them. Research has proven that exercise, Omega3 fish oils, and meditation can have a positive impact on ADD symptoms, with no side effects. Dietary changes such as eliminating food colorings, sugar, and processed foods, and eating a diet rich in fruits, vegetables and complex carbohydrates such as brown rice and whole grains, have helped both children and adults. Yoga and exercise surrounded by the green outdoors have shown to improve concentration and focus, according to some studies, even more the some other forms of exercise. Reserachers have found that zinc, iron, or acetyl-L-carnitine supplements can relieve ADD symptoms, and herbal stimulants such as extracts of Ginkgo biloba, Panax quinquefolius, Pinus pinaster, and Bacopa monnieri may have effects similar to Ritalin and other stimulant medications, but more objective studies are still needed to prove their effectiveness. Biofeedback and neurofeedback have proven to have some positive effects, but they are expensive and not widely available in Israel.
Getting a good night's sleep is essential to surviving with ADD, but it isn't easy. People with ADD tend to have a hard time winding down at night. Their minds are full of ideas, and it is hard to stop thinking and relax enough to fall asleep. Also, many people find that while they are sometimes highly distractable, they can also become hyperfocused on one project or activity and it is hard for them to pull themselves away and get to bed.
When a woman has suffered from ADD all her life without diagnosis and treatment, other emotional issues have often accumulated along the way. In our culture women are expected to succeed in school, get along easily with friends, and help out at home. As they grow up they are also expected to be a balabusta, to turn out four-course meals every Shabbos, keep an organized home, raise a big family, do chesed, and often work outside the home as well. Even a woman without ADD can be overwhelmed by all the expectations, but for a woman with ADD the stress can cause frustration, anxiety, shame, guilt and depression.
ADD can wreak havoc on a woman's life, and of course it affects her family as well. If basic organizational tasks such as laundry, paying bills, food shopping and cooking are not being taken care of, all the family members will be affected. Sometimes a husband will take over some of these responsibilities to ease his wife's burden and keep the home running, but that often builds resentment and frustration that will affect other areas of their relationship, or will make the husband feel like he is more of a father or big brother than a husband. (The same can be true in reverse if the husband has ADHD). In large frum families it is often one of the older daughters who takes over the responsibilities of the ADD mother, which can be helpful, but also have negative consequences if the daughter takes on more responsibility than is appropriate for her age, or if the mother loses her authority to the daughter.
A complete ADD treatment plan should include some form of couseling, either therapy or coaching, to address the emotional and spiritual needs of the individual, and should implement healthy lifestyle changes in diet and exercise. Edward Hollowell M.D., in his classic book Delivered from Distraction sums up Seven Habits of Highly Effective ADD Adults:
Do what you're good at. Don't spend too much time trying to get good at what you're bad at. (You did enough of that in school).
Delegate what you are bad at to others as often as possible.
Connect your energy to a creative outlet.
Get well-enough organized to achieve your goals. The key here is "well-enough." That doesn't mean that you have to be very well organized at all − just well-enough organized to achieve your goals.
Ask for and heed advice from people you trust, and ignore, as best you can, the dream-breakers and finger-waggers.
Make sure that you keep up regular contact with a few close friends.
Go with your positive side. Even if you have a negative side, make decisions and run your life with your positive side. (Delivered from Distraction, pg. 37.)
How can I know if I am ADD? Maybe my mother and teachers were right and I'm really just a lazy slob?
Have you tried many times to organize your closets, your files or your life, only to find that it very quickly returns to its previous chaos? Do you find that being distracted, losing important things, and having trouble concentrating get in the way of your everyday functioning? When you have a task that requires thought, do you avoid it or delay getting started? Do you start projects with enthusaism but have a hard time finishing up the details? Are you a multi-tasker who thrives on doing more than one thing at a time? Do you fidget and squirm when you have to sit for a long time? Do you have a rush of ideas passing through your mind? Do you get frustrated when you aren’t able to do things that others seem to do with little effort?
Only a qualified medical professional such as a psychiatrist or neurologist can diagnose ADD, but if you answered yes to a number of the questions above, and you feel that the symptoms make it hard for you to manage, make an appointment for a professional assessment.
Being diagnosed with ADD can be scary, but it can also be a relief. Many authors who have written books about ADD and have ADD themselves stress that ADD comes with gifts along with its struggles. People with ADD can be fun and spontaneous, as well as creatively inspired. They have a wealth of new ideas, and strong intuition. Once people learn to manage their symptoms they can harness their unique strengths and live happy and sucessful lives.
DSM-5 Criteria for ADHD
People with ADHD show a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development:
1. Inattention: Six or more symptoms of inattention for children up to age 16, or five or more for adolescents 17 and older and adults; symptoms of inattention have been present for at least 6 months, and they are inappropriate for developmental level:
· Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or with other activities.
· Often has trouble holding attention on tasks or play activities.
· Often does not seem to listen when spoken to directly.
· Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (e.g., loses focus, side-tracked).
· Often has trouble organizing tasks and activities.
· Often avoids, dislikes, or is reluctant to do tasks that require mental effort over a long period of time (such as schoolwork or homework).
· Often loses things necessary for tasks and activities (e.g. school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones).
· Is often easily distracted
· Is often forgetful in daily activities.
(There are more criteria used to dignose which type of ADHD a person has. For more information see the DSM-V or contact a mental health professional.)
**Keep in mind that most people have some of the symptoms of ADHD sometimes. Someone who truly has ADHD has intense and frequent symptoms. Only a liscenced mental health professional can make the diagnosis of ADHD.
*All names have been changed to protect privacy.
Delivered from Distraction, Edward Hollowell M.D.
You Mean I'm Not Lazy, Stupid or Crazy? A Self-help Book for Adults with ADD, Kate Kelly and Peggy Ramundo
Women with Attention Deficit Disorder, Sari Solden MS, LMFT