A brief history of ADHD

ADHD has come a long way since it was first noted a few hundred years ago. There are still a lot of unknowns, a lot of theories, and plenty of guesswork.

The condition has had numerous names over time as more was learnt about it, and yet ADHD is still not an accurate description. Attention Deficit Hyperactivity Disorder? There is no deficit in attention, our attention is on everything, all at the same time, whether is something we can see, touch or feel, smell, hear, taste, imagine, you name it, if we can be distracted by it we will shift out attention to it even if we don't want to. You don't have to be hyperactive to have ADHD, but it tends to be the overtly hyperactive ones that get diagnosed. Disorder? I would prefer Difference, like boys are different from girls kind of difference.

So on to the history bit starting over 200 years ago...


1798, Sir Alexander Crichton published "An inquiry into the nature and origin of mental derangement: comprehending a concise system of the physiology and pathology of the human mind and a history of the passions and their effects", which he continually updated and reprinted.  In the second chapter of book II entitled "On Attention and its Diseases", he defines attention:

• When any object of external sense, or of thought, occupies the mind in such a degree that a person does not receive a clear perception from any other one, he is said to attend to it.

Later he writes about the perceived lack of attention in a person:

• The morbid alterations to which attention is subject, may all be reduced under the two following heads:
• First. The incapacity of attending with a necessary degree of constancy to any one object.
• Second. A total suspension of its effects on the brain.
• The incapacity of attending with a necessary degree of constancy to any one object, almost always arises from an unnatural or morbid sensibility of the nerves, by which means this faculty is incessantly withdrawn from one impression to another. It may be either born with a person, or it may be the effect of accidental diseases.
• When born with a person it becomes evident at a very early period of life, and has a very bad effect, inasmuch as it renders him incapable of attending with constancy to any one object of education. But it seldom is in so great a degree as totally to impede all instruction; and what is very fortunate, it is generally diminished with age.

He goes on to say:

• In this disease of attention, if it can with propriety be called so, every impression seems to agitate the person, and gives him or her an unnatural degree of mental restlessness. People walking up and down the room, a slight noise in the same, the moving a table, the shutting a door suddenly, a slight excess of heat or of cold, too much light, or too little light, all destroy constant attention in such patients, inasmuch as it is easily excited by every impression. The barking of dogs, an ill-tuned organ, or the scolding of women, are sufficient to distract patients of this description to such a degree, as almost approaches to the nature of delirium. It gives them vertigo, and headache, and often excites such a degree of anger as borders on insanity. When people are affected in this manner, which they very frequently are, they have a particular name for the state of their nerves, which is expressive enough of their feelings. They say they have the fidgets.

This ties in nicely with the next segment...

1844, Heinrich Hoffmann a successful psychiatrist, who was not in favour of the notion in his day that psychiatric patients were obsessed or criminal and preferred to view mental disorders as having a medical basis.  He is famous for his 1845 children's book called Struwwelpeter.  The following year he produced a second edition which included the story of Fidgety Phil, and Johnny Look-in-the-air  which depict characters with symptoms of ADHD, which he no doubt got the ideas for, from the patients he saw.

1902, Sir George Frederic Still is marked by many authors as the scientific beginnings of the history of ADHD, and is seen as the Father of British Pediatrics.  His study of children found some had a:

• defect of moral control as a morbid manifestation, without general impairment of intellect and without physical disease.

1932, German physicians Franz Kramer and Hans Pollnow reported about:

• A hyperkinetic disease of infancy

with the most characteristic symptom was motor restlessness.

1937, Charles Bradley reported positive effects of a stimulant medication called benzedrine when given to children with a range of behavioral disorders.

1944, Leandro Panizzon first synthesized the compound methylphenidate, now commonly used to treat ADHD, and is marketed as Ritalin, who name is derived from Leandro's wife Marguerite or "Rita".

1968, Diagnostic and Statistical Manual of Mental Disorders (DSM-II) contained an entry for "Hyperkinetic Reaction of Childhood" and was defined as "The disorder is characterized by overactivity, restlessness, distractibility, and short attention span, especially in young children; the behavior usually diminishes by adolescence"

1980, DSM-III defines ADD: Attention deficit disorder: with and without hyperactivity.

1987, DSM-III-R a revision of the 1980 DSM-III refined the definition to ADHD: Attention deficit-Hyperactivity Disorder, as symptoms of inattention, impulsivity, and hyperactivity.

1994, DSM-IV further refined the ADHD definition.

2000, DSM-IV-TR the descriptive text of ADHD was changed but the definition remained untouched.

2013, DSM-V the latest version defines ADHD as:

• A persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development
• Six or more of the symptoms have persisted for at least six months to a degree that is inconsistent with developmental level and that negatively impacts directly on social and academic/occupational activities. Please note: The symptoms are not solely a manifestation of oppositional behaviour, defiance, hostility, or failure to understand tasks or instructions. For older adolescents and adults (age 17 and older), five or more symptoms are required
• Several inattentive or hyperactive-impulsive symptoms were present prior to age 12 years
• Several inattentive or hyperactive-impulsive symptoms are present in two or more settings (e.g. at home, school, or work; with friends or relatives; in other activities)
• There is clear evidence that the symptoms interfere with, or reduce the quality of, social, academic or occupational functioning
• The symptoms do not occur exclusively during the course of schizophrenia or another psychotic disorder and are not better explained by another mental disorder (e.g. mood disorder, anxiety disorder, dissociative disorder, personality disorder, substance intoxication or withdrawal)

For more detailed reading, see the source of this information at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3000907/ - The history of attention deficit hyperactivity disorder by Klaus W. Lange, Susanne Reichl, Katharina M. Lange, Lara Tucha, and Oliver Tucha

Forgot to see the man lady about a dog.

So today, apart from work, I had 2 things to remember. One was that Autoglass were coming to repair the glass roof on my car and the other was to take the dog to the Vets at 6pm for a post op check up. For Autoglass , all I had to do was be home which was easy as I had arranged to work from home. The vets appointment was in my phone calendar, so there was no way I could forget that. I finished my work for the day about 4:45pm and thought that it would be really good to take the dog for a walk early, so I'd have a bit more time in the evening. So by 5.15pm I was off on our usual 7 Km walk around Manor Farm Country Park which take about 1.5 hours or so, depending on how long we play fetch sticks in the rivers and streams and who we meet along the way. So I'd walked about 1 Km (I know this because my Walking App on my phone bleeted at me in its female but yet somewhat robotic voice that I had reached 1 Km), when it suddenly dawned on me I was meant to be at the Vets. I looked at my watch and it was 5.30pm, and then, as if our brains had connected from a kilometer away, my wife phones me to tell me I should be going to the Vets. Of course I hurried back, and fortunately the Vets is just around the corner from where I live, so I made it in plenty of time, and saw the lady Vet who I sometimes bump in to while out dog walking. So even with reminders and barely anything worthy of a todo list, I forgot. Luckily I remembered in time, but next time I might not.

Why things take longer when you have ADHD

So this is just a typical example of what happens to me.  Today I'm having diabetic eye screening done (I'm pre-type 2 in case you were wondering), so I needed to remember not to put my eyes in (I actually mean contact lenses but I always find saying "putting my eyes in" amusing), so what did I do, yes I put my eyes in.  "Oh well, I'll just take them out later.", I said to myself.  Anyway one of the lens was being uncomfortable today so I thought I would go back upstairs to take them out and that way I would not be frantically rushing to do this as my appointment time closes in.  I tell my wife I'm going upstairs to do this and she asks, "can you bring your washing down.". I acknowledge her request with a Star Wars Battle Droid "roger, roger", smiling amusingly at myself as I walk away. "Don't forget the washing!  Don't forget the washing!", I tell myself as I climb the stairs.  I get to the bedroom, pick up the clothes, and come back down and put them near the washing machine.

 I sit back down and think, "hmm, my contact lens is a bit uncomfortable.", and then I realise I forgot to do the thing I wanted to do in the first place, so trundle back upstairs to take my lenses out.

Stuff like this happens every day, and this is why things take so long to do as I am forever having to go back and complete tasks that I went to do but doesn't happen because I got distracted by something, was asked to do something else as well, the phone rings, there is a knock at the door, well you get the drift.

More Speed, less haste.

So had a chat with my Psychiatrist about the new ADHD medication and as I wasn't getting any side effects and I thought there may be some subtle improvement she suggested to increase the Elvanse Adult from 30mg to 50mg starting to day.  Now I only have 30mg tablets currently so I can't just double the dose. So to get around this I pull apart the capsule and mix with water and drink two thirds of it i.e. 20mg, so I dissolved it into 150ml of water and drank 100ml and took the other capsule as normal.

Anyway, today I feel like I'm buzzin' (yep it's an amphetamine based drug which is what Speed is).  No anxiety or panic attacks and I'm getting some stuff done.  After a couple of hours I took my blood pressure and it was a normal (for me) 139/69 with a pulse of 71.

It's just day 1, so lets not be too hasty and say its working just yet. I'm working from home today and there are many distractions, "Hey look, a Chinook helicopter!". There are no squirrels in my garden so I have to go with what I can see, and he wasn't flying that high, maybe 1000ft :)

It's not just one thing.

I find when I tell people I have ADHD they seem a bit perplexed. I might get a direct response of "You're not hyperactive. Are you?", or an indirect one like "isn't that, like being hyperactive?" implying that they didn't think I was hyperactive, then there's the disbelieving response of "isn't that something kids get?", and the denial "Oh really?".  I can understand where they're coming from because if you told me I had ADHD  a decade ago, I probably would have laughed, a bit like when you think you're having an "OCD" moment (which incidentally has a number of different types and symptoms and is more than just needing to make things straight or in order).

If I told someone I had a cold, they'd expect maybe a sore throat, blocked or runny nose, perhaps sneezing, a cough, a hoarse voice and that I might be generally feeling unwell.  If I didn't have a cough they wouldn't look at me in disbelief. A cold is more than just a cough, or sneeze and similarly ADHD is more than just hyperactivity. In fact in adulthood, hyperactivity is more internalized, but can manifest in other ways like jiggling of legs, or tapping fingers, clicking pens, much to the annoyance of your colleagues. It can also feel like you just have to get up and do something but you have no idea what. So as an adult you may not appear to be hyperactive.

I'm not going to list all the symptoms here because there is plenty of sites that already have it, and I'll probably mention them in future posts, but like a cold, you don't have to have all of them to have ADHD and some of them might be worse than others. Oh, and there's 3 types of ADHD too.

Random update.

Can't believe that even though I have a daily reminder on my phone to update my blog that a week has passed already. I guess the Round Tuits were in short supply.

Anyway, its been a week on the Elvance and so far no side effects that I can tell.  Not sure if they're having an effect or not because if they are it's very subtle.  I do seem to have written a lot more this week than I usually do, I even managed to arrange for the dog to have his bits chopped off, but then it could have been the reminder from my wife that prompted me to pick up the phone. So watch this space.  I have a review on Monday so we'll see if the Doc recommends continuing or upping the dose.

And now for something completely different.

OK, so the Concerta XL didn't work and I've stopped taking it and took the excess tablets back to the Chemist (they're a controlled drug and they keep them locked up because people like to just take them as they are amphetamine based).

So today I'm taking a new drug called Elvanse Adult 30mg  (ADHD, it's not just for kids :) ).  So far no side effects, but no improved focus either but maybe it needs to build up in the system and the Psychiatrist did say she'd review in a month, so watch this space!

The long name for Elvanse Adult is lisdexamfetamine dimesylate, not sure how I'm going to remember that but for now I'll just break it up like this: lis-dex-am-feta-mine di-mesyl-ate.

What's it like not to know you have ADHD?

This is my personal interpretation of what its like to have ADHD. Not everyone is the same, but there will certainly be some common ground here for sure.

[The following text is purposely in a huge paragraph and I've removed all punctuation, because understanding what you are reading is problematic, and for non ADHD readers this is as close as I can simulate it.]

What is wrong with me?

First of all I'd like to say what it's like not to know you have ADHD there is a misconception that ADHD is just for kids that adults don't have or can't have it so as an adult it's not something I thought I might have in fact I didn't think that anything was different about me as I believed that I was the same as everyone else but I came to the realisation that either that everyone else was better at overcoming their foibles or I was just lazy and lacked common sense inevitably I just thought I was a bit scatty or stupid in fact I berate myself with you twat david because that's what I feel like I try to make up for my shortcomings by saying things like I meant to do that to see what happens when I click on the wrong thing on the computer or I was just coming to see you but I have been very busy when in fact I totally forgot about my meeting with the boss or I was just going to start that when a colleague asks if I have finished that thing I was working on for them I know this is not a sustainable way to be working and at some point something is going to go awry but yet I plough on regardless in the hope that it will all go away my boss asks if I have time to do something and I say yes knowing full well that I will not get it done by the end of next week and I start planning a sick day for when the work is due why do I say yes to everything why do I start things and struggle to finish them if at all why do I get bored with things very easily why do I get distracted by the slightest thing why did I leave the milk out why am I staring blankly at the computer screen hmm screen sounds like cream ice cream yummy rum and raisin at the seaside oh a holiday but it's usually a long drive who's gonna take you home tonight yes this the wrong lyrics because I can't remember them either I wonder at this point how I got here what was I meant to be doing I didn't leave a trail of crumbs rhymes with bums I laugh out loud to the bemusement of my colleagues where does all the time go half an hour goes by but it feels like a few minutes writing oh the drag of writing writing anything it takes sooo long I've been writing for hours yet have little to show for it I knock over my cup of tea because I forgot to put it out of reach yet I know I'm such a clumsy clot so why didn't I do it yesterday my colleague shows me how to do some task I don't write it down because I mean it was so easy why would I but now I have to do that very thing and I cannot remember how some of it goes and my colleague has gone to meeting - aargh wait a minute where did my pen go it was right here I had it in my hand just seconds ago has anyone taken my pen my colleague looks over to tell me I'm still holding it in my other hand phew I think I was going to write something but I cannot remember what it was now hey ho a few minutes go by in reality is been half an hour the phone rings the caller asks if my colleague is back yet and then it dawns on me that the thing I was supposed to be writing down was a message to my colleague to call their spouse they've been there a while and that was probably 25 minutes ago I make some excuse as to why I didn't get around to passing on the message and hand the phone over I hope they won't be long on the phone because now I'm aware they are back I had something to ask them what was it again damn that thing I was doing for a colleague a while back I've just realised I've done it on the live system and not the test system can I undo it luckily this time I can but I'm not always so lucky the times I've had to talk my way out of a situation that was all my own stupid fault I'm such liability why is no one else like me perhaps they are is this normal are they just better at covering up the things that seem totally out of control I really hate this what doesn't help and this is just people trying to be helpful by empathising is when I talk to someone about my problems and they say oh we all do that with the implication that everything is normal and don't worry about it the problem with that is that yes its true people do do these things but the difference is they don't do it every day multiple times a day they don't get upset about it they don't get marked down in their appraisals they just don't understand so trying to convince others that I have something going on is extremely difficult and tiring when they can dilute it so dismissively I start to believe I'm a hypochondriac.

No more Metal Fanny Dates

Well on Tuesday had a follow up call with Dr Cubbin, and as I wasn't feeling any benefit she suggested I increase the dose to 3x 18mg.  So this I did.

After about 45 minutes to an hour of being on 3 tablets, I was getting panic attacks, and was taking all my concentration to not to freak out because it was happening while I was doing 70 mph down the motorway on the way to work.  During the day it was still there albeit mildly and my arms were tingling and it seem like my heart was doing weird stuff, but that kinda happens when you have panic attacks anyway.

I emailed the Clinic to tell them about it and very they got back to me quicker than I was expecting and I missed a call from Dr Cubbin, but after some email ping pong I was advised not to take any more Concerta XL and Dr Cubbin would call me early Tuesday Morning.

As far as I can tell, no withdrawal symptoms today, so all is good.  I wonder what we'll get to try next?

Decaffeinated Dave

Since upping the dose I started getting the heebeejeebees as I like to call it. Basically I was feeling the effect of multiple stimulants, the Concerta XL and caffeine from tea and Pepsi Max. So I've gone cold turkey, and removed caffeine from the menu.  Headaches and tiredness are now my new daemons, but at least I am not feeling the effects of my over stimulation.

Anyway, still not feeling the benefits of the medication, but it's not even been a week on double bubble.

Its not NZT.

So today I got to double my dose of Methylphenidate Hydrochloride, and apart from feeling a bit odd in the morning (which could have been down to the fact I was called out by work at 2:45am for a couple of hours and was lacking sleep), I didn't notice any positive effects.

Maybe its my expectations.  I was kind of hoping for some miraculous change akin to what happens in Film/Series Limitless (the film and series are really good by the way, its a kind of semi sci-fi/crime drama) where the main character takes this drug called NZT which gives him the ability to use all of his brain. OK so not quite that extreme, but I was hoping to notice something.

Meanwhile, Tracy (that's the wifey), thanks me for taking the rubbish out earlier.  I have no idea what she's on about, but hey, brownie points are good no matter how you get them :)

Date with a Female Robot

So firstly, welcome to my new blog about me and everyday things that happen as a result of having ADHD.

Today is day 4 of starting medication for ADHD. I know you're wondering what it is.  It's called Concerta XL 18mg. So far I haven't noticed any effects relating to ADHD but I have noticed signs of what might you might get if you'd consumed a lot of caffeine, and this is unsurprising as the medication is a stimulant. Tomorrow I get to double the dose (36mg)  as directed by my Psychiatrist, Dr. Sally Cubbin, and that may show some results.  She did say that the initial dose would probably not be effective but it would show up any side effects.

As with most medications, it has a brand name and a generic name. Over time the brand name falls out of use, e.g. Prozac is now know by its generic name Fluoxetine. So I like to know what the generic name is for any medication that I take.  In this case Concerta XL is known generically as Methylphenidate Hydrochloride.  A bit of a mouthful and not easily remembered, especially with ADHD.  However, ADHD does give you a great ability to make connections and associations, so I decided to see where I could go with this.

If I split Methylphenidate up into parts, I can get Methyl-Pheni-Date.  Now immediately I can connect Methyl with Metal, Pheni with Fanny and Date can stay as it is.  Now I have Metal-Fanny-Date.  Hmm interesting, a date with something with a Metal Fanny (for non UK readers, Fanny is a slang word for the female genitalia)? A female robot, of course.

Now ADHD also gives rise to being inappropriate, so Fanny fits in really well.  A date with a female robot; a Metal Fanny Date. Excellent.  So there we have it, and it's remembered (for now at least).  The Hydrochloride part is for me easy to remember as it reminds me of chemistry at school.

I'll let you know how I get on tomorrow on the double dosage.