Some sentences begin so badly that it’s impossible to finish them well. The classic, of course, is “I’ll stop beating my wife when…” There’s no good way to finish that sentence. There are others. “Whenever I lose my cell phone, I just…” is another. Who wants practical advice from this person? I’d like advice on how not to lose one, thank you.
There are common sentences in the ADHD world that fit in this group. They include all the sentences that start with, “I need my medicine when…”. I’ve heard a lot doctors, even experts use the words or their even-worse corollary, “You shouldn’t need your medicine when….”
You’ve probably heard someone with ADHD say, “I just need a short boost in the morning to get some busy work done,” or a college student explain that, “I don’t take Adderall in the summer. This job doesn’t need focus like my studies do.” The problem with the “when I need my meds” phrase is that it assumes that people with ADHD are capable of something that we’re actually bad at.
Have you noticed how bad you are at noticing?
When someone’s self-awareness is impaired, how is he or she supposed to figure that out? It’s a cruel bind, since it takes self-awareness to estimate self-awareness. Those of us with ADHD should be forgiven if we don’t immediately notice our impaired self-awareness.
But what about the corollary? Wouldn’t improved self-awareness be especially obvious? It seems, unfortunately, that this is not really the case either.
When physicians want to judge whether an ADHD medication is working for a child, we ask the child what she notices, but also ask her parents and teachers. Corroboration is essential. I’m truly surprised how many children are unaware of their own improvements, despite behavioral changes that are profoundly obvious to me, their family members and school personnel.
Improvements are easy to notice, aren’t they?
What about the opposite scenario—when someone clearly sees attention improvements, does that mean that their self-awareness has improved and that we can trust their judgement? This is an important question when treating adults with ADHD since we are much less likely to have a third-party view of their treatment-related improvements.
Science says ‘no’. The subjective experience of the effects of stimulant medications is not a reliable indicator of actual improvements. An experiment at the University of Pennsylvania demonstrated this. Students without ADHD performed a battery of cognitive tests, then took Adderall and repeated the tests. The students reported that they did better on the tests, but objective measurements said they didn’t. When ADHD subjects do similar tests, we think we do better, and measurements prove we do better, but we are not good at judging the magnitude of improvement. We still misjudge the degrees of various improvements.
As Oprah might say, “YOU feel improvements and YOU feel improvements and EVERYBODY feels improvements.” Think about that for a minute. College students nationwide are buying Adderall illegally, risking felony charges for the illusion of doing better. Fortunately, in a weird twist, those with undiagnosed ADHD who get their stimulants illegally actually do improve.
When we say “I need my medicine for this task” or “I don’t need it for that one” we presume that we can accurately judge its effects, despite evidence to the contrary. It also presumes that we know what demands the day will bring before it even starts. Yeah. Right.
If we can’t clearly estimate our impairment or our improvements with treatment, how can we sort out when we need or don’tneed the medication? In short, the effort is non-sensical. It’s like asking a color-blind person to match a shirt and tie. If we are going to treat ADHD with medication, a regular schedule set in consultation with our doctor is the best we can do.
We need our medication, when…?
So let me take a stab at finishing one of those sentences sensibly:
We need our medication on all the days of the week that end in ‘y’.