Making Noise of ADHD

Making Noise for ADHD

The human nervous system is a powerful, not fully understood system. It is our internal computer and network that is responsible, among other things, for how we think, feel and behave.

There is a natural noise that occurs in a human nervous system. This noise is roughly characterized as “random disturbances of signals.” (Faisol et al., Nat Rev Neuro 2008).   The noise of the human nervous system is part of what can cause variability in behavior, sensory input and movement. For example, this is why, even after shooting thousands of free throws, the best in the world will still occasionally miss.

In ADHD there is extra noise in the nervous system. It is thought that this is due to less availability of neurotransmitters (especially Dopamine) in the frontal lobe.

Most people with ADHD will have increased problems with executive functioning. Executive functioning, to paraphrase Edward Hallowell, is a term that describes cognitive abilities necessary for academic and personal success and well-being. It allows for good self-regulation, which is a strong predictor of academic success.

Specific aspects of executive functioning include effortful control, which is “the ability to inhibit a dominant response to perform a subdominant response (Rothbart)”.   An example of good effortful control would be to turn off a video game in order to do homework that is due.   Included in this would be time management, transitioning or switching focus, consistent planning and execution of the plan, remembering details, and avoiding saying or doing the wrong things.

Over the years, I have worked with children and adults who have ADHD and have incredible abilities but also face major challenges in using them due to the noise in their operating systems.  They tend to be very sensitive people, strongly connected to emotions and patterns in the world. They have powerful abilities to put things together in creative ways that others would not have recognized. They are big- picture thinkers.

Where they struggle is with the daily details of living such as checking a text, returning an email, paying a bill, or turning in homework. There is a pattern of mistakes that may be small at the time but add up.   This causes mental fatigue. It is like starting a day with a pebble in the back pack, but as the day progresses, pebbles keep getting added until that back pack is full. This especially happens if they try to ignore the extra noise instead of deal with it.

These issues with the noisiness of their executive functioning can cause a lot of emotional distress. People with ADHD, as smart as they are, will tend to feel ineffectual at best and, at worst, just plain stupid and lazy. They tend to feel life is difficult to deal with on a daily basis and can start to give up because they expect failure.

Dr. William Dodson, a Colorado psychiatrist, an expert in adult ADHD, has coined a term for this. It is “Rejection Sensitivity Dysphoria (RSD)”.   People with patterns of RSD struggle due to lack of assertiveness, avoidance of necessary things, and deep-seated sadness and worry.

Dr. Dodson describes RSD as a state of “emotional pain triggered by the – perception not necessarily the reality – that a person has been rejected, teased or criticized by important people in their life.” They try to be who they are not to please others.  These perceptions and actions, according to his model, are what lead to dysphoria, which is defined as a state of “unease or general dissatisfaction with life”. This sounds a lot like severe social anxiety, but a big difference is that the RSD is clearly caused by the ADHD.

RSD is a noisy condition and yet it is often quietly dealt with if not overlooked or ignored. It is not talked about much in regards to ADHD and how it can affect a person. In order to handle this problem, it needs to be addressed directly.

First and foremost, the ADHD must be treated.   In milder cases, this may be done with a strong focus on executive function coaching and certain strategies to manage stress and sleep such as cognitive behavioral therapy. For the most part, however, medications are necessary. This may be through the use of stimulants or non-stimulants or a combination.   Even with medications, the environmental and behavior management strategies should be implemented.

Next, as a caregiver, you work to create an empathic environment that encourages patience and good communication. You praise loudly, redirect quietly and encourage acceptance.   Encourage teamwork in problem solving for kids, but encourage them to lead that.

As the person with ADHD, you work toward acceptance of yourself, your strengths, but also your imperfections.   You work on assertiveness and on engaging coping skills that stop avoidant behavior. This allows you to be who you are, not try to be the person you think everyone else thinks you should be.

The process leads to self-compassion and redirects from self-criticism, which is the gasoline on the fire of RSD. These changes will take some time as change of this magnitude is a process. It is easier said than done to get there but it certainly is doable.  Think of it as evolution.

You can’t turn off the noise of the nervous system, but you can turn it down and control the volume. When you truly stop and listen to the noise, you can actually find the music that is in there.