Saturday, March 9, 2013

Distractibility of ADHD is a reflection of anxiety/fear

A young man in his early twenties came to my office for Adderall to help him concentrate upon his studies. When asked how Adderall would help him, he claimed he has ADHD which causes him to be distracted by  anything and everything.
He declared himself to be an anxious individual who has to constantly worry about disaster striking upon all different aspects of his life and so his mind is busy putting out fires everywhere to pay attention to what is happening right in front of him. The only thing that stops his trying to be in 10 different places at the same time is marijuana. But its effects last only for an hour or so and then he feels tired, bored and sleepy, so it does not help him with his studies, and he was hoping that Adderall would be able to help him concentrate for longer periods.
But what has prompted me to write this blog is a statement which he made which got me thinking whether the tendency of ADHD children to immediately pay attention to whatever noise or activity is occurring around them rather than the lesson that is being taught in the classroom itself is not an attempt to avert imaginary disasters.
The patient stated that any conversation happening around him immediately shifts his attention to what is being said there rather than what the teacher is saying. "If somebody is talking about going to the zoo then my mind is there in the zoo with them. If I hear some noise from the ceiling then I am thinking about some animal is hiding there. In fact I cannot sleep soundly at night because every noise startles me in to thinking that thieves are about to break in and enter. Anything and everything that is happening around me gets me immersed in that instead of just filtering it out and focusing upon reading."
So his distractibility was no different then how an anxious mind keeps thinking of all the situations where harm could come to oneself or those who are dear to one. And just like how this fear of harm coming to oneself or one's loved ones leads one to undertake protective obsessive rituals the shifting of attention from what the lecturer is saying to the distracting talk or noise is also done to take some action to prevent harm. His ADHD was based upon a mind-set that was constantly anticipating harm and constantly working upon its prevention. And every distraction was used as a convenient excuse to project upon one's fear upon that and then search for actions to protect whoever was being endangered. For example when he heard somebody talking about going to zoo his mind was seeing that person getting endangered by some animal there and then his attention had to be focused upon imagining himself with that person in the zoo protecting him from animal attacks.
Another patient, a woman in her thirties, claimed that she has ADHD because she has to be on the go go go all the time. "I have to be doing things for others because I am afraid they will not do it right. With my children I am finishing their sentences for them. Poor babies. They cannot speak for themselves because I take over for them."
 Analysis showed she was projecting her own fears of not doing things right upon her children and then doing the job correctly for them.