ADHD + learning disabilities / being a student / kinesiology / stories from the past

modifying the process, not the outcome: part two.

• by kerri

I am a mess at making series properly. I’ll provide background, but for full context…
Related posts:
Modify the process, not the outcome: Assessment results. . . and hope | March 23, 2013
Modifying the process: Part one | April 3, 2013 
Beyond expectations | September 9, 2013
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This one time, I failed anatomy. You know how many people fail anatomy? Lots. You know how many medical students fail anatomy? Lots. As I discovered after googling “failed anatomy”. So, after that I wasn’t too fazed by my first F in university. I mean, it’s anatomy, I didn’t really even expect to come close to passing the first time, it was like the experience round.

Except then, this other time, I failed anatomy again (and social psych, the only other class I was in at the time), and I was not cool with that at all.

Then I was diagnosed with learning and attention issues, and was handed a report that literally says, in part, that I am “not suitable for visual learning” and “therefore, finding ways to have information presented through other means may be [of considerable help].” and to “[…] be mindful that subjects that require an abundant amount of visual learning, such as understanding graphs, charts, and diagrams may be a challenge […]” (Wang, 2013).

Key word there is understanding graphs, charts, and diagrams. That says nothing of the abundance of memorization and application of [memorized] knowledge required to pass Human Anatomy. Yes, a lot of people struggle with these things—anatomy is by no means an easy course for most people (there are some people who are wizards, however, and I cannot explain them). Except not only was it simply extremely difficult for me, I then learned after two terms of extreme frustration that I am pretty much not even wired to do it—especially, at least, not in the format they were providing.

 help me if you can, it’s just that this is not the way i’m wired so could you please, help me understand…

the outsider, a perfect circle

I took this knowledge alongside my recent registration with Accessibility Services to chat with Dave, the Department Chair of Kinesiology. At the time, program requirements for my degree kept changing, so I made a few swap requests which he took to the departmental review committee for approval—two of the requests were approved. The swap of anatomy to physiology, though, was not, as “the department feels it’s important for all of our grads to have human anatomy”. I don’t disagree, but with documentation like the above, it sucked to hear. I had a meeting scheduled with Dave to follow the e-mails, and when I asked if we needed to keep the meeting, the Associate Dean of Kinesiology, Glen, replied, “I think we should still meet to discuss how you are going to handle the Human Anatomy requirement.”

Pause right here to note that Glen has a PhD in Human Anatomy, 30+ years of teaching experience, and a reputation for being awesome. So I was kind of like “Okay, see you Monday.”

I’m pretty sure this was the day he said for the first time “We’ll get you through anatomy, whether I have to help you through, or drag you through.” Yes, dragging apparently can be a thing. I was expecting . . . not nearly as much as he had worked out. I left the meeting with him saying, “Let’s get you through this and get you out of here.”

This was September. I started anatomy in January, for the first time with accommodations (and my iPad).

By three weeks in, I was meeting with Glen once or twice a week. He would quiz me, attempt to figure out how to make things stick in my brain. We’d go sit with a model in the athletic therapy lab, or in the anatomy lab, or around my iPad and binder of notes from the instructor. Beyond this, I was making anatomy a full time job (on top of two other classes and a part-time job, and a contract project with the Asthma Society). A week before the midterm, week 5, I texted him this picture:

Yes, that’s a 3/10 there. 30%. Despite everything we were throwing at this, well, it sucks when your best simply isn’t good enough. I met with Glen the next day—we intended to meet in the open lab session to study, but given that lab quiz result a mere three days before the exam, we took a detour and took over one of the kinesiology instructor’s offices instead.

“Well, I told you that we’d get you through this, whether I had to help you or drag you,” (yes, this was probably more dragging than anticipated) “I know you’re working hard. What’s not working? What can we do to get you through this?”

My brain isn’t working, that’s what. “If I knew, I wouldn’t be almost-failing again.”

Back to the drawing board. We talked about the lab quizzes—the big issue in previous terms, and becoming the (an) issue in this one. We’d already accommodated those by having me do the lab quizzes before lab with the lab demo before my weekly labs so that the time component (quickness required in having the models move by me too fast). Since this was my only form of assessment thus far, it was the one that needed to be addressed. We also covered what, exactly, the struggle was for me outside of processing speed: visual memory. It was just too much for me to be able to hold that information in my head, and manipulate it to get the correct answer without any sort of visual guide to work with. I tried to explain more about this, but three days before the exam I was just really stressing and emotional (I was thankful that the office we borrowed contained Kleenex). Fortunately, to an extent, he got it; he said again that he knew I was working hard, but that things just weren’t working. After three attempts, I knew that I knew more than I was able to demonstrate. Sometimes lab questions involved the model being partly covered and flipped in another direction, and being asked “Does this bone belong to the left or right side of the body?” So not only would I have to figure out the bone from it being partly covered and oriented bizarrely, I had to flip it around in my head and identify the side or structure in question.

He rolled with it. He first contemplated with me whether oral quizzes would be better—except, writing’s not the problem (he’s seen this blog—he knows that now :]). Well, if writing’s not the problem, then, it was decided we’d eliminate the lab quiz aspect altogether, and then assess me in a way that worked with that. He took the reigns and simply pulled me from lab quizzes—the grades thus far were thrown out. Instead, I submitted weekly 1-2 page papers on an aspect we covered in anatomy that week to cover that portion of my grade. We also agreed that I would be allowed to sign out the lab models to work more with them at home, because by my 4:30-6:30 lab time, with all the potential chaos on lab, I simply wasn’t able to absorb enough in that allotted time to make a difference.

Then, of course, I was brought back to earth with, “This doesn’t help that you have a midterm on Friday.”
“Yeah, I have one tomorrow too that I haven’t even started studying for, since I’ve been trying to keep my head above water in anatomy.”

With that he told me he was deferring my midterm and to “get the hell out of lab and go study”, and he would talk to my instructor about the new plan of action. He met me briefly outside the lab after I’d gotten my stuff to discuss when I’d write the midterm (since the next week was Reading Week), but since I had test accommodations with Accessibility Services, I didn’t need anybody to invigilate so I got the “Oh, you can write whenever you want!” response again (like I’d gotten in the Fall when my instructor approved a midterm deferral in Sport in the Ancient World because once-upon-a-time-my-uterus-tried-to kill-me-except-it-failed). We also briefly discussed that we’d have to figure out how we were handling the final lab exam, but we’d deal with that after the midterm. Tutoring was also basically off the table (which we hadn’t implemented yet aside from working with Glen), as were my study sessions with Glen beyond if I had specific questions. In reality, if the sessions with him weren’t working, I think we’d be hard-pressed to find many tutors who could help. As much as this man knows anatomy, he’s an educator through-and-through in my perspective :).

I wrote the midterm a week after the rest of my class, on the Thursday of Reading Week (since I had a project deadline the Sunday of Reading Week with the Asthma Society). I got my test mark back a couple weeks later—53%.

I was all

My instructor was all “How do you feel about that?” “AWESOME. I PASSED.”

These people really didn’t understand I was serious when I said “I just want a D.”

Glen, however, wasn’t quite as enthusiastic as I was (I mean, I maybe was overzealously excited about my bare-pass, but SO?): 

I have looked at you midterm exam and it is unfortunate to see that you were not able to score better (42/80). […]
 
You had difficulty with almost every part of the exam except for the short answer questions.  You had the most difficultly with the Charts section which gave you one or two clues from which you had to determine the anatomical structure being asked for.  Similarly you had difficulty with the diagram section which I would have thought you have done well with given the drawing you were doing on your iPad.

[This] exam is challenging in that it calls for information that is gained by memorization, visualization, conceptualization and functionality.  I think you did well in the  functionality portion of the exam (short answers) but had the most trouble with the visualization aspect (relation of now structure to the other, charts based on one or two clues, diagrams).
 
Not sure where we go from here.  Do you have any suggestions?  Who in disability services are you working with?
[Note: The charts are torture.]

Of course, I was like “WHAT I DID AWESOME” (there’s no punctuation in my brain), and told him that. Except at this point, we not only moved forward with the alternative assessment in labs, we got Accessibility Services in on the shenanigans once more, and Jess had a lot of good suggestions on how we could work with the lab component for the final. For the finals, we eventually decided that we’d do a modified format to both the final written [lecture] and lab [bellringer] exams (more on that shortly).

I kept pushing through—I had, fortunately, also made two friends in the course, helpful in working through the labs with and teaching each other, and also having people to study with outside of labs (…”The articulating end of the radius is conCAVE because that’s where the radial bear lives!” Merry: It clearly worked!). I studied my ass off, with Merry and Ashley, and by myself: with a pile of pencil crayons and coloured pens, many killed trees (sorry trees, blame anatomy), Quizlet and other online flashcards, and $50+ worth of iPad apps to try to get smart things into my brain one last time. I asked initially if there was a way I could get into the lab to use the models more often (since we had so few open lab sessions in a term and were only really allowed to use models during our lab times) but with limited availability of people to provide supervision, I ended up getting permission to take models home. I’d like to say it helped, but I’m also realistic about the amount of information from visual input my brain actually is useful for.

With a now 175% time accommodation for tests, I asked if I could write one exam Monday [two days before the day my class was scheduled to write] and one on Wednesday [the same day as the rest of the class], as otherwise I’d be writing for like 9 hours on a single day, which all parties agreed to—I was no longer writing the same exams as my class, so this was no longer an issue. I did my lab exam in a way similar to the class, except through flash cards and without a per-question time limit, and formatted in multiple choice to reduce the number of variables in front of me (the traditional bellringer allows students one minute per station with an open-ended question and most times a sticker on the model identifying the structure in question. The model can’t be touched). For the lecture exam, I was provided a multiple choice/fill-in-the-blank/true-false exam created by Glen and based on the class exam, and allowed a very simple, un-detailed, un-labelled diagram to use simply to orient myself to the questions.

(I spent much of the night before my final lab exam doing this, above—I have no clue if it helped, though!)

The lecture exam went okay, or so I thought, except for the amount of lower-body questions (what we had covered on the midterm) that I hadn’t realized were going to be on there. The lab exam? I was freaking out even prior to it starting, because of my difficulty on the lecture exam. The epitome of all this? If I failed anatomy, I wouldn’t graduate in June. From Facebook, Jess in accessibility services knew how hard I’d been working, and told me so while I was waiting—she asked me how I was doing and when I almost broke down, she asked if I wanted to go talk in her office. I basically knew if I did this, I’d lose it and declined, so she said to come see her or go take a walk during the exam if I needed to. Of course, the exam was kind of an emotional disaster—I have never cried during an exam before, but this was the one. I spent some time staring at the ceiling and eating a Rice Krispie square to calm myself down; I knew I could leave and take a break, but I also knew if I did, I wouldn’t want to go back in, so I kept going. 

I finished the exam, and went to see Jess, who got the whole anatomy-related breakdown (and was awesome about it, because she’s always awesome), and assured me that if I didn’t pass we’d figure things out, and regardless I’d worked really hard. I went out for lunch and then as I was waiting for the bus, got a text from Glen saying “Check your e-mail – good news :)”. 

Turns out, four minutes was too long for him to wait for a reply to his e-mail.

 

Anatomy = PASSED.

A photo posted by kerri (@kerriontheprairies) onApr 4, 2014 at 3:58pm PDT

77% on the bell ringer? Yeah, my brain just about exploded because that’s the thing I’ve failed hardcore the last two times.

Final grade? C+.

Yes, I had some pretty awesome people on my team. Some very awesome people. But, I didn’t work any less hard than I worked other terms: in fact, I probably worked harder, but also more effectively. The style of my assessment was heavily modified, of course, but in no way was I handed this grade: after the exam, I texted Glen to thank him for all of the work and hours he invested in me, he replied “No thanks required, you earned it” (thanks were still totally required); he told me the same when I took him cupcakes one day in May to [attempt to!] thank him. Not only did I potentially work harder than many of my classmates (who possibly received better grades), I worked that much harder for the second time (the first time through was the first time through, really—many people have two attempts at anatomy).

Accommodations don’t give an advantage—they level the playing field. I know this, and the people on my team know this. I just hope that other people realize it, too. Sometimes, students would ask about certain things, accommodations I had, and say “I wish I had that”—I wish I could use the instructor’s notes/have a volunteer note-taker; I wish I could write tests in a private space; I wish I had electronic textbooks. An honest response, yes, but one that is not well thought out: I wish that I could spend the normal amount of time reading a chapter and taking notes, not one or the other; I wish I had a GPA higher than 2.8; I wish I knew the right technology to access earlier.

Mostly, I wish I knew earlier what I know now. That I have a learning disability and ADHD, that it’s a part of who I am, and that I can work with this.

Maybe it took a bit more time, but I accomplished what I set out to accomplish—and that’s what is important: learning and attention issues or not.

My cousin Dean and I—I still got to graduate 24 hours before him.

Photo credit to Linda Mikulik.

ADHD + learning disabilities / advocacy / life

ADHD/LD and me: executive functioning.

• by kerri

Yesterday’s post covered the basics of my world with ADHD and a learning disability. As I wrote about briefly, a big theme in the ADHD/LD sphere is that of executive functioning. I know, I know, it conjures up images of fancy businesspeople, specifically at a cocktail function. (No? Just me?)

So, what is executive functioning? Why does it matter? I’ll let the experts—and a sixth-grader named Josh—handle that in infographic form, made by the awesome folks at the National Centre for Learning Disabilities:

[View infographic here since the link broke]

(Source)

Nope, I’m not a sixth grader, but I struggle with most of these areas.

Organization: I was the person who never had a pencil or pen in school (fortunately, my friends—especially my friend Sam—were excellent with dealing with this annoying trait of mine…). Even in university, I usually had to get lucky on this one! I miss buses because I can’t find my keys, or I miscalculate how long it will take me to get ready before getting to the bus. A later pane has Josh unable to remember the correct place settings when setting the table at dinner—at twenty-three, my mom is still telling me to switch the position of the forks and knives more often than not! In a later frame yet, Josh forgets to put his finished homework in his backpack—yup, just because it’s important, doesn’t mean it’s making it where it needs to go: been there.

Working Memory: This is why it’s important for me to write everything down somehow. Whether it’s the post-it notes of chores, or making notes of what I’m reading… say it with me: “If it stays in your head, it gets lost.” (…Thanks for that mantra, Jay!). Sometimes, let’s be honest here—most of the time, I just simply didn’t do a lot of readings in university. Others, I would spend a ton of time doing the reading, and it wasn’t much different than when I actually did it. “I don’t know… I wasn’t thinking of those words when I read last night. I’m so overwhelmed.” is how I felt—and, hoping the instructor didn’t call me out for an answer: yes, I raised my hand when you asked who did the reading, no I didn’t lie—I did it, but, I can’t get the information you want in cohesive thoughts quickly enough to not look dumb or like I didn’t do the reading. “His heart sinks thinking about all the steps answering this question takes.”

Self-Monitoring/Impulse Control: In the big picture, I appear okay with impulse control. Sometimes I catch myself talking way too much and apologize. But let’s go back to prior to the infographic when I noted that I took a 30 minute deviation looking for t-shirts. That’s because I impulsively read an e-mail instead of selectively ignoring it until I was done this task, and then allowed it to take priority over writing. Now, once again—how much is me, how much is ADHD? How much is that I desired to do that versus this, and how much of that was pure choice vs. choice with a side of impulsivity driven by ADHD? For instance, if I want to change my behaviour on a bigger scale (make it habit, perhaps), will it take me more sustained effort to change that behaviour versus someone with a “typical” balance of neurotransmitters (aka, a non-ADHDer!); how much of the success of this desire to change is derived of ADHD, and how much, more simply, of pure personality? Am I less likely to, for instance, adhere to an exercise routine because of my ADHD, or purely because of personality, than someone without ADHD? I don’t have answers for that, but for more on self-regulation theory and its applications, check out this article.

Cognitive Flexibility(/Working Memory): Here’s a parallel: Josh in the infographic struggles with keeping his thoughts organized in a soccer game… and kicks the ball into the wrong goal. This is 100% me. Interestingly, I coach now, and keeping the rules to the game straight is still very difficult for me—as is quickly revamping a plan without having somebody to talk it through with. This also translates into simply making/keeping plans and obligations. The combo of cognitive flexibility and working memory are probably also the difference between finishing a project early (be it a paper, volunteer research, or editing a video) because I remember it at other times and not simply the days before a due date! (I could be interpreting this wrong, but, that’s my take on it.)

Emotional Control: Little things -> big reaction? Sometimes. I still struggle to express anger or frustration in any other way than bursting into tears—or being on the verge of doing so. And, when so many basic things can be the source of my frustration, this is just another thing that is very difficult to deal with sometimes, because sometimes the small reminders feel like personal attacks—even if they aren’t at all, it’s just that when I forget my keys for the thousandth time or don’t have bus fare, I’m already frustrated enough at myself—so any outside digs are simply more than I need in a given moment.

Task Initiation: Going hand-in-hand with organization, switching from one task to another or prioritizing, can be extremely difficult. Why am I writing a blog post instead when I have a task I was supposed to have submitted yesterday is incomplete? Why did I not do any preparation for coaching Goalball on Sunday until the night before? Because it is difficult for me to initiate tasks that require a lot of mental organization or “figuring out” beforehand—even if they are things I really want to do. Because “I don’t even know where to start.” is 100% accurate. Which, of course, goes along with the next point…

Planning + Setting Priorities: I remember one occasion specifically where I started writing the bulk of my final paper for Sport in the Ancient World two days before it was due. I went to bed at 6:45 AM. I’d done the research, or at least a lot of it, but the writing of the paper itself went on the back-burner. I’m legitimately surprised that I had as few all-nighters as I did in university. Not being able to figure out the structure of a paper isn’t a mystery to me either—a combination of poor planning and task initiation lead me to having no idea how to write a midterm paper for Sport Ethics a couple years ago—I couldn’t figure out how to structure it, and it was due the next day. Had I planned better, I’d have been able to get help from the prof; instead, I dropped the course—a common thread in my university experience, and probably much to do with difficulty in terms of cognitive flexibility and planning/prioritization!  Refer also to task initiation.

Those are just a few ways executive functioning issues affect my life. As a young adult who is supposed to be gaining more and more responsibility, this is why my ADHD/LD diagnosis is key: in understanding myself and how I interact with my world, I am able to be more patient and self-accepting when I do mess up. It will happen, so best to prepare for it—and accept it!—through understanding the impacts of my quirky brain on my interaction with the world.

…The problem, of course, is that I think I’ve been too self-accepting: as I alluded to yesterday, my room is still a disaster :].

ADHD + learning disabilities / advocacy

this is what a learning disability and ADHD look like.

• by kerri

I wake up as After the Fire by Andrew McMahon fades in on my iPhone on the edge of my bed. Like most, I assume, I tap the back of my phone and the music fades out—the SleepCycle version of snooze. A short time later, the process repeats but instead of tapping snooze, I sit up, unplug my phone, and start getting ready for the day. I take my morning dose of Concerta—occasionally, however, checking the water glass beside the sink to indicate whether or not that it was indeed this morning that I took the Concerta! Sometimes the mundane tasks blend into one another, and it’s the little tricks that help me figure out what I’ve done when.

I step over something or another, and attempt to find clothes within my room. Yes, I’ll admit, it’s a disaster in here. There are a pile of books, papers and textbooks beside my bookshelf, many residual from April when i finished exams, or yes, dare I say it, February when I was working on a project for the Asthma Society of Canada and was reconsulting many of my books from school. Yet, I graduated university in June, and those piles remain. So do the ones of clothes on the floor, a byproduct of my normal cluttered life, and the fact that I spent every weekend for nearly six months packing up a bag and heading out of the city. Others of the books on the floor are notebooks, journals, and yes, my kickass yet not-utilized Moleskine Lego planner. Lesson learned: not even the kickass Lego planner can take the place of Google Calendar in my heart—or brain. I find some clothes to throw on—well, eventually; sometimes that doesn’t happen until 2:30. I graduated university in June, and resigned from my job at the beginning of October, so at present I’m hunting for jobs, doing some quantified-self-ing, and trying to make productive use of my time. Writing, video editing, coaching… A myriad of tasks and habits I’m trying to build or un-break stack up in HabitRPG.

Routine, especially building it, is probably one of those things that’s harder to work at with ADHD. It’s hard for everybody, but because I am so dependent on reminders (such as Google Calendar/iCal), it is difficult when these reminders become too repetitive and, thus, no longer intrusive enough—like I said, problem for everybody, but potentially disastrous for me in terms of meeting obligations and being accountable—another thing I try to stay conscious of. I have excellent intentions of organization: sometimes I am able to stick to them, especially with the right technology. Others, the act of organizing the organization is simply too much to organize—or, I get distracted in some subset of organization and then never accomplish the initial task! (This, is what happened in my bedroom, really. I went in to start cleaning and organizing. I decided I needed a file cabinet to keep all the paper in. I needed, then, to acquire the file cabinet. Oh, file cabinets are expensive, what about some plastic drawers? Oh, those all sort of don’t meet my needs. Hey, guess what? This was May—it’s October now. All that paper is still on the floor right where it was! (I still don’t have a file cabinet or any such organizational implement—but yes… I am trying.)

Right now, the first thing I do (and last thing I do, and maybe 85% of what I do in between…) is sit down at my laptop. Usually, my mom has affixed some sort of post-it note to it with a task or two or seven for me to accomplish. Today is “wash + dry dishes + sweep floor”. (But I swept the floor yesterday with no prompting!) Usually, with these notes, the job will get done (even though, to my dismay, the dishwasher is still not working—usually the notes say “empty dishwasher and reload”—dishwashers are probably an independent ADHDer’s best friend, except I live with my parents), because as I tell her and as my friend Jay said, “Write it down; if it stays in your head it gets lost.” That’s why not very much stays in my head very long—it gets lost super quickly in there. I struggle significantly with memory related tasks: my visual memory sucks, and my auditory memory isn’t a ton better—so, I work on the deficits of both of these by combining them to get stuff down. That’s why lists are so important… well, if I don’t lose them or can figure out how to implement them!

Back to the Concerta for a minute, the Concerta does help in that regard—it keeps me focused a lot longer on a task, and things tend to get lost in my brain less easily (things getting lost in my brain include the result of what happens when my attention wanders from a task, and I move onto another one without finishing the first one. Like starting a blog post, and then finding myself an hour later trying to work on a website… with only two and a half sentences in the blog post window. Actually, case in point on the Concerta right now? I’ve been writing this for 28 minutes now and the only thing I’ve glanced at is my phone once to reply to a text message, and the post it note of chores—which are already done. It helps, like it does for most ADHDers, that I want to be writing this right now—but even that without the Concerta, was a big issue! Medication isn’t for everybody, but to me, I’m pretty sure it was the difference between graduating university and possibly dropping out. So yes, I am distracted by bright coloured things, but so long as those bright coloured things are like my post-it note of things needing to be done, well, that’s okay. The Post-It notes are necessary because, yes, if you just tell me something to do, it’ll be forgotten. If I have that visual cue that can keep reappearing, then I’m much more likely to actually follow-through with the task.

I contemplate writing things multiple times a day. Sometimes it happens and I open up the Evernote notebook of a project I’m working on, or throw a post onto Quantify This. Sometimes though, it doesn’t. I’ll intend to go write a post on the other blog, but then spend five hours trying to install a Windows VM onto my Mac, or learn how to download all my Fitbit data into a Google spreadsheet, and then get that spreadsheet to autopopulate into Excel. Except by then it’s midnight and nope, no blog post. This is why I’m not a good daily blogger! ADHD, I think, lends itself more to this infinite curiosity, except like other infinitely curious people, ADHDers tend to have faulty brakes—we either stop too frequently, or we get into something and can’t stop. The latter, known as hyperfocus, is kind of a compensatory mechanism: we bounce around so quickly, that sometimes if we get really engaged in something or have pressure to complete a task [ie. a deadline tomorrow] we simply power through and may barely look up from a task for hours—so, right now, I’m probably a tad hyperfocused on this post because the pressure that October is ADHD and LD awareness month and it’s the 21st of October and I forgot until two days ago is enough pressure for me to get this one cranked out—that, and enough people on Facebook expressed interest in my sharing of this article last night, that I figure sharing more of my story was important to do right now. (Run-on-sentence.)

The ADHD brain is kind of like a run-on sentence in itself—I’ve said before, “I don’t stop, only pause”—there are only commas in here, no periods. I may not be physically moving, but my brain is going full speed until I eventually go to bed—something that I also have to prompt myself to do: yes, eventually I feel tired, but I rarely feel it until I make the conscious decision to go to bed—sometimes annoying, and the reason that 11 PM prompts a (now frequently ignored) reminder to “wind down” on my iPhone.  [Okay, stream of consciousness: There we go. I remembered to follow up on an e-mail prior to sitting down to start this, and that reply to the e-mail lead to searching for t-shirts… Yes, can’t make this stuff up! So, there was a 30+ minute gap in there… Typical.] The ignoring of the reminder at present, however, might be because I no longer have engagements requiring being awake at 6:45 AM.  

Which begs the question:

So how much of this is me, and how much is ADHD/LD?

Well, I’m not sure I can really separate myself from them—how my brain functions is as much me as my personality or my affinity for Cheetos. It’s just the way I am, and I’m okay with that.

I’ve written about my LD here before, because it’s kind of nonspecific. A lot of it has to do with my visual memory: I can’t read an analog clock (at least, I can’t without using my fingers to help me determine what span of time the minute hand is pointing to, which is essentially equal to being unable to read a clock), I struggle with reading comprehension when attacking large works, because it’s hugely dependent on visual and visual working memory, areas in which I am deficient, despite my reading ability being above average. I may best fall into the category of Nonverbal Learning Disability, but have not been diagnosed as such—not that it makes a huge difference. At this point, my LD comes up in ways that could be associated with my ADHD, and ways that don’t presently affect me in the day-to-day now that I’m not in school—or, ways that are much a part of me and I don’t notice as much more than quirks.

ADHD and learning disabilities come in many flavours. I have primarily inattentive ADHD—making things like sustained focus (especially for the uninteresting), organization/remembering where I put stuff, initiating/changing tasks, and coming through on commitments more challenging for me. These things are because of the effects of neurotransmitters affected in ADHD on executive functioning… but, that’s a topic for tomorrow. [It’s already written, but, it makes more sense to split into two posts at this length! :)]

Questions about learning disabilities or ADHD? Leave them below!

ADHD + learning disabilities / life

starting concerta

• by kerri

Resistance was a major thing I felt in regard to the last point in the Recommendations section of the report of my psychoeducational evaluation.

It is important to recognize that though an ADHD diagnosis cannot be made based on the results obtained, the possibility of an ADHD diagnosis has not been ruled out. Considering that [Kerri] does exhibit some ADHD traits, she may consider discussing with her physician the possibility of a pharmaceutical intervention to alleviate her ADHD symptoms.

(Wang, p. 8, 2013)

It wasn’t a decision I had to rush into. However, given the realities of the Canadian medical system, I gave myself time to think on it, but talked to my primary care doctor pretty quickly on the subject of medication. I know of a handful of primary care doctors who are comfortable prescribing ADHD meds–mine wasn’t, which I was more than okay with. Instead she told me she could refer me to a psychiatrist–which for me was a much better solution. Because of the inconclusiveness of my “diagnosis”, I wanted to be sure that somebody with actual expertise in these things was working alongside me in the decision process surrounding medication.

That appointment came on Thursday. Wednesday, I didn’t want to go–the resistance returned when I screwed up dosing times for all but one of my asthma meds which resulted in waking up at 4 AM when the Zenhale and Atrovent simultaneously wore off, and forgot my pill at dinner until the next day at lunch. At this point, I had growing resistance to going on yet another medication.  I psyched myself up by reading the treatment chapter from Delivered from Distraction the night before–which helped because it made me realize, unlike my other meds, if I try meds and either a) they don’t help or b) I simply don’t want to be on them . . . I can stop this one. So, I went into the appoitnment a bit more open minded.

Fortunately, the vibe of the appointment was really good, too. I was definitely nervous, which is typical of whenever I see any new doctor, but I had zero idea what to expect from this appointment. I filled out three more pages of assessment questionnaires then waited a long time. Things got better when I walked in to the doctor’s office to neutral colours with the lights off, natural light coming in from the open window, and the doctor’s bike propped up underneath the window. By the time three minutes had passed, she had told me about picking blueberries in her front yard and having “eight thousand mosquito bites”–between that and the bike, I figured things would be good.

After she glossed over my report with a highlighter, we did an hour of story of my life–all the typical intake stuff like I did with assessment. Through that and the new questionnaires she confirmed the ADHD stuff they had uncovered in my original assessment–that I experience significant inattention and impulsivity (but not so much hyperactivity aside from fidgetiness). The impulsivity thing always throws me for a loop–I don’t see myself as particularly impulsive (but maybe that’s part of the problem?). Her final “diagnosis” was that things were still inconclusive, but she was strongly leaning towards ADHD-PI (primarily inattentive).  Story of my life not fitting into boxes (not sure I’d want that any other way :]).

Despite the inability to confirm a diagnosis, she concluded that I do have significant symptoms and medication could be a constructive way of dealing with them. Some discussion, explanation and demonstration with a wicked cool model of a tablet later, I walked out feeling a lot more confident about a lot of things . . . and a super intense looking prescription for Concerta tucked amongst some brochures in my backpack.

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So, I then exchanged super intense prescription for innocent-seeming bottle of controlled substance [which at the time was totally freaking me out haha]. In reality, the extended release meds [like Concerta] are manufactured in a way that they’re basically impossible to snort/inject.

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(Slide 40 – Credit to Medscape)

So, this thing allegedly lasts for 12 hours (which really means from like, 8-14 hours depending on what your body does with it). The outer layer starts working within an hour, then as it hangs out in your stomach, water gets absorbed into the capsule and pushes out the rest of the medication in a controlled-y manner or something. Fancypants. The #1 most well known ADHD med is Ritalin–all Concerta is, is extended release Ritalin (methylphenidate). “Did it on Ritalin, I got me some good grades . . .” / “On a steady diet of / soda pop and Ritalin . . .” / “Cause I’m worth more than this / so stop writing prescriptions for my Ritalin…” [Matthew Good, Green Day and Katy Perry all off the top of my head… there we go!].  Methylphenidate is a stimulant medication–as my doctor explained it, people who have ADHD have brains that don’t know how to “put on the brakes”–stimulate meds “wake up” the part of the brain that helps put those brakes on–focus attention, control impulsivity, and decrease hyperactivity.

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It’s all a game of playing with dosing. Day one was like magic–I wasn’t fidgety, I had one thought in my head at a time. Day two wasn’t quite as good, but I also didn’t drink as much water throughout the day, so I’m trying to work at that. I’m at the kick-in point on day three now, and mostly I’m trying to keep really close notes on my symptoms and how the meds are working–after three weeks, I can either increase to a 36 mg dose in the morning, or split it in two [the bonus of splitting is that I get longer coverage from the meds–11.5h doesn’t really cover a productive school/work day if I’m studying until like 10 PM or something.

But it’s good. It’s another step that is hopefully in the right direction. It’s another tool that hopefully helps make things better.  Every step, each modification means a bit more work . . . but also hopefully more success, too.

If you’re interested in the day-to-day bits, I’m tweeting on #startingconcerta.

ADHD + learning disabilities

modifying the process: part one.

• by kerri

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Seriously . . . have to find memes where I can, right?

(source)

I have been almost overwhelmed by the positive words I have gotten from people following the results of my assessment.  I had a few comments that I had to shrug off because, like anything, sometimes people really do not understand–that said, I can’t claim to understand everything either.  However, now that the results and initial meetings are out of the way, it’s about taking the action to modify the process.

This week has been all about seeing that being put into motion. And feeling thankful, grateful for the people around me who are on all sides of making that happen, and helping me to make this transition successful. In reality, it is a continuation of what is going on outside of me, but also a fresh start of what’s going on inside of me. It is knowing that, on the road ahead, that I will have the right things in place. It’s knowing that maybe I might actually have a graduation date in reach. It’s knowing that I can do this, even if I have to do it a bit differently than I have been.

Yesterday I wrote my first exam with accommodations. I used a few minutes of my extra time allowance, and the private room was louder than I thought it would be (so, I will probably take them up on the earplug offer next time. Because that is an available service apparently). I was asked if I wanted a clock or time-prompts during the test (they said it was okay to look at my Fitbit, so I declined). Bonus perks: I got a soft spinny chair and a foot rest. I am not joking people. There were also pencils and an eraser provided on my desk which was unexpected, and I forgot my ID in my jacket pocket which was not with me, and somebody on staff at Accessibility Services [AS] just vouched for me.  (Also everything is really hush and confidential–considering my entire life is on the internet I am not super concerned about this, but it cracked me up when she whispered “What’s your name again?” and I replied at a normal volume.  On the exam-room booking schedule, I was only in there by my initials).  After I finished, I went and hung out outside the room my class was writing in (as they were being held captive for a full class period) to snag my friends Courtney and Rachael after the test to see how it went, and my instructor came and asked how things went.  The test was harder than we thought it would be, and we all didn’t really study the right stuff, but really, it’s Intro to University. It’s fine!

Today I’ve seen things unfolding.

After my instructor left the room in Scientific Principles of Fitness and Conditioning this morning so we could fill out course evaluations, I ran into her as I was leaving the building. “You’re Kerri, right?” [Well, something had to do it. My long standing ability of being another non-descript student to a lot of instructors is coming to an end!] “I was just talking to Accessibility Services about getting the course notes document to you–I’ll send you an e-mail later today.” Sure enough, a few hours later I got a couple of Word documents of the course notes popped into my inbox, cc’ed to my Accessibility Advisor, with an apology for things taking so long. After thanking her (and my advisor who is so fabulous), my instructor then asked me if she needed to provide AS with the final exam for me, following which we had some fun back-and-forth e-mails, which was totally unexpected but, once again, very appreciated.

I also received an e-mail about textbooks for next term from AS, and navigating that audio-conversion process again, and got in touch with my prof for my spring Classics course to see if I could get a syllabus [I need to provide AS with one due to the audio-book thing]. I am only mildly looking forward to this course [see also: lots of reading], but I am now really looking forward to meeting the prof, as she started her e-mail back to me with “Thank you for your beautifully written e-mail.” which totally made me smile. Cracking my shell also involves, of course, self-identifying (I’m getting an official Letter of Introduction for my instructors in upcoming terms, but an informal e-mail is always a good start, too), and making the choice to meet with my profs early on in the term so that I can gauge how best to approach their class and what that process will look like as it unfolds. (This may be the one important tip I took from intro to university!)

I’ve felt grateful. I’ve felt inexpressible appreciation. For all the people in this unexpected journey.  For people who are not only helping these things fall into place, but actually wanting to ensure things happen effectively. For people who are going beyond what they need to, especially at this point in the term, to help me. For people who maybe I have had second thoughts about . . . who are now not only doing what they are required to . . . but going beyond that and helping to meet me where I’m at.

Staring into the intersection, she thinks that she can fly, and she might.

straw dog, something corporate