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Episode 16. ADHD and transitions: Why are they such a struggle?

Transcript

Lindsay (00:02):

You’re listening to episode 16 of Refocused with Lindsay Genzel, all about ADHD and the struggles many of us face when it comes to transitions.

Lindsay (00:31):

Here’s the thing with the later-in-life ADHD diagnosis. You have a lot of time to look back on. There’s phases of life, jobs, relationships, friends to unpack, and you all know how much we love to ruminate. My name is Lindsay Genzel. Like many people, many women, I was diagnosed smack dab in the middle of the pandemic after months of staying home alone, out of work. And while all of that was incredibly stressful and overwhelming and very much changed the way I function as a human being, it’s not where my ADHD story starts. It’s simply where all of the things that had been holding me back in life, well, they got a name. There was a diagnosis.

Lindsay (01:21):

My ADHD origin story starts in Territorial Hall, one of the freshman dorms on the University of Minnesota’s Eastbank campus. Yes, my undiagnosed ADHD brain chose a massive university with not one, not two, but three campuses, which of course came with the expectation that every student could transport themselves from campus to campus to make it to class on time.

Lindsay (01:46):

Now, prior to the good, old-fashioned senior slide, I was a pretty decent high school student. I got good grades, I tested well, and I was involved in more activities than should even be allowed. But I had no idea what was next or what I wanted to come next after high school. I just knew I wanted out of my small town. And the stinky part of sharing this is having to acknowledge that there really wasn’t anyone around me helping me make these decisions. In fact, the two schools I applied to, I never even visited. I never even sat down with someone to go over what programs were offered or what I wanted out of my college experience.

Lindsay (02:32):

I actually had dreams of going to UCLA, so like Minnesota to Los Angeles, but the application process was too intense, and it required SAT scores. And my school only offered the ACTs. And as a 17-year-old, keeping in mind that this was 2003 and the internet, well, it definitely wasn’t what it is now, I just didn’t know what to do. And so I never applied.

Lindsay (03:01):

Long story short, I found myself starting my freshman year at the University of Minnesota. And by that spring semester, I was barely hanging on. I mean, who decided that it was a good idea to let 18-year-olds pick their own schedule? And I do say that fully acknowledging that the majority of my classmates and my friends had no problem laying out not only their class schedule, but also their paths forward in life, deciding on programs and declaring majors and getting internships and finding jobs. And looking back, it all makes sense. Graduating high school and moving out of my parents’ place and suddenly having to rely on myself without any understanding of what I was supposed to do on a day-to-day basis, it was new and exciting, and there were so many shiny objects pulling me in different directions.

Lindsay (03:54):

But the biggest issue was everything that kept my life in check up until that point was now gone. That structured school schedule, start and end times for everything, accountability from homework and grades and extracurricular activities, and my classmates and my parents and my big sisters, it was all gone. And here’s the part that’s incredibly frustrating. It’s not just big transitions that trip us up. It can be massive things like starting college or getting a new job or having a baby or getting divorced, or it can be moving through a different set of tasks at work, getting your brain to disconnect from what you’re currently working on so you can transition to your next responsibility, simple everyday things. Except for us, they’re not simple.

Lindsay (04:49):

I found this quote from Noelle Madison, another woman who received a later-in-life ADHD diagnosis and has been sharing parts of it online for the last couple of years. I thought I did a really nice job of putting into words the complexity of how transitions can affect people with ADHD, and I wanted to share it with you. She said, “Transitions with ADHD create a contradiction because it seems that people with ADHD both crave change and are overwhelmed by it. It is difficult to find a good balance between being overwhelmed and bored.”

Lindsay (05:25):

And like I said, these moments of transitional funk can pop up in so many different ways during the day for all of us. So what can we be doing to help ourselves? I’m excited to dive further into this topic with Dr. Gayle Jensen-Savoie. Gayle’s the division chief for psychology and teletherapy for ADHD Online. And as a practicing psychologist, she’s treated adolescents with ADHD in both outpatient and inpatient settings for more than 30 years. And you’ll hear our conversation right after this.

Lindsay (06:04):

ADHD Online is the telemedicine healthcare company that specializes in diagnosing and treating ADHD through convenient and affordable assessments and personalized treatment plans, typically in just seven days. It’s healthcare run by tech, not tech running healthcare, and that’s an incredibly important distinction. It was started and is run by healthcare professionals who treat the whole person, from diagnosis to treatment, to medication management and teletherapy. If you’ve been wondering if you have ADHD or perhaps you’re seeing behaviors in someone you care about that have you questioning a connection, head on over to ADHD Online to find out more about their diagnostic process and how their team of healthcare professionals across the country can help you move forward in life with more answers and understanding.

Lindsay (06:59):

I’m overthinking the best way to get into this topic. So why don’t we start by looking at the connection between people with ADHD and transitions? Why are transitions so difficult for some of us? How do you explain that?

Gayle (07:15):

Thank you. It’s a really good question. If you break it down to the brain, folks with ADHD, we believe have fewer neurons in their reward center, what we would look at as the reward center. So they typically find things in their day less rewarding than people that don’t have ADHD. So if you have less neurons in that reward center and you eventually find something that’s rewarding that you like to do, then people with ADHD will hyperfocus on that. That’s why they don’t want to make that transition, because they found something that is rewarding. And so to make that transition to something else seems like a punishment even if it’s something that they want to do. If they’re hungry and it’s time to eat, they’re focused on the email, the video game, the whatever’s they find rewarding, and making that transition then feels more like a punishment.

Lindsay (08:17):

I’m curious how that plays out when we’re looking at something like back to school or starting a new job. All of those things are exciting, but for people with ADHD, they can just be very difficult despite the excitement and the anticipation.

Gayle (08:34):

For folks without ADHD, you think, “Oh. It’s exciting. I’m going back to school. I get to go pick up my school supplies, find out who my teacher is, maybe look where it’s a new school building, all these great new things.” Well, somebody that has ADHD, just thinking of having to make all of those transitions, they’re not thinking about… Because what someone with ADHD, typically, they live in the now. So thinking about tomorrow is no consequence. Yesterday’s not a big deal. How are they going to change each of those steps? And again, when they don’t have a great working memory and a great way to think, “I’m going to do this first, this second, that third,” what happens is they get irritable. I mean, you don’t want to make all those transitions because what happens in that transition time too, we look at folks without ADHD just move from one item to the next.

Gayle (09:30):

Well, when you have ADHD, you’re leaving something that you may find rewarding, moving to something that may not be rewarding, so going to school. So what happens between the time of, “I’m stopping my video game, and now you’re telling me we have to go to the store to get school supplies,” or, “I’m stopping my patchwork quilt that I’m working on and I’ve got to start a new job tomorrow. So how am I going to get my clothes ready? What time am I going to get up, set my alarm, make sure my car has gas?” All of those different things, that whole transition period. It’s what happens between the two activities that is really the difficulty.

Lindsay (10:10):

And because more women are being diagnosed later in life, we know that for many, it was those transitional periods that really stand out as the moments that a lot of us realized something was off. I mean, I can look back at my own experience with college and transitioning out of high school where there was a very set routine. I knew what I needed to do. I knew what was expected of me. There was a lot of body doubling going on. And then I got into this massive university where there was so much freedom and everyone had a different schedule. I mean, my roommate and I weren’t even in the same college, and our colleges were on different campuses. So we weren’t together on most occasions. We were living very separate lives and I couldn’t body double off of her. And obviously, at the time, I didn’t know it was ADHD, but we see that with adult women, these periods of transitions. They’re incredibly difficult. But why? What is the connection?

Gayle (11:12):

Yeah. I think that oftentimes what happens with women and getting diagnosed later and the transitions, what I have seen is just what you described. Things are going along okay. You really don’t know why it feels different. But then you get later in life and you have a career, and maybe a dog, a cat, a husband, a child, all of these issues which make for a lot of transitions, and knowing that with classic ADHD traits like hyperfocusing and distractability, difficulty completing tasks, procrastination, those all just get magnified as a woman or a man get diagnosed later in life because they’re having so many daily transitions. So you’re really looking at what can you do to help yourself work through those transitions is really the golden egg for a lot of folks.

Lindsay (12:11):

What are some of those resources or workarounds? What do they look like? I mean, how can we be preparing parents with kids going back to school or college students who are making that big jump of independence, or heck, any of us adults who are starting a new job or even thinking about it? I know it’s a loaded question because there are so many things that work for different people, but at the end of the day, what are we trying to change or mediate?

Gayle (12:41):

It’s things that I’m sure that lots of people have found themselves doing that is helpful, but really making sure you do. So for kids, going back to school or going to college or taking a new job as an adult. I always think have yourself a transition day. So making sure that there’s a day between where you can make sure everything is okay as a parent of a child with ADHD. You’re not waiting till Sunday night before Monday, the first day of the new school year to make sure you’ve got all your school supplies. You’ve got everything laid out. You do that in that transition day maybe early on that Sunday morning, or if you’re starting a new job, you’re making sure the day before you’ve got an alarm clock that works. You’ve got whatever it is.

Gayle (13:36):

And I’ve always been a fan of this. If you go on vacation, you don’t come back the night before you start school, the night before you go to work. You give yourself a transition day to get laundry done, to pay bills, to get back to your normal life. That way, it gives folks with ADHD time to process those transitions. I think for parents and adult folk to use a checklist. I always think checklists are great. If you can write them down, have them on your phone, have whatever works for you to have a list. And I think for parents, it’s good because the parent and the child can make the list of, “Here’s the things you need to do before your next assignment is done, before your start school.” And so then it becomes about the list, not about the parent. So you are able to decrease those number of power struggles, perhaps.

Gayle (14:33):

And I think as adults, we kind of work that way too. We’re looking at, “Oh. We got to get our list finished.” And then we don’t internalize as much of what we did or didn’t do. I think there’s lots of things. Making sure every night you plan the next day, making sure you’ve got all your stuff set out, your stuff ready, making sure your child has everything out, making sure… I see a lot of times parents that have ADHD and their child has ADHD, making sure that you’ve packed your child’s lunch for the next morning and you’re not trying to race and do all those things the morning school starts.

Gayle (15:07):

I think in this world of Zoom calls and Google Meets and everybody working remotely, we typically find ourselves scheduling everything down to the last minute. It’s very important to give yourself some time. So if the meetings are at 9:00 AM, 10:00 AM, and 11:00 AM, making sure your meetings are only from 9:00 to 9:45. So you’ve got a 15-minute window that you can have a chance to think of, “Okay. What just happened in that meeting? How am I going to get to the next meeting? What do I need to do at that meeting?” So always giving yourself some kind of that buffer time. I guess those are the top ones for me.

Lindsay (15:48):

I’m curious how you’ve seen things change in your time working as a psychologist and how we view the connection between ADHD and transitions. What have you learned from your experiences working with people with ADHD over the years when they’re talking about these timeframes?

Gayle (16:04):

I think the world has changed very quickly. Initially, when I was beginning as a therapist, everything was still on paper, and you drove your child to school. They had a list of all their school supplies, big cheap tablet, number two pencil, all of that. So the transitions had things that in some ways could make it easier to see that transition. A child going to school had all these things to know that he was moving from grade five to grade six or whatever.

Gayle (16:43):

I would say in the year 2022, there aren’t a lot of those things. I was talking to a physician friend of mine. Her son started first grade. What they get is a tablet. So first grade, you’ve got this computer. So they don’t necessarily have all this stuff. And I think that makes the transition even seem more confusing, more vague, more nebulous, whatever, if you’re not able to have a ritual of getting things together. So I would say that I think in many ways, it’s harder. It’s harder than for adults. Before, adults at work, it could be more structured. There was people around. Typically, when you have ADHD, you train the people either consciously or unconsciously around you to help you structure your world. Now, in the year 2022, people are working from home. There’s nobody there to help them structure that. So I think in that respect, it is very different than it was 20 years ago, for sure.

Lindsay (17:47):

And if someone is looking down the line and they know there’s a transition coming, how do you recommend they approach that, whether it is with their family members or their therapists? I imagine it’s best to start getting ahead of the inevitable problem by starting to work on it slowly versus waiting until the night before. But sometimes the planning can’t or doesn’t happen. But if it can, what should people with ADHD or parents of children with ADHD, what should they be thinking as they start to realize, “This is something I have to start addressing.”?

Gayle (18:25):

Yeah. That’s a great question. And I think a few things, whether it’s your therapist, your significant other, your parents, your children, again, you train the people in your life to help you and to know that they need to know transitions are hard for you. So you’re going to start long before they’re going to start and that they can’t say, “Oh. You know what? It’s time for dinner. What if we go to the steak restaurant?” when you had already thought you were going somewhere else. You have to train people around you that it takes more time to make those transitions. And you have to train yourself into what are you going to do within each transition period knowing that it’s going to take you longer?

Gayle (19:11):

And we all have areas, whether you have ADHD or not, that you like or you don’t like. So if you know you don’t like going on vacation and that whole process, if you have ADHD or you don’t, give yourself an extra day of how you’re going to get there, how you’re going to make that transition clear. I think it is about time and it’s about communication with the people that are in our lives that can be so helpful to us. When we think usually with ADHD, you get mad at the people who are trying to help you through the transition, but learning how to train them and train ourselves to really make that as easy of a process as it can be.

Lindsay (19:54):

And I think what you touched on is such an important reminder for everyone that we as humans, whether we have ADHD or not, if you need something from someone, we should be comfortable asking for that, especially if it’s someone who’s in your inner circle or someone you trust or your family member. And it’s just a great reminder that we as humans have the capacity to ask for what we need, just so we get out of our own way to do that.

Gayle (20:23):

Exactly. And I think so often we forget or we’re unwilling or we don’t want to be a bother or any of those things, and remembering life’s about relationships. And it absolutely is how well you can manage that helps how well you can manage your life.

Lindsay (20:43):

All right. So bottom line, what do we need to know? What should we always be considering about the connection between ADHD and transitions?

Gayle (20:52):

What you may not see as a transition may be seen as a transition for someone else. So just jumping up to do the next activity because it’s easy for you. And even if you have ADHD, maybe at this time, it’s easy. But to know that it may not be easy for someone else. So not only to give yourself a break, but to give other people a break. I think we get awfully hard on folks. And just to know that with ADHD, especially, it’s a brain issue and it’s not about a badness or not wanting to do it or being oppositional. Truly, it’s a brain issue. So work with the people that you’re closest to that care about you and you care about to make life easier.

Lindsay (21:58):

There is so much to talk about when it comes to ADHD and transitions, including more ways for us to help ourselves make it a little bit easier. And I’m very excited to continue that conversation next week while bringing in a new voice for the podcast.

Christina (22:18):

Hello, my name is Christina Gonzalos and I am a licensed psychotherapist who is neurodivergent and focuses on chronic illnesses as well as developmental disabilities.

Lindsay (22:31):

You can catch Christina as my guest on the next episode of Refocused with Lindsay Genzel. And in the meantime, you can head on over to adhdonline.com for more resources on back to school and transitions and tips and tricks and workarounds. And the one thing I want to remind you, if you’re not a student going back to school… I am not… it can be really easy to dismiss some of that information, some of those resources, because they’re not directed right at you. But the one thing I have learned since I was diagnosed with ADHD is creativity and persistence go a very long way in making my life a little bit easier. So don’t be afraid to check out some of those resources and give them a try in your own life.

Lindsay (23:30):

And before we wrap up this episode, I actually want to go back to a conversation I had with Keith Boswell a couple of weeks ago. This was in the midst of us talking about medication, both stimulant and non-stimulant. And it sparked from something that happened in a webinar I was hosting for ADHD Online. And I think it’s a really important conversation for a number of reasons. And so I just want to play it here because I think it provides some good insights on how we should view medication in our treatment plan.

Lindsay (24:23):

We hosted a webinar with Rick Webster from Rena-Fi. It was about the ADHD tax. And essentially the entire webinar was on ways that people with ADHD pay more money for things or just throw money away because of many times a lack of executive function. So in the webinar, what’s great about them is there’s live Q&As happening as the show was going on. You get to ask questions in real-time. And so in the midst of this webinar, someone asked a question, essentially wondering if the suggestions Rick was making would be different for someone who was taking medication for ADHD and someone who was not taking medication for ADHD. And I thought this was a very interesting question, and I wanted to come back to it because I think sometimes people have this idea that medication, that prescription medications are going to solve all of the problems. And the unfortunate reality is many times for people with ADHD, that’s not the case.

Lindsay (25:30):

I can speak from my own experience. I’ve been taking stimulant medications for over a year and a half now. And yes, it helps. It is a push in the right direction. Is it changing the 35 years of habits I have built up? I wish. I wish you had this magic pill that you could take that would make me pay my bills on time. Wouldn’t that be amazing? And so I wanted to talk about this for just a second because I think sometimes, especially with something as frustrating as ADHD that comes up in so many different areas of our lives, that ebbs and flows and changes and morphs itself and sneaks into all of these tiny little crevices, it’s really important to look at the long-term picture. You have your diagnosis. You understand your brain better. You have better connections in life of people who can help you. The medication will help, but it’s not an end-all is essentially what I’m trying to get to.

Speaker 4 (26:32):

Yeah. And it’s not going to solve things for you. I mean, a month in, that’s definitely my experience. I mean, I’m not a different person. I started this, but it’s not like it’s just changed my life overnight. I see a big improvement in my own daily satisfaction with the day that nothing else that I’ve tried yet has done. I mean, therapy has certainly done tremendous amounts for me. I don’t want to discount that. But in terms of just improving my ability to feel stood up and present and focused and able to sort through all the things without jumping around. And I mean, that is a great question before and after, but I mean, I think living in the present, I would have to say, it’s going to help you get more motivated to follow a system or develop that system, but you still have to do it. To your point, it doesn’t do the work for you.

Speaker 4 (27:36):

I was talking about this before I started treatment. So it’s interesting because I would often use the percentages of like, it feels like medication is maybe 10% to 15% of the work. And now, being on the medication, that still feels pretty applicable. I might be getting more done. All the things I was tackling before, I’m just dealing with them rather than putting them off. So it’s not like it’s gotten any easier. It’s just gotten… It’s hard to describe. More satisfactory, I guess. I’m not struggling with it as much, or I’m not as resistant to my own inner turmoil stopping me or sabotaging myself. And so that does feel like an accomplishment. It’s not like I’m looking at it thinking like, “Wow. Okay. I’ve started something for life now. This is the key.” I mean, it started the car. I still have to drive.

Lindsay (28:35):

I totally know where you’re going with all of that. It’s like you mentioned you have more satisfaction at the end of the day. The medication I take… And again, I take Vyvanse… I feel better. I function better. And therefore, I have more energy to put in the time to change the things that aren’t working. We are a society built around immediate results. We want things immediately. And I get it. I spent almost 35 years living without knowing how I was actually supposed to be functioning. And to be thrown into this and just be told like, figure it out. And that’s sometimes how it feels. It feels like everything in the world is set to work against you.

Lindsay (29:26):

And I’m going to tell a story because I know you will relate to it. I know a lot of people can relate to it. I was getting ready. I grabbed the wrong can of hair stuff because I was in a hurry and I sprayed a massive amount of the wrong stuff in my hair, which meant that I had to wash my hair. Essentially, it just was big old mess. And I said something along the lines of like, “Oh,” expletive, very loud, and very not internalizing shame or anything like that. Just like, “Oh. Come on. Another thing to add to the list.” And I hear this tentative voice from the other room, my boyfriend, he’s like, “Are you okay?” And I was starting to say, “No, I’m just having a day.” And in my head I was like, “You know what? I’m actually having a lifetime of all of this.” It is a lifetime.

Speaker 4 (30:25):

I can totally relate to that.

Lindsay (30:26):

Yes. And it just made me feel like some days you just have to remind yourself you’re better off now than you were, but it doesn’t mean it’s easy or that it’s enjoyable or that-

Speaker 4 (30:36):

Yeah. Or that you’re going to nail it every day. I mean, last night was the first night… I mean, I’ve been being really good about exercising and getting out and giving myself that time to decompress. And a couple of things came up, and it was later than I was hoping, and I just found myself getting frustrated and angry in ways that I used to get a lot more. And it felt like I was like, “Whoa, I haven’t felt this in a while.” And it was just that weird emotional rush when you get flustered with ADHD and you just… I mean, sometimes I just want to flip a cart over or just… I call it the peaceful riot, just turn the furniture over gently. I don’t want to break anything, but I want to show my unhappiness.

Speaker 4 (31:28):

I realized what I was most upset about in the moment was not what I was being asked to do. It was because I wasn’t advocating for myself and I wasn’t saying what I needed. And I realized how much I’d done that. And I think it’s not ADHD, but it was just a personal trait. And I realized how my ADHD fed it, I guess. And so it was the first comeback since I’ve started this treatment and it just felt… It’s a great reminder to me of exactly what we’re talking about. I mean, I haven’t changed as a person. I just have a different take on it. And it’s great. I mean, I welcome it because I don’t think I would be growing if I wasn’t.

Lindsay (32:11):

I feel that. I feel that a lot. I think it can be really hard to get out of your own way. For anyone who is starting down this journey and is trying to figure out what they need to live their best life, learning how to become your own advocate. And that does sometimes mean setting boundaries about certain things you need in your life, like working out or sleep or 20 minutes of Sodoku on your phone to start the morning where no one bugs you. I’m totally speaking from experience. I just need 20 minutes to wake up like, “Don’t talk to me. I will be over here in the corner.”

Speaker 4 (32:48):

I totally feel that. I think that’s part of this learning as a person. I’m grateful to keep learning. You’ve got something to help you see a way through it rather than getting trapped in the bounce around in the brain where I always was.

Lindsay (33:10):

And I’m going back to the comment about what suggestions they would make, if you’re on medication or if you’re not on medication. The one thing that I think is super important to make a note of is have these conversations with your provider. Tell them what is working for you. Make a journal or jot down notes and see what’s happening, and know that what works for me and what works for you, Baz, is going to be very different for every single person. So just being open and honest with your provider and taking advantage of that. You have done the same with your stimulant medication, going back to your provider and talking about those things.

Speaker 4 (33:47):

I think you have to ask if you’re wondering, and you can’t be embarrassed by any of it because again, that’s why you’re there. And that’s the comfort of a good provider, is their understanding of where you’re at so you don’t feel alone.

Lindsay (34:09):

Refocused with Lindsay Genzel is a collaboration between me, Lindsay Genzel, and ADHD Online, a telemedicine healthcare leader offering affordable and accessible ADHD assessments, medication management, and teletherapy. You can find out more by visiting adhdonline.com. The show’s music was created by Lewis Ingles, a songwriter and composer based out of Perth, Australia, who was diagnosed with ADHD in 2020 at the age of 39. And a producer shout-out for the show, goes to Lauren Terry, who was instrumental in getting the research started for this conversation on transitions and ADHD.

Lindsay (35:00):

Remember to subscribe, rate, and review wherever you’re listening now. And if you would like to connect with me directly, you can do that a couple of ways. Email podcast@adhdonline.com or on social at Lindsay Genzel and at refocused pod. Thank you so much for listening and join us again next week for another episode of Refocused with Lindsay Genzel.

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