Executive Functioning

Maria Manco/Stocksy

In Search Of A Diagnosis For My Son, I Got One Instead

“Well, I mean, everyone kind of has ADHD, right?”

My older son Raffi has always been “spirited,” “active,” “a handful” — those euphemisms people use for a constellation of behaviors that I always suspected would eventually, once he was older, merit a more official-sounding diagnosis.

I hoped for that diagnosis, anyway. I wanted a name for whatever the thing was that made him incapable of walking a block without dicking around for ages or made him take 30 agonizing minutes to put his shoes and socks on. A diagnosis might mean solutions we hadn’t thought of, tactics we hadn’t tried yet.

And then the pandemic happened. On virtual school mornings, I sat Raffi down at the kitchen table with my laptop. If I didn’t sit next to him the entire time he was in class, he would wander off to play, but the problem was, I couldn’t sit still next to him, either. Instead, I retreated behind the kitchen counter, where I scrolled through every app on my phone, opened emails and then forgot their contents immediately, cleared half the dishwasher and then lost track of whether the dishes were clean or dirty, began making a cup of tea and then abandoned it until it was cold, scrolled some more and then realize that my credit card payment, library books, and period were all due and I had planned for none of them. Time to do more dishes; the dishwasher was dirty now, or might as well be. Time to respond to some texts, then switch to cajoling Raffi into finishing a worksheet during his break between classes by promising a video game, then inadvertently leave my text correspondent on read for days. Time to make more tea!

As the year of toggling back and forth between virtual and in-person school wore on, I was struggling to manage my own work and Raffi’s online kindergarten schedule. I mean, of course I was! It was a horrible situation! But when I complained to my fellow kindergarten parents, I got blank stares; they weren’t feeling quite as bad in quite the same way as I was, for some reason. I was hovering on the edge of a distressing revelation about executive functioning that had nothing (and everything) to do with my kid.

It was around that time, when I was trying to decide whether to get an ADHD evaluation for Raffi, that I went out for a brain-pick coffee date with a colleague. In theory, we were there to talk about work, but as soon as I learned that one of her kids had been diagnosed with ADHD, we abandoned the pretense that we were going to discuss anything else. We talked about sensory symptoms and interventions and at some point I said to her something I’d probably said offhand in a million other conversations, for years if not decades:

“Well, I mean, everyone kind of has ADHD, right?”

She looked me straight in the eyes and said something that shocked me.

“No! They don’t. They really don’t. I don’t have it.” She went on to describe the way she saw her son and husband struggle in ways she never had, and as she did, I recognized aspects of myself that I’d never seen in an online quiz. I made an appointment that day to start the evaluation process — not for Raffi, but for myself.

Everyone’s process was different. Mine was that I procrastinated constantly, felt terrible about it, and did excellent work when I couldn't stand how guilty and filled with self-loathing I felt for a single second longer.

“What would it mean to be diagnosed with ADHD?” the therapist who I’d been seeing about my anxiety and depression for years asked me when I threw out the suggestion that I might have the “girl version” of ADHD, i.e., the one that’s characterized more by inattention and hyperfocus than hyperactivity and sensation-seeking. I paused, trying to come up with an answer. I really didn’t know. In the past, I’d chalked up my problems with concentration and distraction to the culprits that were more obvious-seeming to me, like having a series of traumatic events associated with my writing life. But I had figured out elaborate workarounds to compensate for my innate flakiness, which meant it was OK; I had my own process, and everyone’s process was different. Mine was that I procrastinated constantly, felt terrible about it, and did excellent work when I couldn't stand how guilty and filled with self-loathing I felt for a single second longer. Trust the process, right?

Several hundred dollars later, I had a diagnosis of my own, plus a prescription for 18 milligrams of Concerta daily.

I took the first pill with trepidation and also, if I’m honest, a thrill of anticipation. I imagined the world turning Technicolor, feeling like the novelist character played by Bradley Cooper in the movie Limitless, the one where he takes a drug that enables him to write brilliant novels really fast. Unfortunately, that didn’t happen. I didn’t even feel caffeinated. I barely felt different at all.

Over the course of the next few weeks, I experimented with raising the Concerta dose, which made me just grouchy and twitchy enough to decide to stick with the lower one. But I didn’t find myself glued to my desk, churning out perfect pages. I worked with my new therapist (and my old one) about behavioral interventions. Mostly, we focused on how I could manage my expectations for myself, breaking my work down into small, manageable pieces. It felt like I was accomplishing nothing. I was so used to working in binges, punctuated by long stretches of complete uselessness during which I indulged in social media habits that weren’t even fun or relaxing, only distracting. Now, instead of doing that, I forced myself to take breaks that were actually breaks, and felt my patience muscles creakily beginning to stretch and grow.

Gradually — so, so maddeningly gradually — I began to make what even I could not deny was progress. I piled up pages, not with Limitless-style speed, but at a snail’s pace. Still, the pages were there, rather than trapped in my racing brain under a pile of to-do lists and unfinished chores.

Concerta hasn’t been a panacea. With depression, it was always clear to me that medication was just a flashlight that let you see the depth of the hole you were in, and maybe permit you to find your way to the ladder leading up out of it. The ADHD journey is less linear. Instead of a ladder, maybe the flashlight … stick with me, I know it’s a bad metaphor … just lets you see a map of the terrain. Now that I have a sense of the shape my brain is in, I can learn to mitigate its weaknesses and exploit its strengths.

For now, though, my mission is just to stay open and curious about what he’s going through, in the same way I’m trying to stay curious about my own idiosyncratic brain.

We did eventually also get a diagnosis for Raffi, via a psychotherapist we’d managed to see in person only a couple of times before switching forever to Zoom. Raffi, in her opinion, has “subclinical” ADHD. The label wasn’t as satisfying as I’d imagined; basically, the therapist told us that Raffi had some symptoms of ADHD but not enough of them to merit an official diagnosis. Also, she promised, the developmental changes we’d see in the coming year would be massive. Though we didn’t believe the therapist at the time, she ended up being right. As he got better at expressing and anticipating his own needs, many of our struggles magically disappeared. He puts on his clothes and shoes with minimal begging. He no longer goes from zero to tantrum because his socks feel wrong, and he bops his little brother in the head for no reason much less often.

When in-person school resumed, his wonderful kindergarten teacher told us that he was quiet and sweet, and that she wished she could keep him. We just shook our heads, wondering whose child she had confused with ours. But it was really Raffi. In the classroom, at least, he was able to keep his act together.

Though I’m hoping to be able to avoid medication for him, I do think that Raffi will soon benefit from a kid-size version of some of the same behavioral strategies I’m using. I want to make it so that he can find joy and ease in school, instead of the abject terror I once felt about things like timed math tests. For now, though, my mission is just to stay open and curious about what he’s going through, in the same way I’m trying to stay curious about my own idiosyncratic brain. We’re not the same person, after all, though we do have a lot in common.