Jeremy P. England

nadeauStillDistractedAll2022

22 min read

Cite

Nadeau, Kathleen G. Still Distracted After All These Years: Help and Support for Older Adults With Adhd. First edition. New York: Hachette Go, 2022.

Jeremy

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FirstAuthor:: Nadeau, Kathleen G.
~
Title:: Still Distracted After All These Years: Help and Support for Older Adults With Adhd
Year:: 2022
Citekey:: nadeauStillDistractedAll2022
itemType:: book
Publisher:: Hachette Go
Location:: New York
ISBN:: 978-0-306-82891-1

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Abstract

“We’ve known that ADHD affects us throughout our lives, but until now, there’s been little to no attention paid to the ADHD-related need of adults over 55. Whether you suspect that you may have ADHD, have recently received a diagnosis, or were diagnosed years ago, Still Distracted After All These Years is a much-needed resource for coping and thriving with ADHD as an older adult”— .

Notes

ADHD in older adults : why it matters

  • The challenges of getting older —

  • It’s hard to understand it if you haven’t lived it —

  • How do you know you have ADHD —

  • Stimulant medication for older adults with ADHD —

  • Learn to understand, accept, and thrive with ADHD —

  • Ways to help yourself —

  • Working with an ADHD coach —

  • Brain-healthy daily habits —

  • Getting connected, staying connected —

  • Marriage and ADHD in older couples —

  • The long and winding road —

  • Making ends meet —

  • Creating an ADHD-friendly retirement

Jeremy’s review

A multi-faceted approach to treating ADHD is a relatively new practice, and treating adult ADHD even newer than that. Dr. Nadeau goes into relatively uncharted territory by speaking specifically to the issues of adults 55 and older being treated for ADHD. Her book highlights the issues, struggles, and successes surrounding ADHD treatment in elderly patients. The important thing is to discover what that means for the church as most of the people she writes about in the book will be in positions of leadership today.

# Reading Notes

Intro

“Parents were now eager for a diagnosis that might help their children get the support and accommodations to help them in school.” (Nadeau, 2022, p. 2)

  • Getting help is relatively new. As slow as education is, the church is slower.

“At the time, there was a standard view that students who achieved the level of academic success required to eligible for law school or medical school couldn’t possibly have ADHD. Denial of accommodations for these very bright students with ADHD has driven numerous lawsuits against the National Board of Medical Examiners and others against the LSAT, GRE, and GMAT examiners, claiming disability discrimination. (Those suits are likely to continue: in 2011, the federal government published a thorough assessment of ADA compliance by the companies that produce and administer high-stakes testing to gain entrance into postgraduate education. It found that the Department of Justice had failed to develop a comprehensive approach for dealing with complaints about noncompliance. Instead, they dealt with the lawsuits on a case-by-case basis.)” (Nadeau, 2022, p. 4)

  • Accommodations are relatively new and people would rather deal with the denial of them rather than address the issue to a fuller extent.

Research about older adults consistently reports that ADHD declines with age-but I was observing no such decline in my clients who had been diagnosed earlier in life. (Nadeau, 2022, p. 5)

  • Understanding ADHD in older adults is just getting started, and who runs churches? Mostly older adults.

“ADHD has the same fundamental symptoms in older adults as younger adults, but adults may express those symptoms different, in later years.” (Nadeau, 2022, p. 6)

  • Coping mechanisms will be developed if ADHD is not recognized and treated. They might be healthy or success, but there are patterns and routines that will be put into place.

“I’ve learned that the visual presentation of information is nearly as important as the information itself.” (Nadeau, 2022, p. 9)

  • Presentation matters to people who have little bandwidth to read. Presentation matters if you want to “stop the scroll” in someone’s brain.

Chapter 1

“Living with ADHD, especially in industrialized nations, is to live with scorn and criticism. To those who don’t understand the neuroscience of ADHD, being slow, late, or inefficient is viewed as a choice rather than the result of well-documented brain differences.” (Nadeau, 2022, p. 12)

  • Lack of understanding of how ADHD actually affects the brain can have detrimental effects on a person’s life.

“A heartbreaking number of older adults are weighed down not only by the stress of keeping everything up to date, but by the guilt and shame they feel in struggling with basic tasks. Unaware that their struggle stems from a neurological difference, many have internalized the belief that there is no excuse for their long-standing struggles to manage their daily lives.” (Nadeau, 2022, p. 15)

  • Lack of understanding of how ADHD affects your own brain robs you of give yourself grace and actually putting structures into place to lead a happy life.

Chapter 2

“In school alone, not considering criticism from parents and coaches, it is estimated that a child with ADHD could receive twenty thousand corrective or negative comments by the time they are ten years old.” (Nadeau, 2022, p. 27) (ref: 1)

  • If we criticize in the formative years, what chances do people have when they are supposed to be fully formed.

“Today’s adults, aged fifty-five and older, for the most part, were raised by parents who didn’t understand ADHD and believed that their children could change if only they tried hard enough. They grew up feeling “different” but didn’t know why they didn’t fit in.” (Nadeau, 2022, p. 29)

  • The issue is here here now! These older people are leaders from a generation that were told to “just do better!”

“You may read such figures as “sixty percent of individuals with ADHD symptoms in childhood continue to have difficulties in adult life.” Those figures were calculated in the late 1980s when an ADHD diagnosis was an “all or nothing” affair. If you met diagnostic criteria (six or more symptoms), you “had it” and if you only had five symptoms or fewer, you didn’t. Our thinking has evolved in the years following. We are slowly coming around to a consensus that ADHD is a dimensional disorder’ in which you can have a range of symptoms from mild to severe. The more we recognize ADHD as a dimensional disorder, the clearer it becomes that ADHD persists across the life span.” (Nadeau, 2022, p. 32-33) (ref. 6, 7)

  • ADHD is a spectrum and can fluctuate across the entire life of someone with ADHD.

Chapter 3

“Because so few neurologists or adult psychiatrists have received substantial training in diagnosing ADHD in adults, much less in older adults, there is a risk of overlooking ADHD and misdiagnosing mild cognitive decline or early Alzheimer’s.” (Nadeau, 2022, p. 47)

  • Even the doctors don’t know, or aren’t familiar.

    • Similar to my story with the VA psych

“Sadly, the mistaken belief that you can’t have ADHD if you succeed in your chosen profession is still quite common in the medical and mental health community.” (Nadeau, 2022, p. 50) (ref. 5)

  • Sometimes nobody know anything. Success can cover a lot of dysfunction.

“Think about this name—it implies we have a “deficit” of attention-in other words, an inability to maintain our attention or focus on an activity. And yet it is well known that people of every age with ADHD have, if anything, a surplus of attention when they are engaged in an activity that interests them. Many in the ADHD community refer to this as “hyperfocus” -becoming so intensely focused on an activity that you don’t know what time it is and don’t realize that someone is speaking to you or trying to get your attention.” It seems more accurate to think of a dysregulated attentional system, one in which you can be highly distractible under certain circumstances and able to focus intently at other times.” (Nadeau, 2022, p. 52) (ref. 11)

  • Even the title itself (ADHD) leads to a misunderstanding of the dysfunction and how it manifests itself

“Generally, ADHD is classified as a disability under the Americans with Disabilities Act. You won’t hear from physicians trained to diagnose and treat diseases, maladies, and disorders that there are positive aspects of having this condition that we call ADHD. The focus in medicine is to look at what’s wrong and try to “fix” it. And the reason for classifying ADHD as a disability is to qualify for accommodations in school or the workplace.” (Nadeau, 2022, p. 53) (ref. 12, ADA)

  • ADHD is a disability, but it doesn’t mean those people are a pariah. It is a way to accommodate the world to a different brain.

“Many people with ADHD thrive upon risk and crisis. People with ADHD can make excellent entrepreneurs because challenges energize them; they are risk-takers, and often see opportunities that others don’t. Many people with ADHD thrive in careers that call for intense focus in emergencies. One study shows, for example, that the rate of ADHD among wildfire fighters is four times that in the general population. Their brain thrives on intensity, allowing them to focus better than most in critical situations.” (Nadeau, 2022, p. 54) (ref. 15)

  • Excitement and chaos can seem like overwhelm to other people, but those with ADHD might actually find the world catching up to to their speed of thinking.

“Thom Hartmann, a man with self-diagnosed ADHD, wrote a book titled ADHD: A Hunter in a Farmer’s World,16 in which he described those with ADHD as the “hunters” of the world, craving movement and variety. The “hunters” were able to intensely focus on “the hunt,” in contrast to “farmers,” those without ADHD, who preferred predictability and regularity in their lives.” (Nadeau, 2022, p. 54) (ref. 16)

  • Compare ADHD to pioneers vs. settlers (APEST Model)

“Research suggests that ADHD is significantly underdiagnosed in adults.” In fact, when adults with undiagnosed ADHD seek mental health treatment, they typically seek treatment for other conditions, such as anxiety and depression, which so often accompany ADHD.” (Nadeau, 2022, p. 57) (ref. 17,18,19)

  • It seems that once you missed the ADHD boat as a kid, it must be understood that as a adult you have any other type of dysfunction.

“In the past, girls and young women were not diagnosed at the same rates as boys and, even today, girls continue to be underdiagnosed to some extent.” (Nadeau, 2022, p. 60) (ref. 24)

  • Women are left behind in diagnosis of ADHD, which means that that population is left behind in accommodations as well.

“Another reason that a smaller percentage of older adults are identified with ADHD may be strongly related to Russell Barkley’s research suggesting a significantly shorter life span for many adults with ADHD due to unhealthy lifestyle choices that lead to chronic diseases, such as diabetes and heart disease. In other words, those over age seventy are the ADHD “survivors” as many in their age cohort are no longer alive.” (Nadeau, 2022, p. 61) (ref. 27)

  • ADHD die young. Can we mitigate that? (Yes) This is a healthcare issue alongside being a spiritual and mental issue.

“When older adults complain of forgetfulness, regularly misplacing belongings, and being unable to manage the tasks of daily living, few family members first think of ADHD. Instead, the immediate concern is possible early-stage dementia. As I mentioned earlier, only one in five memory clinics regularly screens for ADHD.” And among these more ADHD-aware clinics, very few of them seek crucial information from family members who could provide details that these issues have been lifelong and are more likely to reflect undiagnosed ADHD rather than the onset of cognitive decline in later years.” (Nadeau, 2022, p. 63) (ref. 29)

  • Getting older is hard enough, so to add on ADHD (and undiagnosed ADHD at that) can seem like an overwhelming burden to some.

“While research suggests that symptoms of ADHD decrease as one ages, the opposite is true for symptoms of mNCD. This distinction-whether memory issues are the same, improving, or worsening over time—is critical to accurate diagnosis.

ADHD is a life span disorder, whereas mNCD is a disorder of old age. Of course, it’s possible that an individual has both ADHD and mNCD, which is why an accurate history is important. ADHD symptoms may have been present throughout adult life, but may have worsened due to mNCD or other health factors in older age. Too often, neurologists and neuropsychologists focus mostly on current functioning and don’t get a careful and detailed history.” (Nadeau, 2022, p. 66)

  • Proper diagnosis must look at all factors

Chapter 5

“Although most adult psychiatrists will state that they treat ADHD in adults it’s a very common condition, so all psychiatrists have seen it), this doesn’t mean that they have expertise in ADHD.” (Nadeau, 2022, p. 81)

  • Finding a trusting, knowledgeable doctor is such a chore.

“Pills don’t build skills” (Nadeau, 2022, p. 88)

  • ADHD must require a multi-faceted approach to treatment

“Josh Geffen, MD, a psychiatrist and ADHD specialist practicing in Brisbane, Australia, writes, “Like many psychiatrists, we began our medical and psychiatric training in the last century. We were taught that patients with adult attention deficit/hyperactivity disorder (ADHD) had a dubious diagnosis and were probably seeking stimulants for nefarious purposes. Doctors working in this field were viewed with suspicion. They were regarded either as gullible, permissive clinicians or, worse, unscrupulous suppliers of stimulants to drug seekers.”

Dr. David Goodman, one of the few psychiatrists with a specialty in treating older adults with ADHD, reports that the typical psychiatrist receives less than a single day of instruction on the diagnosis and treatment of adult ADHD."" (Nadeau, 2022, p. 95) (ref. 16,17)

  • A lot of psychs have terrible training when it comes to ADHD. A lot of psychs willing to treat ADHD are viewed poorly among their peers. It seems like treating ADHD has to be done with strong resolve or a calling to do so.

Chapter 6

“Effective therapy for ADHD also needs to address the core elements of ADHD that have to do with executive functions.” (Nadeau, 2022, p. 113) (ref. 3)

  • Treat everything wrong with you, but please do not ignore the ADHD.

“Too often, the focus of ADHD therapy is on the negative. What’s getting in the way? What do you need to change next? It’s also essential to recognize, celebrate, and emphasize the strengths you bring to the table.” (Nadeau, 2022, p. 117)

  • ADHD doesn’t mean we are helpless or broken. ADHD brains simply work differently.

“A central, overarching issue for those living with ADHD is the self-blame and outright self-loathing that many engage in.” (Nadeau, 2022, p. 117)

  • How can one minister if they are self defeating? How can they talk about grace if they don’t give themselves any?

“Even when ADHD is “uncomplicated,” there are often two to three mental health professionals involved in treating an adult including a psychiatrist, a psychotherapist, and often a coach.” (Nadeau, 2022, p. 118)

  • So much support is involved in the treatment of ADHD for one person. How can the church step into that helping process?

“As strange as it may sound, you may need to coach your therapist to better understand your needs:” (Nadeau, 2022, p. 120)

  • Self advocacy is a must in a world that doesn’t understand ADHD.

Chapter 7

“The more you know about ADHD, the better you can understand your challenges, make positive changes in your life, and stop blaming yourself.” (Nadeau, 2022, p. 125)

  • Knowledge is power, especially when the “experts” know nothing.

“Internationally known ADHD authority Russell Barkley has popularized a phrase in the ADHD community-that for people with ADHD, “The problem isn’t not knowing what to do, it’s not doing what you know."" (Nadeau, 2022, p. 129) (ref. 3)

  • There is a disconnect between knowing what to do and engaging that part of yoru brain.

    • Reminds me of Paul “slave to sin”

“When you have ADHD, the problem isn’t that you don’t know what to do. The problem is that you don’t how to do it.” (Nadeau, 2022, p. 129)

  • Disagrees a little bit with Dr. Barkley’s statement. I think this is probably true in some instances. Perhaps there is a stepping process in this. First you know what to do. Then you desire to do it. Then you accomplish doing it.

“The key to successful change is to figure out the right level of structure and support you need to accomplish a particular task or to make a change in your habits, behaviors, or emotional reactions.” (Nadeau, 2022, p. 133)

  • Find out what you’re bad at doing, and get some help!

“Make Peace with Your Need for Extra Help

The first step, and sometimes the most difficult step, is to accept that you need assistance. So many older adults are mired in self-blame. “I should be able to do this,” they tell themselves, despite evidence to the contrary. After a lifetime of being told, “You can do this; you just need to try harder,” it’s likely that you often tell yourself the same thing. Instead of “trying harder” and failing, your goal is to understand how your ADHD brain works best and then look for the structure and support you need to succeed.” (Nadeau, 2022, p. 134)

  • Find grace for yourself in your journey to dealing with ADHD

Chapter 8

“In each case, Vince, Steve, and Marcy had been able to manage their professional lives, but their “bandwidth” had been taken up with work, leaving little energy or desire to manage their home environment. There was no time for planning, organizing, off-loading, and rearranging. And when they finally faced the mountain of accumulated belongings, the task was insurmountable. What’s important to understand is that none of these three was a “hoarder” in the classic sense of the word. They had not engaged in compulsive acqui-sition; they weren’t intensely attached to their belongings, unable to let go. They simply hadn’t managed to make the thousands of decisions required to get rid of unused items over the years to maintain an orderly home.” (Nadeau, 2022, p. 153)

  • Being a professional is easy compared to managing your own affairs.

“In 2011, researchers using functional magnetic resonance imaging (fMRI)—a type of brain scan done while the person is performing a task—found that clearing away clutter resulted in better focus and greater ease in processing information, and improved working memory (the number of things that we can keep in mind without writing them down). Problems with focus, processing speed, and working memory are all negatively impacted by ADHD. In addition, those with ADHD typically have difficulty maintaining order in their environment, which gives them a double dose of ADHD-the first dose resulting from their ADHD brain, and the second resulting from the distracting clutter of their environment.’ Clutter can even trigger unhealthy eating patterns! One research project placed undergraduate females in either an orderly or a chaotic kitchen environment and found that those in the chaotic kitchen made more poor food choices, especially overeating sweets.” (Nadeau, 2022, p. 154-155) (ref. 9,10)

  • Clean space = Clear mind

Chapter 9

“The impact of unhealthy lifestyle choices made by adults with ADHD is huge. Russell Barkley found that the average life span of an adult with ADHD is significantly shorter on average—11.7 years shorter for those with hyperactive/impulsive ADHD and 8 years shorter for those with inattentive ADHD. Accidental death and suicide both play a role in a shorter life span of adults with ADHD, but an unhealthy lifestyle is a major factor, in terms both of life span and in quality of life as we grow older.” (Nadeau, 2022, p. 164-165) (ref. 12,13)

  • How can we sense God well if we are so unhealthy?

“To offset Dr. Barkley’s bleak news, Dale Bredesen, a leader in the field of geriatric medicine, offers some very encouraging findings demonstrating that older adults can make changes that dramatically improve their cognitive functioning and overall quality of life.” (Nadeau, 2022, p. 165) (ref. 14, ReCODE Project)

  • Healhty changes can help with longevity in people with ADHD.

“MENDSS is an acronym I created to help you remember the brain-healthy daily habits I introduce in this chapter. MENDSS stands for:

  • M = Mindfulness/Mindfulness Meditation/Stress Reduction

  • E = Exercise

  • N = Nature

  • D = Diet

  • S = Sleep

  • S= Social connections”

  • (Nadeau, 2022, p. 168)

“Bottom line: one of the best ways to preserve or even improve cognitive functioning is through aerobic exercise.” (Nadeau, 2022, p. 172) (ref. 21, 22)

  • Raise your heart rate, raise your brain.

“Research shows that our ADHD symptoms are lower and our general health improves by taking time to be outdoors in nature every day—ideally more than once a day. A “green break” is a great habit to get into as an alternative to heading to the kitchen to drink or eat something each time you need a break. There is a growing body of research on the brain benefits of spending time outdoors in nature.28” (Nadeau, 2022, p. 176) (ref. 28, Japanese “Forest Bathing”)

  • God made nature. It is good for you. Go and enjoy it.

“People with ADHD have a much harder time than others eating in a healthy way. When and what we eat can have a big impact on our cognitive functioning.” (Nadeau, 2022, p. 179)

  • How we fuel ourselves will determine how we run.

Chapter 10

“Research shows that a sense of well-being in later years is strongly tied to one’s social connections, family involvement, and volunteer work that provides a sense of purpose and belonging in the community.}” (Nadeau, 2022, p. 198) (ref. 1)

  • We are built to be around other people. It is vital to our health.

“Stephen Hinshaw, PhD, a highly regarded ADHD researcher at UC Berkeley, described the girls with ADHD that he studied as either “socially rejected” (the hyperactive/impulsive girls) or “socially neglected” (the shy, inattentive girls). Social skills impairments can lead to low self-esteem, social withdrawal, and even self-harm. It’s so important to look for others who accept your ADHD foibles and appreciate you for your good qualities.” (Nadeau, 2022, p. 200) (ref. 2)

  • The church should be accepting of the foibles and good qualities of everyone, even more so if they are rejected by others.

“A number of studies of adolescents with ADHD suggest that social struggles and social rejection are a greater issue for girls than for boys. Whereas adolescent girls report significant unhappiness in relation to peer rejection, adolescent boys do not report feeling socially rejected or unhappy about their limited social life. Parents, teachers, and peers describe these boys with ADHD as being rejected, not included, and having fewer friends and fewer social activities in comparison to boys without ADHD, but the boys themselves do not describe themselves as socially excluded. This is in marked contrast to girls with ADHD, who crave social acceptance and inclusion but can’t seem to achieve it.” (Nadeau, 2022, p. 202) (ref. 3,4,5)

  • How can the church bridge the gap between different and community? If boys don’t recognize (or care) that they are excluded, why is the epidemic of men’s mental health a thing?

“Many older adults with ADHD who live alone are more at risk for leading chaotic, dysregulated lives that make it difficult to build or maintain social connections.” (Nadeau, 2022, p. 204)

  • Why do we fail old and/or different people so much?

“All the people who described their later years as happy ones were connected to their community, to friends, and to family.” (Nadeau, 2022, p. 210)

  • People and purpose makes us better and more vibrant.

“Social connections are a basic human need; retreating into solitude will only lead to depression and eventually to poor health.” (Nadeau, 2022, p. 214)

  • People are relational and it feeds into all aspects of our lives.

Chapter 11

Chapter 12

“Most older adults with ADHD today did not have the benefit of understanding their own ADHD as they were raising their children.” (Nadeau, 2022, p. 245) (ref.

  • Taking care of your own issues is so hard when you have to care for others.

“In many ways, the years of parent-child conflict when both have ADHD are a situation of “complex trauma” for both parents and children. (Complex trauma is a relatively new concept to describe the effects of frequent smaller daily traumas, in contrast to the trauma caused by a single traumatic event.) Complex trauma is very common among family members with untreated ADHD because both parents and children feel stressed, frustrated, and overwhelmed—a situation likely to result in frequent conflicts, verbal abuse, even physical altercations, and, to varying degrees, family dysfunction.” (Nadeau, 2022, p. 248)

  • A lifetime of frustrations can breed trauma, which breeds a lifetime of frustration.

“One treatment program that has shown positive benefit was developed by Eli Lebowitz, PhD, at Yale. Instead of working directly with young adults, his treatment approach is to work exclusively with the parents.” (Nadeau, 2022, p. 256) (ref. 1)

  • If you can help the helpers, the helpees (sp?) will eb better for it.

“Growing up is a long process. Young adults with ADHD who impulsively leave home due to family conflicts or because parents think they should “be on their own” at age eighteen fall into self-defeating patterns and self-defeating relationships. The more your adult child can develop self-sufficiency while still under your roof, the more likely they will be to succeed once they leave home.” (Nadeau, 2022, p. 263)

  • Good parenting and good discipleship can look similar. Provide solid foundations in either scenario for best chance of success.

Chapter 13

“Being financially prepared for retirement can be challenging when you have ADHD.” (Nadeau, 2022, p. 266)

  • Financial stability is hard as clergy and really hard if you have ADHD.

“Seventy percent of all Americans live paycheck to paycheck during their working years and can’t imagine putting aside something for retirement. When you add attention deficit disorder to the mix, financial management becomes even more challenging.” (Nadeau, 2022, p. 267-268) (ref. 2,3)

  • Serious considerationto the financial care of seniors will need to take place, especially in the church.

Chapter 14

“Finding people who know us, care for us, and accept us is never easy, but it can be especially challenging when you have ADHD.” (Nadeau, 2022, p. 299)

  • Clergy support is hard enough….ADHD on top of that?!

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