I don’t remember much that would be pertinent prior to seven years old, but by the time I was seven my fingers were often bleeding because I had bitten fingernails so low. I lay in bed at night waiting for the sound of my father’s truck returning, from some bar. Then I got down on the floor next to the register to listen to the fight between my father and my mother, which happened often. I was waiting night after night. I was ready to save her, when my father tried to kill her. I felt afraid all the time. It became worse after my brother and I intervened when he was trying to choke her. That however was not the big problem for me at 7 or 8, I accepted that my father would kill my mother and he would be taken away. The big problem was I was sure that left me to take care of my brothers and sisters and I couldn’t figure out how I was going to do it. In fact, every night I went to sleep trying to figure out how I was going to take care of them and that thought cut a groove into my little brain.
The thing I most remember about grade school was looking out the window, watching the leaves turn, watching the leaves fall, observing the subtle shades of gray in the bark of sleeping trees disappear from awakening trees. I concentrated on how soon I could detect buds, and how many shades of green leaves progressed through as they moved toward summer. I lived for summer, when I could get out of school and escape it all.
The only problem anyone identified with me was my severe stuttering. The more anxiety I had the less I was able to talk. Consequently, I was assigned to be harassed weekly by a speech therapist. I made the requisite chart and reported my progress weekly until I graduated. My first therapeutic failure-my fault. My brother who was 16 months older than I was had much worse problems, which would later be identified as childhood schizophrenia. One of my sisters was two and half years younger than I am, had much more obvious problems, dyslexia and behavioral problems. With these challenges and four additional children, my quiet disassociation was welcome.
The only thing I’ve found to take some perverse pride in was my ability to do no homework and still pass tests, usually with very good grades. I have found that somehow, I am and have always been able to soak up huge amounts of information from whatever environment I’m in without consciously focusing on it. Having a very high IQ is one component of that however I’ve had several instances where it became obvious I’m able to acquire information from several sources simultaneously. I believe everyone can do this I’ve just developed it to a greater degree than most people, of necessity. It is a nice trick, it in no way makes up for some of the deficits associated with my psychic condition. I stood out only as an artist.
When I was 14 I started drinking alcohol. I quickly understood why my dad was so devoted to it. It was immediate relief from the horrible situations inside my head. I drank as much as I could for the next six years. It became more important than anything else-I drank until I nearly died. Right at that point, I got sent to the nation’s most noted alcohol rehabilitation program. It worked; I tossed my valium and quit drinking. (Do not try this at home!)
A soon as I quit drinking, however, my mental health problems became glaring! I regularly had panic attacks that lasted two and three hours at a time and spent day after day after day in bed, so depressed I could not or would not answer the telephone or the door. Occasionally I would wander into the kitchen to watch the dishes turning green in the sink. That activity was so exhausting I would have to go back to bed. There was really nothing I could do about it, the alcohol rehabilitation program, disallowed medications for my condition. The first few years, I tried and tried, working steps over and over, feeling like more of a failure every time it didn’t result in an obvious “spiritual awakening” or put me on “the road to happy destiny”. The answer to my complaints, according to the gods of the rehab. Program, was to “work with a newcomer”. I worked with a few dozen, some disappeared, and many stayed sober worked their steps and became happy and comfortable. Of course I could no longer relate to those who became happy and comfortable-so I would have to go find myself another newcomer. I churned through a couple dozen jobs. Killing myself became a frequent comforting thought. I wouldn’t tell anyone for fear of being locked up, like my aunt, my father and my older brother. That went on for seven or eight years, until I became imminently suicidal. At the time I was working as a psychiatric nurse in a maximum security state mental hospital.

More tomorrow-Now a bit about ADHD / ADD

A Missed or Wrong Diagnosis
An inaccurate diagnosis remains a common reason for a delayed diagnosis of ADHD and this problem usually results from incomplete diagnostic formulations. Often, depressed mood becomes the focus of treatment, usually to the exclusion of ADHD.[13] The phenomenon of patients with ADHD receiving a diagnosis of depression is both understandable and unfortunate. Patients with untreated ADHD become frustrated with their symptoms. They are angry at themselves and irritated by their pervasive procrastination and chronic disorganization. Their employers abhor their tardiness and after repeated episodes of overdrafting bank accounts or impulsive overspending, their spouses regard them as irresponsible. Psychiatrists may misinterpret this frustration as depression, and antidepressant medications may be prescribed reflexively. Of course, sometimes depression is present, along with ADHD, and the depression is identified while the ADHD remains undiagnosed.

Yet frustration is not always related to major depression, and if the individual’s issues primarily stem from ADHD rather than depression, then conventional antidepressant treatment will be ineffective.[5] Ideally, a failed trial of an adequate dose of antidepressants should alert the clinician to reexamine the underlying diagnosis; however, in standard practice, many clinicians move from 1 antidepressant to another, perhaps switching from a selective serotonin reuptake inhibitor to a selective norepinephrine reuptake inhibitor or adding bupropion or a low-dose atypical antipsychotic to the antidepressant. Unfortunately, the most commonly referenced study regarding strategies to address treatment-resistant depression does not emphasize the necessity of an accurate diagnosis.[14] In this algorithm, the use of stimulants in tandem with antidepressants receives little notice.[14]

Adults with ADHD may be misdiagnosed with bipolar disorder. Although mood lability is not part of the diagnostic criteria for ADHD, the reality is that patients with undiagnosed ADHD may overreact to simple stimuli and demonstrate mood inconsistency. This characteristic can be amplified in the treated state as well; mood swings may occur as the stimulant level wanes.[15] This end-of-dose effect might be misidentified as a bipolar disorder and inaccurate treatment can occur for years.

Atmaca and colleagues[16] describe a patient with mood swings that were initially diagnosed as bipolar disorder. The authors detail a 6-year history of multiple psychotropic treatment failures, including an unproductive psychiatric hospitalization. In the end, the patient consulted another psychiatrist, was diagnosed with ADHD, treated with stimulants, and dramatically improved.[16]

ADHD can mimic other conditions. Comprehensive screening of all patients who present in psychological distress necessitates an assessment for anxiety, depression, mania, substance use disorder, and also ADHD. Developing and then confirming a differential diagnosis reduces the likelihood of overlooking this highly prevalent and debilitating disorder, and treating a patient unproductively. Screening tools for ADHD can achieve this goal.[17]
Raw data from a recent, not yet published survey of adults treated for ADHD show that 59% reported a 2-week period of depressed mood. Nearly half of those surveyed reported panic attacks, and 60% endorsed generalized anxiety (Young JL, Saal J. A survey of outpatient adults with ADHD. 2009. Unpublished raw data).

ADHD is a disorder that originates in childhood and thus always predates the onset of anxiety and mood disorders. When these conditions do co-occur in adults, ADHD is often not identified.[18] Existing data on the treatment of comorbid conditions is limited; a study of young patients with both ADHD and generalized anxiety revealed that atomoxetine improved both symptom complexes.[19] Only a few trials have examined comorbid ADHD and depression but combining selective serotonin reuptake inhibitors and stimulants is a common practice.[20]