I loathe doing my clinical documentation, and have many clever ways of putting it off.
When you look at the DSM-5 clinical criteria for hyperactivity/impulsivity under ADHD, you see all kinds of symptoms that are most observable in young boys and hardly ever found in adult women, such as leaving your chair when expected to remain seated, such as during a meeting. I mean, who does that?
Oh shit, I do. Why’d DSM-5 authors have to subconsciously narrow our focus and thus obscure our vision with that whole “during a meeting” thing? Most of us who have managed any degree of success in life have learned how not to do that. But if it were phrased “frequently leaves seat when achieving levels of productivity considered normal for functioning adults would require remaining seated”? Oh, then you might see all the clever ways I manage to avoid remaining seated. See, my deeply disgruntled resistance toward sitting my butt in my chair and getting it done fuels all kinds of other activities. This week, it’s the reason my whole house is clean and my garage is organized. I tell myself that once I have attended to all the material things around me that have the potential to serve as sensory distractions otherwise, then I will sit down and do my work.
But you know what happens when I sit down to do my work after all that? Now suddenly I need to make some tea and light some incense and put on the right playlist and grab a snack even though I’m not usually an emotional eater and oh! now look, there’s another dish to do. And before I get back to work, I should probably check my Therapists with ADHD Facebook group to see if anyone left any helpful comments on my post about problems with documentation and — ohh, ha, I see what you’re doing there, self. Clever. Nice try.
Alright, let’s power through one document. I’ve got an assessment to write. But wait, I don’t like the assessment form I’m using for this new client. I need to edit these questions. Alright, time to go into my EHR settings and invent a new assessment form. Somehow even that is more fun than writing the actual assessment.
Uggghhh that was so hard, now my body is sore. How can I possibly keep going and do another document? It’s time for a HIIT workout! FitnessBlender.com, here I come! Even strenuous exercise is more appealing than sitting my butt down and doing something I have done thousands of times before: eight years of being a therapist times several hundred appointments per year…
So adding to the list of things I would rather do than clinical documentation, not only do we have cleaning and organizing, we also have exercising, updating my website, creating new forms in my EHR, (writing this blog post, duh)… and that’s not nearly all. I will even confront my email inboxes, another loathsome task, before doing my documents. At other times, the urge to spring out of my seat has compelled gardening, piano, and all kinds of other creative projects, not to mention various forms of social engagement, online shopping, and more.
Last but certainly not least, my ADHD has compelled me to go down countless research rabbit holes. In the past two weeks I have researched: the size of the black hole in the center of our galaxy, how eels reproduce, how on earth mullets are making a comeback, how CRISPR/CAS-9 gene technology was derived from studying the ways in which bacteria in a highly saline environment evolved a means of protecting themselves from viruses that would otherwise destroy the bacteria cells to turn them into virus reproduction factories…
Yeah, I nerd way the f out. To be clear, there is no correlation between ADHD and intelligence. The higher one’s IQ, the later the age of diagnosis, because intelligence can both mask and compensate for executive dysfunction. As a kid in the gifted program, my IQ was tested at age 7 and reported to be “165+”. I later had all kinds of behavioral problems and dealt with some serious consequences of my unchecked impulsivity, all of which led more to shame, social ostracization, and embarrassment than to compassion, support, or understanding. I got weird looks and “are you okay?” but I don’t recall anyone giving me honest feedback about the nature of my particular issues and any reasonable, informed guesses about what might be underlying them. I saw many therapists and made little progress. It wasn’t until the age of 34, with a Masters in Counseling, several years of professional experience in the field, a couple of continuing education trainings on ADHD, and excellent modeling by a very likable colleague who was open about her own ADHD, that I self-diagnosed, then confirmed my diagnosis with a formal assessment from an appropriately trained psychologist that I sought out with this aim in mind.
I’m slowly getting better at compensating for my executive deficits, and I have a lot of successes to be grateful for in spite of the risks I’ve incurred. But every day I recall embarrassing moments from my past untamed impulsivity. With all the traumas I’ve had in life — some of which were not my fault in any way, while others were results of my own poor decision-making — somehow it’s not those memories that haunt me, so much as the memories of how I must have come across to others along the way.
It’s easy to let this stuff shut me down. It’s tempting to stop trying. And there are some ways in which stopping trying may in fact be the best thing for me. For instance, I’m experimenting with reducing or eliminating making lists, plans, schedules, and so on. I know it’s not going to serve my sense of self-efficacy to keep attempting things that history would predict I will only fail at. I mean, I am brilliant at coming up with those systems, and I’ve even invented some that others are still using years later. It’s just that my brain doesn’t work in such a way that I am able to implement any of them consistently.
So, I keep my schedule limited to the commitments I make to other people, aiming to show up on time to appointments and social plans. But I don’t promise myself I will do Task A during Window of Time B, because that doesn’t work.
And instead of lists, I have a couple of forms of inboxes: my email inboxes, and physical containers that collect things that need to be attended to. This works because I hate both email and clutter alike, and tend to want to eliminate them. Visual clutter is a major distraction for my ADHD, so I will tend to it more readily than a list. It’s kind of like a laundry basket or a sink full of dishes: I don’t like seeing it pile up, and I know how much better I feel when it’s clear, so I handle it. So, on my desk, I have an inbox that collects papers and small items that need to be attended to in some way. I can also jot a note down and put it in the box. Near my front door, I have a wooden chest that collects items to be donated to a thrift store. Near the doors between rooms, I have baskets for items that need to be moved into another room. For instance, there is one in my living room near the door to the kitchen. Anything that needs to go into the kitchen, or otherwise toward that side of the house — dishes, outgoing mail — gets placed in that basket. And in the garage, I have a bin that collects various items that need to be sorted, such as being placed into another bin that is organized. Thus, any material task is organized visually, and any non-material task is handled as either an item in my email inbox, or a note in my paper inbox.
Perhaps most challenging, I have learned to let a lot of things go. I won’t get back to everyone about everything, and that’s okay. I won’t even write every blog post or potential future book chapter I ever dream of writing. I have to preserve time and mental bandwidth for my basic responsibilities toward myself, my clients, and my loved ones. Yes, this leaves me with some guilt and feelings of loose ends, but I know I am only human and modern life is too fast-paced to keep up with everything.
I really appreciate what Jessica @ How to ADHD has to say here. I hope some of you find comfort in it.