Competence

Being good at something makes people happy. I have learned many truths over the years of practicing psychiatry, and that’s one of them. If you’re great at doing your job, get straight A’s, play a sport exceptionally, are an accomplished dancer, musician, gardener or artist, you have something to feel good about.

 

It’s not enough, however, to be competent. A second requirement, although it may seem related to ego or pride, is essential. You must also be recognized for your competence. Praise, accolades, kudos, 5 out of 5 on a job performance review – whatever form it may take – being recognized for your competence is a type of reality testing which confirms your suspicions that you are, in fact, good at what you think you’re good at.

 

This recognition need not be in the form of verbal confirmation from others. It may be simply the letter grade, points scored, increased number of clients resulting from positive word of mouth, or even applause. Different types of competence are recognized in different ways that are sometimes obvious, but can be subtle. Stand up comedians know if their audience finds them funny by the volume of laughter. A “not guilty” verdict is confirmation for the defense attorney of a job well done. Removal of an appendix, resulting in alleviation of pain and lack of infection lets the surgeon know she is competent at prolonging life and health.

 

Most of us strive for excellence in what we do, consciously or not. We might not start our day by thinking “I will improve on my skills and do my very best today,” but we do just that anyway. Problems arise when we try our hardest and the results are less than optimal. A student who studies for several hours and then gets a “C” on the test starts to doubt the connection between effort and outcome. The writer who gets his work rejected by one publisher after another might start to think his abilities are less than adequate.

 

When a person puts in what they feel is a very strong effort and the feedback is not good, competence and the ability to achieve it may be called into question. One might take such negative feedback as constructive criticism and adjust the approach taken, but only for a limited period of time. Rejection or invalidation of earnest work is sustainable by the persistent individual for varying lengths of time, and depends on the support of close friends and family, the person’s inner conviction that their ability has not yet been recognized but will be in the future, and the belief that they have a “calling” which must be pursued, regardless of recognition by others.

 

People with ADHD are constantly confronted by the disconnect between their innate ability and what they are able to manifest in reality. Although they have great ideas and can visualize in their mind’s eye the completed product, they are often unable to see their vision through to fruition. This results in frustration, discouragement and eventually doubt regarding their true capabilities. Ultimately, low self esteem and depression can result, leading to the cessation of attempts to demonstrate competence

This is why the recognition of and treatment for ADHD is essential. Children are especially vulnerable to negative feedback in the face of solid effort. Adults, having endured years of rejection and failure, become slowly traumatized by their experiences and often choose “safe” occupations which do not challenge them, but offer the solace of competence in the absence of self nullifying criticism and defeat.

 

We all start out in life with an innocent, if perhaps naïve belief that if we try hard enough, we can accomplish anything we set our minds to. Nurturing this belief is the job of parents, teachers and coaches entrusted with fragile emotions and limitless potential. With just enough encouragement and praise, persistence and confidence is solidified, leading to competence and recognition thereof. Every person deserves no less, but sadly, not everyone receives these minimal prerequisites.

 

If we all try to create conditions in which our own sense of competence includes mentoring and instilling this feeling in others, we can “pay it forward,” ensuring the continuance of confidence.

 

Brain Pattern Recognition Software

No matter what your profession, you use your brain’s pattern recognition capabilities to quickly assess and identify problems. Once you’ve diagnosed the problem, this neural network, unique to your brain, will point to possible solutions. Whether you’re an auto mechanic, investment banker, attorney or IT manager, the information patterns presented by challenges you encounter register unconsciously throughout each day, manifesting in the efficiency with which you perform your job.

 

The same can be said for physicians and other health care professionals. We listen to patients tell their story, pay attention to facial expressions and mannerisms, rank issues in the order determined by their emphasis, calculate the probability that various diagnoses fit the pattern, and eventually recommend a treatment plan.

 

“Practicing medicine” is an accurate description of what doctors do. The more time we spend with patients trying to identify patterns and solutions, the more chances we have to be mistaken or correct. The more we learn from treatment failures, the less likely we are to repeat such errors. On the other hand, when we accurately identify a pattern which leads to effective treatment recommendations, the probability of future success increases.

 

With this in mind, I frequently tell patients that whatever they have to say is important. As I listen and observe, an intangible “vibe” is created by the words, tone of voice, expressed emotions and body language. Over time, a pattern emerges which, although unique to the individual, indicates the most likely diagnosis and hence, the most effective treatment.

 

When it comes to ADHD, symptoms tend to be consistent. Inattention, procrastination, disorganization, impulsivity, restlessness, inability to complete tasks, inaccurate sense of time passing, hyper-focus and difficulty staying in the moment are, to varying degrees, usually present in those who meet the diagnostic criteria. Underlying personality, work ethic, ambition, frustration and the recognition that more can be accomplished can all affect treatment outcomes.

 

Coexisting depression, anxiety or bipolar disorder are frequently present in those with ADHD, resulting in different symptom patterns. The degree to which these conditions may be causing impairment and whether they are primary or secondary to ADHD symptoms is key to formulating an effective treatment plan. Because symptoms overlap, accurate pattern recognition is crucial.

 

As you go through each day, try to observe when you engage in pattern recognition. When the problem and solution seem obvious to you, but not to others, chances are good that you unconsciously ticked through a “differential diagnosis,” quickly arrived at the most effective “treatment plan,” and went on to the next issue at hand. As you become fully aware of the pattern recognition software in your brain, you’ll be able to access and use it consciously, resulting in more effective and efficient problem solving.

Welcome

Welcome

This is my first attempt at blogging, and I’m pretty excited about it. We have a new website as well, and we’re hoping to interact more with those of you who take the time to look over the site. My intention is to answer questions that are asked of me, either by email, form submission or in person on a daily or weekly basis, and to write about subjects of interest to the ADHD community.

ADHD and Relationships

ADHD and Relationships

In early childhood, our ability to pick up on social cues is dependent upon the degree to which we devote our attention to noticing these cues. When an environment full of stimulation and often confusing information is thrust upon us, we tend to focus on that which is most urgent and pressing. If attention is limited, some things will go unnoticed. If our ability to filter out extraneous stimuli is lacking, we assign equal importance to everything that gets through, making it impossible to prioritize and process information.

ADHD and Priorities: Making a List, Checking it Once

ADHD and Priorities: Making a List, Checking it Once

When you have a lot of important things to do, it may seem impossible to prioritize. In fact, when everything on your list is a high priority, you may feel paralyzed, unable to make the choice of what to tackle first. This, of course, feels very bad indeed. So many tasks to check off that list, but no progress made.

How to Turn Overwhelming Circumstances Upside Down

How to Turn Overwhelming Circumstances Upside Down

Microsoft Word provides me with four definitions of the word overwhelm: 1. overpower somebody emotionally, 2. provide somebody with a huge amount, 3. overcome somebody physically, and 4. surge over somebody or something. A quick online search reveals the original meaning, dating back to the 14th century, was “to turn upside down, to overthrow,” which I much prefer, as it implies conquest and action.

Timeless Advice

Timeless Advice

From the sundial to the atomic clock, humans have been obsessed with measuring the passage of time. Philosophically controversial, the idea that a sequence of events takes place, one after the other, and that we can accurately use the terms before and after have given time the status of a dimension. Physicists often use the term “spacetime continuum” to put their theories in context.

Prescription for ADHD and the Fountain of Youth: Get Moving

Prescription for ADHD and the Fountain of Youth: Get Moving

Laughter may be the best medicine, but a good workout is definitely in second place. Exercise improves mood, decreases anxiety and increases concentration. Breathing hard and sweating for an hour or so can do more for your productivity than any other form of therapy. Time spent exercising is time well spent.

Early to Bed

Early to Bed

If he was alive today, I’m sure Ben would have included women in his quote. His point, however, was as true then as it is now. But sleep is boring, right? I mean, even talking about sleep is a snooze. We’re supposed to spend a third of our lives in dreamland, which adds up to about 4 months per year. What does this prolonged unconsciousness do for us? Although it seems like a waste of time and productivity, even the most energetic souls among us must succumb to slumber to avoid fatigue, psychosis and ultimately, death.

Food for Thought (literally)

Food for Thought (literally)

First, a disclaimer: I’m a psychiatrist, not a nutritionist. I have a pretty good idea of what’s healthy to eat and what isn’t, but my purpose here is not to get specific about food. Rather, it is to give simple, practical advice for those who wish to maximize their ability to concentrate consistently throughout the day.

All Things Shiny and New

All Things Shiny and New

We all like new things. New is interesting. New is exciting. New is stimulating, sexy, captivating and scintillating. New holds our attention… for a while. Then new is old, boring, passé and dull. There is usually a bit of time between new and old, that transitional period during which an object, relationship or idea is still fresh enough to taste before being ripe enough to throw out.

How to Get Your Dopamine On

How to Get Your Dopamine On

In my last blog entry, I described a way of thinking about ADHD. If you consider the various brain regions as a team of players, each having its own position and function, then the prefrontal cortex (PFC) would be the coach, coordinating the team and making sure the plays were executed properly. In people with ADHD, the coach falls asleep when things are not interesting or exciting.

How ADHD Medication Works

How ADHD Medication Works

In recent blog posts, I’ve written copiously about dopamine, the neurotransmitter primarily responsible for our ability to sustain attention, organize our environment, prioritize tasks and resist our impulses. Excess dopamine recycling in the prefrontal cortex results in relatively low levels of this chemical messenger’s “availability” for nerve cell communication in that part of the brain, resulting in deficient executive functioning.

Procrastination: The Art of Deferring Until.. Whenever

Procrastination: The Art of Deferring Until.. Whenever

Looking back, it seems I’ve taken the summer off from writing. I’m not sure why. I didn’t mean to avoid it. In fact, I had every intention of writing quite a bit during my usually less busy months. I realize that by not doing what I intended to do, I was engaging in something I advise my patients to avoid at all costs. I was procrastinating.