Baseline Your ADHD Symptoms To Improve Therapy

How do I know this is going to work?

I am a bit obsessive about this question when considering any kind of intervention, but there is something I obsess about even more.   I can research with mainline medical sources such as WebMD or The Mayo Clinic, or dig deep into medical journals, or read the about what we’ve learned from long experience in well-known treatments, but the thing that always bugs me about medical research is that it is a game of percentages.   Even a good treatment might only work on half the people who try it.   Or worse, it might “work” but only make you 10% better.   So, even if I have a good feeling some treatment might work, I still have to ask after the treatment:

How do I know what I just did worked for me?

When I started seeking professional help for ADHD, I thought long and hard about whether I would start medication.   I tried every habit change, every process I could think of and exhausted those with years of practice before I let myself give drugs a try.   I worried about addiction, resistance, stigma, and more but my struggle with focus was enough of a problem that I was ready to try just about anything.   I was not, however, willing to leave anything to chance if I could help it. 

I have a strong background in science and I know that it can be tricky to evaluate any experiment, especially so when we are measuring a mental state.  There needs to be some way to compare how things were before and after the treatment.   So,  before I was going to take any medications, I knew that I needed a “baseline”.   A baseline is a measurement you take before an experiment to figure out what “normal” is.  Then we keep taking the same measurements through the experiment so that we can compare our state afterwards and see if it made things better or worse.   To get my baseline, I chose a set of questions to help me evaluate my mental state.    They were something like this, with numerical answers:

  • How much do I feel like working right now?
  • How tired am I?
  • … etc. ..

I answered these with a numerical scale (1-to-5) so that I could do numerical analysis on the results.  At 8am, noon, and 4pm every day, I would write down my answers to these questions.  I did this for three weeks and because I could see a regular pattern in my numbers, I felt this was a good sign I had enough data.   With my baseline in hand, I was ready to try medications.

I researched the known ADHD drugs at the time and felt best about Adderall and Ritalin, because this class of drug (methamphetamine) has been studied for many decades and these had a good record for effectiveness and safety.  I also chose to take the plain form instead of time release so that I could vary the dose.   I then took a few months to conduct an experiment.  I started with very tiny doses (7.5 mg per day) and then worked up to higher doses until I noticed an effect, and then worked up to even higher doses to see if the effect levelled off.     After two months I learned that I was able to see a significant positive effect at 10-15mg/day – an effect that leveled off at about 20-30 mg/day.   Results were the same for both Ritalin and Adderall. After 10 years, I still take only 15mg per day on average (an amount much less than typical prescription doses of 40mg/day).  

Long story short: I was able to document a strong positive effect with medication that continues to help me 10 years later.

Big Caveat:  A good scientist is going to choke a little on the story I just gave.   A baseline is certainly a helpful start, but my approach was definitely not robust.  The data sample was small, the numbers are susceptible to my emotions and desires to have a particular result, the questions were just made up by me instead of evaluating them for how effectively they measure ADHD in the general population, and on and on.   These are justified concerns, to which I have two answers: First, Any kind of a baseline is probably better than what most people do, which is no baseline.  Second, I happen to be OK treating myself by placebo.   If a baseline helps me believe a treatment is effective, even if it is not especially accurate, that should increase any placebo effect.  Therefore, if I can make a treatment work by tricking myself into believing it works, then that is a fine outcome in my opinion.   (Just to be clear: I will say that 10 years of Ritalin and Adderall experience lead me to believe that the drugs really do work.) 

OK, now I am trying "talking" therapy instead of a medication.   I’ve seen therapists before- it was a therapist who helped me consider getting diagnosed and treated for ADHD in the first place-  and with therapy, I feel like the science of it is much “squishier”.   Talking therapies are less exact than a drug- the procedures usually have flexibility, the therapist can be just as important as the procedure, and a mental reaction to a stimulus is much more complicated that a physiological reaction to a drug.  This makes choosing a therapy much more difficult, but I can still benefit from the careful approach of first taking a baseline.  If the therapy isn’t supported strongly with science, at least I might derive some placebo benefit by seeing it work in the numbers.   I think the potential for a placebo benefit should be even stronger in the case for talking therapy anyway.

With my new therapy, I am trying to work on the stories in my head; my self-talk makes it hard for me to navigate certain kinds of work.   I’m not 100% sure what all is going on inside my head, so with my baseline questions I need to focus on how my self-talk manifests.   I’ll use 1-to-5 style of answers again because that makes it easier to measure the results.  Instead of questions,  I came up with statements that can be rated on a 1-5 scale, when 5 is “exemplary day”, 3 is an "OK day" and 1 is “crummy day”:

  1. I made progress on tasks that are my "main job"
  2. I asked for help in areas I am learning
  3. I engaged rather than avoided
  4. I felt I provide value worth my compensation
  5. I felt generous and kind with other's flaws/mistakes/incursions
  6. I felt like celebrating successes of others
  7. I had a restful sleep last night

The procedure is to answer these around 4pm every day, and this will give me about two weeks of data before my first appointment with my new therapist.   I’ll continue to make measurements through the therapy.   I’ve been at it about a week now and I’m seeing an overall average score of about 2.7, with sleep and engagement being most negative.  I use Microsoft Excel to track the data and I color-format the numbers so it is easy to see the trends.   Here is what it looks like:


  I’ll post more numbers over time.  

 

 

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