ADHD And Cognitive Anxiety – Now 3 Types

by Dr Charles Parker on December 19, 2011 · 28 comments

ADHD Anxiety Is More Than Just A Feeling  

2133261517 315afe3623 m60 ADHD And Cognitive Anxiety Now 3 Types

Thinking - Frozen by Erik Eckel via Flickr

To fully understand ADHD anxiety symptoms you/we must understand a new form of anxiety: unmanageable cognitive abundance. I’ve been speaking and writing about ADHD and cognitive anxiety for more than 16 years now, not just the OCD subset, with its focused obsessional topics, but counterproductive excessive thinking that ranges across the landscape of Everyman’s everyday realities. The key operational word for ADHD diagnosis and treatment considerations: counterproductive.

If you’re stuck in thinking, if you are thinking too much, it’s counterproductive to your development, your work, your family, your education. Excessive stuck thinking can result directly from problems with working memory – the pre-frontal cortex becomes relatively frozen in time.

But before we cover those three new Cognitive Anxiety subsets, let’s consider the background noise:

An Anticipated Retort: “No Problem”

At first you may say, as many do, ADHD itself is not a problem, everyone suffers from attentional problems. Quickly, following that first denial point, a reductionistic thinker, a label seeker, a 100% name caller looking for the “only” silver bullet – the categorical answer,  would say, “anxiety’s not a problem – everyone thinks too much at times.” Since it’s not a 100% a problem, even if anxiety is 99% active and debilitating, creating profound counterproductive time loss, it’s not a categorically correct, all-the-time problem. [Notice how time and context keep sneaking in to the discussion?] If it’s not a 100% problem, – it “looks like” it’s not a problem. icon confused ADHD And Cognitive Anxiety Now 3 Types

Yes, But…

My response: yes, quite so -everyone does think too much at times – but then permit a deeper question: do they suffer from the thinking problem, does that thinking problem create unmanageable circumstances for their lives, does it encumber their decision-making, does it arrest their development, does it put them out of sync with changing reality?

If so, consider ADHD. Consider the strong likelihood that Executive Function is disordered. Then consider these three presentations:

The Three ADHD Anxiety Subsets

1. Frozen Thinking – Unmanageable Cognitive Abundance – Without Worry: Without affect, not feeling constrained, but nevertheless stuck with thinking too much about inconsequential items – small stuff. These folks think so much they become exhausted, and with encumbered mental lives they often make untimely decisions. They are operationally too stuck, too often, for their own interpersonal comfort. They can still make decisions and often flip this presentation around to micro-managing so they can control – correct – the thinking.

2. Frozen Thinking – Abundance With Indecision And Worry: These folks get overtly stuck – not a little stuck – and more often, not all the time, [but way too often] they either can’t make that decision or make it too darn late. The indecision becomes relevant in their interpersonal relationships, at home or work.

3. Thinking With An Anxiety Feeling: In this ADHD presentation, the feelings arise as derivative from the mental/mind thinking too much, then move into indecision and worry, the appear going down into the body. They feel it in their chest, their stomach – it becomes somatic instead of, or in addition to, mental.

Yes, these can occur separately or all together, depending on circumstance and context – the realities of life.

See this YouTube video, now more than 9000 views on Cognitive Anxiety and OCD from 2009.

And By The Way – Attention “Deficit” Is Only The Default Appearance

Another Big Diagnostic ADHD Correction is in order: The problem dear readers, for both the informed practitioner and the informed patient is a functional one – “attention abundance” is the problem, not “deficit” – too much thinking, not too little. It looks like too little if you aren’t thinking correctly about the thinking process, – but if you know about Cognitive Anxiety it changes your thinking about thinking. Think about it if you have ADHD, do you feel that the DSM missed you, and they you have had to suffer with a negative connotation of stupidity when your real problem is that you are smart and suffering from too much thinking, not too little?

The ADHD label inaccurately describes the mental condition, it only punctuates what can be observed, not what is.

This ADHD nomenclature problem is pervasive, global, and quite important enough to change the diagnostic code – but as you may recall, don’t count on it for DSM 5, the Paleolithic “new” Diagnostic bible. The tenure seekers, the psychoanalysts charged with diagnosis, aren’t thinking about brain dynamics, they are thinking only about observable behavior, not reported mind activity.

We really don’t need affirmation from the DSM-5 to scrap the “deficit” and focus on this very real and correctable Executive Function Disorder – EFD, which embraces both deficit and abundance [not EFDD with the deficit disorder carried forward].

Do Tell Your Friends:

The new ADHD is now EFD. EFD is more accurate, less derisive, and sets more clear treatment targets. Please Tweet, RT and forward this important message with LinkedIn, or FaceBook – the ADHD community can use a different Holiday gift – one that’s done with outdated and ineffective name calling. [Recently at the national CHADD meeting Dr Russell Barkley agreed  icon wink ADHD And Cognitive Anxiety Now 3 Types - ...but he liked EFDD! - and btw, I sent him a note on this different perspective before sending out this post...] Russ is on the right track with the Cognitive Anxiety we have been seeing and treating in the office since 1996.

If you write, think, treat or otherwise reflect upon these ADHD matters, please do pass this along. The downstream effect will be constructive for those who suffer with Cognitive Anxiety and haven’t yet been treated.

Do drop a comment and weigh in on your personal observations about this mind process =>

cp

Related articles
ADHD And Cognitive Anxiety Now 3 Types

Digitally available now at Nook, Kindle, Barnes and Noble.
ADHD Medication Rules – PDF For Your Desktop  
ADHD Medication Rules | Paying Attention To The Meds For Paying Attention – Kindle Version


Tagged as: ADHD, adhd anxiety, adhd diagnosis, Adult attention deficit hyperactivity disorder, anxiety, anxiety adhd, anxiety disorder, anxiety disorders, anxiety symptoms, attention deficit hyperactivity disorder controversies, Attention-deficit hyperactivity disorder, cognition, cognitive, Disorders, education, executive functioning, Health, Mental health, obsessive compulsive disorder, OCD, Psychology, sluggish cognitive tempo, types, understanding adhd, youtube

  • http://www.ADDandSoMuchMore.com/ Madelyn Griffith-Haynie

    Hey!  I just linked this article to the first two posts of a series I’m writing: “When Beloved Has ADD . . . altenatives to murder and divorce.  LOVE your new look, btw.
    Madelyn Griffith-Haynie, SCAC, MCC – (blogging at ADDandSoMuchMore and on ADDerWorld – dot com!) ”It takes a village to transform a world!”

    • http://www.corepsychblog.com Dr Charles Parker

      Thanks Mads,
      Popped over to your site, and appreciate the way you structure your thinking regarding the downstream effects of ADD/ADHD in relationships.
      cp

  • Pingback: Surviving Beloved’s ADD « ADD . . . and-so-much-more

  • Pingback: When Beloved Has ADD « ADD . . . and-so-much-more

  • Anonymous

    Dr. Parker,
    Thank you for replying. I’m very sensitive to pain meds, anesthesia, and Alcohol. 1 glass of wine and I slow way down. I have regular BMs 12hrs apart. I had a thyroidectomy for Hashimoto’s back in 1995. My TSH is always normal.
    I’ve never felt good on any antidepressants/anxiety drugs. At least not the euphoria or the lifted feelings people describe on the depression forums.

     I get anxious because I know when I’m in meetings and people are talking over each other I can’t follow one conversation. I get anxious because I fumble with words while speaking, lose my train of thought, can’t remember peoples names or terminology, or go off on tangents. I see them drifting or becoming uncomfortable. I often get dismissed like my point isn’t valid, or interrupted without getting to the point.

    I’m also looking into HRT because I’ve entered the PHASE in a woman’s life where hormones begin to fluctuate. My PC does not want order any hormone test. She just wants to prescribe birth control pills.

    My Psych wants me to switch to Viibryd.

    I keep checking for your book. Please make it available at audible.com My reading comprehension has degraded. 

    • http://www.corepsychblog.com Dr Charles Parker

      Not,
      Thanks for the suggestion on Audible.com, will have to chase that connection down.

      Even tho you don’t meet criteria for overt symptoms of bowel dysfunction, encouraging a clear path to IgG issues, I am quite certain you nevertheless do suffer either 1. from an immune dysfunction secondary to foods, or 2. trace element/toxic element compromise.

      Life is short, the cost for the testing is less than a small fender bender. Likely you, as others would tighten up and fix your car, but hesitate to spend the money on assessments. Nothing in medicine is 100%, so can’t blue sky this, but I am quite certain you would find good data for improvement, and you don’t have to do both, start with one and move on. If you are in a hurry, want to be done with it, do both test: IgG with Neurotransmitters, and trace/toxic elements.

      I can read them wherever you are, if you want me to manage the whole biz, come on down. If you want to talk briefly for no charge write to Sarah at patient.corepsych at corepsych dot com.

      Let’s chat – yes, I do think I can help.
      cp

      • Anonymous

        Dr Parker,

        I have lots of fender benders too. I get lost in your website jumping from link to link with my head in research mode. I remember seeing the link to your office to call Sarah because I would like to talk briefly. I don’t think that I could come down for a scan. But I’m interested in the IgG and Neurotransmitters. Would it change the choice in medications and would it validate what I’m feeling?

        Hope to chat soon.

        • http://www.corepsychblog.com Dr Charles Parker

          Not,
          I still do scans for even more complexity, if these easier and less costly testings for neurotransmitters and IgG [and some other lab tests] don’t pan out. Scans are just too expensive and don’t render the precision as well as the less costly lab testing.

          I have not seen a test yet that didn’t give us significantly more info. I’ve had a very few [maybe 3 in many years of work with these labs] that surprised us with no results… but no results sends us down a different path – many options and yes, very likely will significantly change your treatment strategy for the better.
          cp

  • http://www.corepsychblog.com Dr Charles Parker

    Pat,
    This is where a consult comes in. We often do consults on a one or two time basis just to make recommendations – often to an informed, more workable GP. Psychs, as a rule, simply don’t want to hear it from another psych.

    Using Skype is jut like in the office, but we can do a phone consult without the tech, and just work thru the problems. That small investment in time can change the situation for years,
    cp

  • http://www.corepsychblog.com Dr Charles Parker

    Herding Squirrels,
    Daytrana is certainly an alternative, works well, and has the added advantage of longer DOE. Take a look here on CorePsych Blog at the Daytrana post with details on the Post Patch Time to dial it in most effectively.
    cp

  • Anonymous

    Dr. Parker,
    I totally struggle with all 3!
    I was diagnosed in Nov ’11 with ADHD. I looked into it because after the 2nd half of 1st grade, my 8 yr son was continuing to have behavior problems in school and home. Homework was frustrating for him & he cries over little things all the time. I think we’re dyslexic too. When he’d struggle, all the mean words and looks my parents would say to me came flooding back. I couldn’t keep myself from crying. I was searching for parenting programs and I heard a discussion on Dr. Radio about Mom’s getting diagnosed with ADHD after their son’s were and decided to investigate.

    I had both of us evaluated. He was diagnosed in September before me. Schoolwork and Parenting have improved. When I tried to get tested (May 2011), it was difficult. A psychologist gave me the Barkley form and diagnosed me with Depression. She also said I had PTSD. They gave me Sertraline (Zoloft). 50mg did not make me feel calmer or stop my crying. They increased it to 100mg. She said she wouldn’t test me for ADHD because of my insurance. But the Zoloft should help.

    After educating myself about ADHD through the summer and fall I kept pushing my PC and got a Psych consult he put me on Concerta 18mg for a week and I would increased my dose every week. He said I might need to increase Zoloft to 200mg if I started to feel anxious or depressed. At 54mg I started to forget what I was doing, lose my train of thought and forget words. At 4 pills I got agitated and couldn’t put sentences together. So I started to take the 200mgs Zoloft. Then everything at work made me sad. I couldn’t stop crying at work. I couldn’t make decisions and started overspending. I was really cranky at home. I started yelling at my brother and husband. I would get extremely cold and then sweaty. I even missed my Dr. appt which I never do. When I had my follow up visit, I could not stop crying. I wanted to explain what happened at work and he interrupted with “would you like to try Adderall?” I felt terrible on Zoloft and Concerta. My family said I was scaring them.

    As I started I Adderall XR found your you Tube video I dropped my Zoloft back to 100mg. I felt bad at 3, 15mg Adderall  and 100mg Zoloft. I feel even more unmotivated an my leg and arm are twitching and I keep running into things. I talked to my PC and Psych about dropping the Zoloft. Psych highly disagrees. I’ve found several people in med discussions complaining of the same thing. I mentioned that my Anxiety was from always being worried that I forgot something, made a careless mistake, or missed what was said in a meeting. Cognitive anxiety. My sadness in May was PTSD and my uncertainty about my child’s future. But I am no longer sad about our ADHD. It explains all my quirks. I learned how to use my strengths.

    I am currently employed as a product designer. The reason I want to manage my ADHD with medication is I have so many ideas for concepts that I can’t finish one. Before I’m done with sketches, I get a better idea and scrap what was doing. I struggle sitting still and listening in meetings and talking about concept ideas. I feel like I stumble with the same problem over and over. And I most certainly don’t want to be caught crying.

    The combo of Zoloft and Aderall XR are listed on drugs.com as having severe interactions like “additive risk of serotonin syndrome.” I checked with my pharmacist and he said I was just worry too much.

    I need your advice.

    • http://www.corepsychblog.com Dr Charles Parker

      Not depressed,
      As you already well know something isn’t right – so here are some thots:
      1. Agree with your pharmacist, no interaction in the lit, likely not the problem.
      2. The titration thing almost always requires considerable detailed thinking. I am not a fan of Zoloft, as it’s a potential weight gainer, would suggest your doc consider Venlafaxine ER generic but it may cause probs too, – just need to get that trial out of the way.
      3. Dial in the XR carefully, use the DOE, works almost every time.
      4. Main point, the first thot in my mind on reading your notes, good doc, good patient, bad metabolism, ask the #2 question and look at Transit Time.
      5. I am adding a Naturopathic Doc to my staff to look at trace elements like copper and heavy metals, that one would be important to pursue. We’ve had excellent outcomes looking at IgG, changing the diet after, and modifying neurotransmitters – failing those interventions we’ve had some remarkable turn arounds with discovery of bismuth and significantly imbalanced trace elements – go to traceelements.com for more info.

      If in a jam where ever you are, we can test and consult long distance if that would be helpful.
      cp

  • http://www.corepsychblog.com Dr Charles Parker

    Jbrees,
    Quite agree! No confusion intended, clarification is the objective. You are quite right on the way you have sorted it out – and I use the same principle: organization around one thought, one pattern [e.g. counting numbers on signs]= more OCD. But, and this is a big but, it doesn’t work that way in the office all-of-the-time. Suggested and best meds for more pure OCD are SSRIs.

    But as I have repeatedly pointed out, hoping not to bore anyone, that treatment recommendation is not universally workable as many, repeat many with even pure OCD, single thought challenges, still suffer from more PFC ADHD mediated anxiety.

    My intervention here: look for the real comorbidity of the three types of depression [new post coming on that one soon] as the vulnerability, the underlying sensitivity is a key to the effective reconciliation of the SSRI and the ADHD/stimulant Dopamine reuptake inhibitors.
    cp

  • http://www.corepsychblog.com Dr Charles Parker

    Mer,
    Having had gastric bypass you obviously qualify for having suffered with, and likely continuing to suffer with, a metabolic challenge. Those with slowed metabolic times, based upon liver slowing not demonstrable on liver studies of the superficial, readily available and often-ordered *liver profile8 genre almost always have trouble with any ADHD meds either slow or immediate release – doesn’t matter.

    The facial tic problem with any stimulant is addressed in this first-in-a-series tic disorder posts here at CorePsych Blog: http://www.corepsychblog.com/2011/11/tic-disorder-5-essential-questions-1/ We see tic in our offices as a metabolic challenge, and your history argues significantly for that likely explanation. Metabolic testing will likely be helpful in understanding what will work best to treat the ADHD, but won’t necessarily become the final answer for tic disorder – as tic could be encouraged by other subsets of problems.

    The short answer is no. My experience is extensive with ADHD and bypass, and my own experience is one that disagrees with that common admonition to bypass patients: forego the long term XR meds. Why? Because most often it doesn’t create a problem when common sense indicates that it might/could.
    cp

  • http://www.corepsychblog.com Dr Charles Parker

    Thanks OCD, stay tuned for more careful breakdowns on the interface between cognition and affect regarding anxiety!
    cp

  • http://www.corepsychblog.com Dr Charles Parker

    Paul,
    Evidence exists that chiropractic treatment is helpful for ADHD, and just as any casual reader here will see we support every piece of the ADHD puzzle that works, and argue regularly against reductionistic, simplistic only “medical” solutions. It takes a village, and teamwork in treating ADHD complexity is always recommended. We have see significant improvement with cranial sacral interventions as well, and appreciate your weighing in on these matters here at CorePsych Blog.
    cp

  • Pingback: Adult ADHD and Loneliness, Part II | Jeff's ADD Mind

    • http://www.CorePsychBlog.com Dr Charles Parker

      Hey Jeff, Big thanks for the mention… stay tuned for the cognitive depression piece coming as soon as I get further along with the upcoming presentations. Happy New Year!

  • Pingback: ADHD and Loneliness, Part II | Jeff's ADD Mind

  • Sherri L.

    Haha Dr. P sounds like you were talking about me in some of that….lol  As usual you are the bomb!!!

    • http://www.corepsychblog.com Dr Charles Parker

      Surprising how frequently generalizations about these issues apply to so many. Rest assured, you we’re on my mind!
      cp

  • http://www.corepsychblog.com Dr Charles Parker

    Brook,
    Love your blog, and agree with the simplicity – the real deal breaker, the point of differentiation: no longer to those with working memory problems have to be relegated to the swamps of “deficit.” EFD is both deficit and abundance depending on place, time, and specific functional issues.
    cp

  • http://www.corepsychblog.com Dr Charles Parker

    Mother2,
    SPECT images would be helpful, and we do see them especially helpful for specific interventions – to drive the biologic point home in a general way for those who are locked in the challenge of over-thinking and denial.

    Your son is quite right, however, to remain suspicious of the usual med interventions, as the mistake most often made with folks who present with his probs – dependence on SSRIs that simply make the situation much worse – that would make him feel like a treatment failure. OCD is not just cingulate gyrus as Amen often implies, nor is it always ADHD, but frequently needs a combination of meds.

    The other very important point: biomedical measures of other contributory conditions… all of which we can to long distance in LA. Have him take a look at this video that goes more down the ADHD path, but highlights the importance of brain function as opposed to appearances: http://youtu.be/fu0mN68rkEs

    We can consult by FaceTime, iChat or Skype and easily point him in the right direction, just can’t treat with meds without an office visit. – and yes, TCM could be helpful, but for my take on the current science: use it, don’t overlook the basic cellular physiology for advanced diagnostic accuracy.
    cp

  • http://www.corepsychblog.com Dr Charles Parker

    Robert,
    Completely agree, and many thanks for weighing in on the importance of dealing with the multiple variables of ADHD treatment including the importance of sleep. I added a separate chapter in “ADHD Med Rules” on sleep for that very reason.

    I thought, as I began to read your comment, that you were going to go down the path of diagnosis: “did not have ADHD.” Do remember that the criteria of studies, the diagnostic criteria for ADHD are amorphous at the very best. So many more children have significant executive function challenges but don’t meet the outdated criteria present in the DSM 4 or forthcoming DSM 5 – Search here and in Rules for more on this ‘missed diagnosis’ subject… including this last post here on the oft overlooked functional presentations of simple anxiety that lives downstream from corrupted PFC/working memory dysregulation.

    Thanks for your links and remarks, so true!
    cp

  • scottthutson

    Dr.P., You have done it again! EFD is right on target! A great example (maybe?) could be, the way EFD’ers are so easily distracted by, lets say, a broken limb hanging crooked on a tree that is visible from the garden. The task at hand is to work on the garden, but the world(working on the garden) screeches to a halt for at least 10 min.’s. Not the mind/brain or thinking, that’s going full speed, but it’s focusing on that broken limb? Same thing with driving down the road @ 70 mph. ……That’s a major disorder there.No? 

    • http://www.corepsychblog.com Dr Charles Parker

      Scott,
      You got it – the functional component gives us more precise targets. The new questions arise from what is functioning and what is not – and in what context do they deteriorate. SPECT dramatically shows that ADHD is not a 24×7 diagnosis.
      cp

  • Justdowhatisay

    Thank You for the mention above!
    ohmygawdjustdowhatisay.wordpress.com
    @wordpress:disqus 

    • http://www.corepsychblog.com Dr Charles Parker

      No prob, super postings! Love the evidence!
      cp

Previous post:

Next post: