Expert: Dr Billy Levin - 4/17/2009

Question
Hi there, I'm frustrated to absolutely no end with my common-law boyfriend of 4 years, Jesse.  He's driving ME insane! But, contrary to my friends' advice "he's not worth it". . .I truly believe he is.  

Jesse is 25 years old, and fairly physically healthy.  The problem is this:  although he's never been formally diagnosed, it's 100% obvious that Jesse is ADD.  There's a lot of reasons that he hasn't been diagnosed - he doesn't have a strong understanding family support system, which actually put him in/out shelters/on the streets at 14 years old and on. . . I've tried for 4 years to get him to keep his appointments (even though it takes forever to get one), but read on as this is part of his symptoms.  Either way. . .there's no doubt in anyone's mind.

Let's talk about his symptoms first.  Jesse's day goes like this: gets up after an hour of me jabbing him in the ribs or throwing water on his face (he asked me to do it, please don't think I'm abusing him. . .he just can't get up in the morning).  He goes, makes his cup of coffee (I know, bad. . .but it's his drug of choice in the mornings.), sits down at the computer and checks his email. . .checks the latest music videos. . .checks the latest parts out at his favorite vehicle parts online store. . .then I come down "what time are you supposed to be at work?" he runs out the door (he's late typically and never takes a lunch).  This is IF he's working (keep reading).  He gets home from work, maybe on time, maybe not. . .depending on what he got distracted by on the way home. . .(he’s forgotten to pick me up from work because he got talking with someone. . .) he gets home, gets involved in something, whether it be sitting on the computer, working on his project car, whatever. . .If I don't make dinner, he forgets to eat or just munches all night (peanut butter sandwiches typically) and then around 1 or 2am, finally gets tired enough to sleep and crashes. The thing is, I'll give him a task to do (ie: his household chore is bathrooms - not because I'm mean. . .but because he actually enjoys it.  He gets mad at me if I do it for him), and he'll either not do it or do it only partially because he gets distracted, or it takes him 4x as long as anyone else.  I have to write down exactly what I want him to do, in the order it needs to be done.  We'll be walking through a store, and he'll pick up a magazine or a video, or a cereal box or whatever. . .and sit there and read it.  I can walk away, do my shopping and come back and he's still there, didn't even realize I've left and come back with a full cart.  None of these things are my concern.  A lot of these things can be chalked up to "a guy thing".  However. . .where it gets REALLY bad is professionally and socially.  Jesse cannot keep a job.  Either he can't stop talking, or can't complete tasks in a reasonable time because he's getting distracted (not because he doesn't have the skills).  He’s had a 2-day “why can’t you keep your jobs” neuropsychological evaluation.   Jesse also has a really hard time keeping friends which makes it hard for ME to keep friends, as well.  I've been asked over and over to come out alone (please don't tell him I said that) because we can never get a word in edgewise and he never talks about anything that we're talking about or constantly cuts us off or whatever.  You know the insult "you like to hear your own voice, don't you?". . .Jesse lives this and not on purpose!  I've been trying to help Jesse, but when we talk about how he could tone it down a bit, my 25 year old big tough man turns into a blubbering baby.  He is so depressed about it, but can't do anything about it.  I can't remember how he explained it to me one day about noise in his head.  When we book an appointment with the family doctor, for something as simple as test results the doc makes sure he has 3 slots available because that's how long the appointment is going to be and he STILL has to push Jesse out the door because Jess gets on the topic of the magazines in the waiting room, or our dogs, or whatever he happens to be thinking of.  What takes a typical person a sentence to explain, it takes Jesse 50 sentences, and he repeats himself a lot because he forgot what the first sentence was! Anyways. . .it's OBVIOUS he has ADD, I just can't 100% confirm it because I don't have a piece of paper to say that he does except that he shows signs of it.  Our family doctor has most recently prescribed Concerta 54mg (as most ADD people do, we've been though a lot of different drugs. . .one psychologist gave him Olanzapine - which helped, a lot.  But as we've moved and have been in search of new doctors, we find that they're scared to put him on such an anti-psychotic.  It probably was helping the symptoms, but not the problem.  Our church family has also kind of pushed him away.  Even psychologists in a way reject him (miss 3 appointments and we drop you and you have to start the whole process again. . .which makes ME angry because this is why he’s coming to see you. . .he can’t function to remember to come see you. . .).  To cope with all this, and since conventional drugs don’t work, Jesse decided years ago to self-medicate (to tell you the truth, a lot of other people I know who are ADD do the same and our family doctor previous to this one, on the side/behind closed doors recommended it because the benefits for Jesse, (ie: calming down, getting sleepy – “burnt out”) outweigh the risks (cognitive skills).

Now, the reason I'm writing this is not to tell you all about how Jesse has ADD (have you guessed that I do too?  I’m a mild case and don’t require medication. . .I can usually stay on topic and have learned how one word answers usually go a long way, I cope by way of physical activity and I’m in engineering to wear myself out mentally/physically. . .just don’t let me not have a challenge, cuz the symptoms will shine through).  I'm starting to get honestly worried about him.  As social situation after social situation and job after job don't work out, and doc appointments seem to get us nowhere . . .he gets more and more depressed which has started becoming anger.  And not just at the people, employers or things that have rejected him.  At the people who COULD reject him, too.  Sometimes he gets so mad at what he’s doing, he flips out and hits the wall or any THING in his way (he’s never hit me or our animals).   The other thing is he’s getting really egotistical and anti-everything that isn’t him – as in, if it’s not his perception, it’s wrong.  And he holds grudges. . .he can remember who hurt him, how and when. . .even if it was 10 years ago (ie: someone rejected him, or did something against him  
Because the local mental health system is taking it’s sweet time and aren’t very accommodating, I’ve been doing my own research and something I’d like to ask you to discuss is the correlation between ADD, Aspergers syndrome and/or Oppositional Defiant Disorder.
Also, what can we do in the meantime until we finally get a proper psych evaluation and the right drugs.  Just to get him to do what he needs to do, I already write his tasks/duties out (as I mentioned), we’ve tried the daytimer thing and he just misplaces or forgets to write in it, or forgets to look at it when he knows he has something to do.  Is there any kind of therapy we can do at home on our own to help with the talking?  The key here is not to self-diagnose and so on but to help him build his self esteem and self worth so he wants to function at a typical level.
Thank you so much for your time,
Bobbi


Answer
Dear Bobbi,
           Perhaps you should firstly consider what would happen if I were asked every time to read a book length question. I have only read part of the excessively long description of your problem. There is absolutely nothing I can suggest other than if he has this problem to see an expert who will know how to diagnose, treat and council him. The rest would be up to him to decide if he would co-operate with the doctor for his own sake. The little I did read clearly suggests he has ADHD severe enough to warrant treatment.