What is ADHD?
- We have a lot of neurological images that tell us something is different, in ADHD peoples’ brains1.
- We have lots of behavioural checklists that are under and over used, often depending on your socio-economic status, geography and school environment2.
- We have an evolutionary psychology critique which argues that humans are designed to produce hunters and these people have a hard time sitting still3.
In short, we have a bio-psycho-social model of a condition that strikes fear into teachers, youth workers and employers. People with ADHD are less likely to be employed, more likely to be incarcerated and form an unequal proportion of chronic drug takers 4,5.
This is my story.
I was an angelic child and a demonic teenager. From puberty onwards, my mental health deteriorated faster than the Democratic result on Election night 2016. I collected diagnoses like scouting badges (ironic as I was expelled from the Guides) – anxiety, depression, anorexia, bulimia and my all time favourite “school phobia”. How my parents and siblings survived it was a miracle (I love you all dearly). I think they just used to hang out without me, which was fine because I was usually sneaking out of the house to drink alcohol in the park. I wrote gut-wrenching self indulgent poetry and listened to too much Pink Floyd, usually at two am because I rarely slept – the noise of the trees was too loud and I could hear my family breathing (see- ‘misophonia’, another unnamed condition that has emerged since my childhood). Ear plugs have literally saved my sanity.
I had lots of friends but never felt part of a group, instead I rotated myself through different circles. Despite a 20% attendance in my final two years at secondary school I somehow managed to ace my GCSEs but then left home two weeks before my 17th birthday. I auditioned with hundreds of people to achieve one of sixteen places on a Theatre course and then abandoned it after one year. I looked after old ladies, mental health clients and disabled people as a care worker. I ran club nights. I started eight A Levels but only scraped together three finished results with low grades. I took advantage of my dual US/USA nationality and ran away from my home town in the UK to New York City aged 20 with $100 dollars to my name. I was a waitress, a nanny and a volunteer afterschool club helper. I was like a human pinball, bouncing around knocking into things (apologies to those people) occasionally falling into the pit and then launching myself out again with ferocity.
Am I ‘better’?
Today I am a Chartered Psychologist, a mother, a business owner and have been married for thirteen years. How did I get from A to B? How am I not dead? What was it all about? I spent a lot of time in my twenties trying to work what ailed me, as I gradually calmed down. I had been well loved in my childhood and I had never gone hungry (apart from when I refused to eat). There was not a clear reason for my difficulties, as many psychologists, psychiatrists and counsellors had tried to excavate. I had felt raw and laid bare for all the digging, the reason sifting. My twenties were a time of building back up, constructing layers of a self through some genius personal development courses, workshops, coaching, yoga and powerful friendship with like-minded souls who saw through the fire to the heart underneath.
I became very hardworking, threw myself into professional projects, academia, friendships, clubbing, love, driving – whatever I did it took 150% of my energy. I had early success in corporate life, winning company awards and managing sales teams but by twenty-three I had grown to hate the constriction and the politics. I became self-employed and haven’t really had a boss since, though I have been blessed with many excellent mentors. I found my Bachelor’s and Master’s degree an engaging stretch of mind and while I could grasp the concepts and discuss them well, I could never quite re-read my work enough times to construct perfect papers at that level; I did well, but never my best. As part of my developing psychological consultancy work, I learned to diagnose dyslexia. I asked the colleague who taught me if she would run the tests on me first, so that I could understand how it felt. After an initial IQ profile she remarked how odd it was that my profile looked dyslexic. I have the classic rocket-level visual-spatial IQ and the comparatively weaker working memory. There’s two standard deviations between them, which is technically neurodiverse. We discussed my background and how the A Levels that I eventually finished were French, English Language and English Literature. I aced the spelling and reading tests. We decided that I wasn’t dyslexic. It seemed odd but we said no more.
Funnily enough, around my mid twenties everything had got a lot easier.
Human neurological ‘executive-functions’ mature at this age; these are the bits that help us pay attention, switch attention, make decisions and inhibit impulses. For a lot of ADHD people this brings blessed relief6. I learned to exercise and keep myself well. I stopped eating crap food and started to manage my alcohol intake. I fell in love with a wonderful man.
As I progressed in my career I learned more about ADHD. Everything seemed very relevant – overlap with anxiety, eating disorders, insomnia7 – and yet I felt so distant from my teenaged self. It was almost like that was a different person and the adult Nancy didn’t need help, so why raise old demons? Also, critically, the psychiatric evidence suggested that ADHD symptoms had to be present from younger than age seven, so that ruled me out. Until one day the rules changed. Some excellent research from the USA demonstrated that girls were missing out on diagnoses because they (we) often don’t present symptoms until puberty. Also, they (we) were (are) more likely to ‘day-dream’ than ‘act-out’, so don’t quite get to the threshold of referral in a system stretched for resources8.
Now at this point as well I had made a career for myself espousing the benefits of neurodiversity; challenging the idea that it is solely a deficit, a disability, instead demanding recognition for the rocket-level strengths. I have lectured, presented, written and advocated that the adjustments needed for the comparative weaknesses are because we live in a society that measures success by our literacy ability alone, which we need to focus on demand, concentrating in busy classrooms / offices.
We are only disabled because the world has become too polarised, too focused on the homogenous jack of all trades and excluded us, not because there’s anything inherently wrong about having extreme strengths and weaknesses. 2000 years ago I’d have been a shield maiden, a hunter, a child entertainer (all of those things and probably seven more).
(I know, I can only dream of being Lagertha…. but I do dream)
Why did I need a diagnosis?
Surely I could just accept myself, and in the business that I’ve created make sure that my difficulties were accommodated and my strengths recognised? I think the turning point for me was a period of prolonged stress and insomnia that reminded me how fragile my mental health still is. Growing businesses have a difficult transition from micro to SME and in that phase the infrastructure support is not in place but the need becomes more pressing. Many fail at this point. I dragged myself through with the support of some amazing colleagues and an amazing husband but many relationships became strained. In the small wee hours of watching the moon set I knew I needed some closure. I had found ideas easy to generate, clients easy to come by and the set up of ethical practice involving longitudinal evaluation, robust training and company culture satisfying. The aspect of my work that felt the hardest, the most painful, was managing performance, dealing with difficult internal relationships. As we grew larger and I was no longer working with familiar colleagues I found that I was constantly having to keep my emotions in check, becoming hyper aware of when my excitement made some feel left behind and the need to suppress my frustrations. I was struggling with self-regulation. That’s ADHD.
I saw a trusted colleague. We reviewed my IQ results and she conducted the diagnostic interview with my husband and I. We knew the answer but now I have a piece of paper. But you know what? That was four years ago.
So why come out now?
I dunno. I’ve avoided it so far because I find something of a rescuer complex in people who set up organisations trying to save others from their own struggles. To be fair, when I set up Genius Within I was aware of my mental health past but not my ADHD.
I could say it’s because a very senior role model in the field of neurodiversity has recently confessed ADHD to me, despite being openly dyslexic for many years, having never previously discussed ADHD.
I could say it’s because I want to role model and provide inspiration because ADHD has so much more stigma than Dyslexia and Autism; many still think it’s made up and more so than the others (at least people have heard of it though, unlike dyspraxia).
I could say that some clients with Tourette Syndrome (which overlaps with ADHD for around 60% of people9) have touched my heart recently and I want to remind them not to gloss over the ADHD aspect of their complexity as well as the obvious tics.
I could say it’s because I can see the signs and symptoms in one of my children, and I’m getting my excuse in early for his soon-to-be tumultuous adolescence.
- Krain AL, Castellanos FX. Brain development and ADHD. Clin Psychol Rev. 2006;26(4):433-444. doi:10.1016/j.cpr.2006.01.005.
- Schwartz A. ADHD Nation: Children, Doctors, Big Pharma and the Making of an American Epidemic. New York, NY: Scribner; 2016.
- Armstrong T. The Power of Neurodiversity. Cambridge, MA: De Capo; 2010.
- Hechtman L, Swanson JM, Sibley MH, et al. Functional adult outcomes 16 years after childhood diagnosis of attention deficit disorder: MTA results. J Am Acad Child andAdolescent Psychiatry. 2016;55(11):945-952.
- Matza LS, Paramore C, Prasad M. A review of the economic burden of ADHD. Cost Eff Resour Alloc. 2005;3:5. doi:10.1186/1478-7547-3-5.
- Seidman LJ. Neuropsychological functioning in people with ADHD across the lifespan. Clin Psychol Rev. 2006;26(4):466-485. doi:10.1016/j.cpr.2006.01.004.
- Edwin MF. Adult ADHD outcome audit based on NICE guidelines. Adv Ment Heal Intellect Disabil. 2014;8(5):331-337. doi:10.1108/AMHID-08-2013-0054.
- Quinn PO. Treating adolescent girls and women with ADHD: Gender-specific issues. J Clin Psychol. 2005;61(5):579-587. doi:10.1002/jclp.20121.
- Robertson MM. Attention deficit hyperactivity disorder, tics and Tourette’s syndrome: the relationship and treatment implications. A commentary. Eur Child Adolesc Psychiatry. 2006;15(1):1-11. doi:10.1007/s00787-006-0505-z.