Since my previous post on ADHD, Life During Lockdown, several folk have asked me how I got my diagnosis. It’s a fairly complex answer, so I wrote another piece specifically about that. Hopefully what’s below might answer some of those questions, but there’s plenty online help too if you need it.
What Has Been Causing My Depression All These Years?
In short, I’ve suffered from bouts of depression for most of my adult life and it was looking for the root cause of this that finally led me to consider ADHD as a possibility.
Over the years I’ve attended cognitive behavioural therapy (CBT) and mindfulness sessions with a psychiatrist. These treatments were for depression (used in conjunction with anti-depressant medication) and helped provide me with a new set of ‘thinking’ tools. They also gave me a degree of stability and calm so I could deal with the day-to-day issues I’d been having. But 2 decades down the line I felt that none of this had properly addressed or even identified the real underlying problem: why is every single thing such a bloody struggle?!
Could it be … ADHD?
It was a friend who suggested I might have ADHD. I hadn’t considered it a serious option before, despite several other’s having made ADHD jokes about my frequent scrapes and misadventures over the years. I did a bit of googling and was surprised by how much of what I read seemed to fit my own life experiences, past and present. It was uncanny!
For example, did you know that folk with ADHD are twice as likely to suffer an accidental death? Most people seem to find it quite easy to cross the road without coming to harm. Alas, not I. I’ve wrestled with cars on 3 occasions and lost each time, twice ending up in hospital for long stays. Yes, I’m very accident prone and rather inattentive.
Or maybe I am just stupid?
It’s almost inevitable that being told ‘… you’re just lazy/hopeless/stupid/underachieving … and you never listen!’ constantly as a child will lead to low self esteem and depression in adulthood. Over time, these impressions (whether external or internal) can take root and become core beliefs, going on to direct not only how you feel and think about yourself, but also how you live your life in general.
But I knew I wasn’t lazy. I can work ’til I drop when I like what I’m doing. I’m often plagued by a feeling of underachievement though, and in spite of all the effort I put into my work and everything else I never seem to get much done. Yes, I procrastinate a lot and find it hard to finish things I start, but doesn’t everyone? Maybe I’m a perfectionist or do I just fear failure? I drift off a lot during lessons, films or conversations and no matter how hard I try I just can’t do small talk. What is that anyway? Sorry, what’s your name again? Bloody hell, where have I/you left my keys, wallet, phone, camera, car, kids, etc etc ……?
When I was at school ADHD wasn’t yet a thing, so my constant day dreaming, fidgeting and general restlessness began to attract the wrong kind of attention. From about 8 onwards I’d be getting the belt almost daily. Eventually it stopped hurting and became part of my comedy routine. Something else to make folk laugh and pass the time. Me and the other ‘bad’ kids would even compete to see who could achieve the most lashes in a day. This was much more stimulating than lessons, with even some teachers appearing to enjoy their part in it (not naming any names).
At secondary I was sent to remedial classes, on the pretext that it would improve my ‘awful’ spelling and writing. Again, this was really just another form of punishment, by humiliation (the belt having recently been banned). My spelling really wasn’t too bad and I eventually got a degree and a job as an editor.
Looking back I was obviously being disruptive at school, but all of that could have been prevented if only we knew then what we know now about ADHD. But for me being at school for 11 years was like serving a jail sentence. The day I turned 16 I walked out for the last time, having failed on every level. And so it went on …
What are the Symptoms of ADHD?
Having a list of typical ADHD symptoms has been handy to help assess myself against. Here’s one complied by the Mayo Clinic and these symptoms can range in number and from mild to severe in any given case (other lists are available):
- Disorganisation and problems prioritising
- Poor time management skills
- Problems focusing on a task
- Trouble multitasking
- Excessive activity or restlessness
- Poor planning
- Low frustration tolerance
- Frequent mood swings
- Problems following through and completing tasks
- Hot temper
- Trouble coping with stress
All of this seemed very familiar to me and, importantly, to the people who know me best. It was pretty much unanimous: you must have ADHD!
Getting A Psychiatric Referral
But a positive diagnosis can only be made when several of these symptoms are a constant factor, you’re clinically distressed by this and they have a significant impact on how you function in everyday life. So I went to the GP and described my thoughts as outlined above. I also discussed how I felt maybe having undiagnosed ADHD could explain the depression. The doctor asked some fairly standard health questions then we talked about my history of depression and medication, childhood behaviour, schooling etc. He concluded we should get a specialist opinion and made the appropriate referral.
A few months later I was invited to attend 2 hour-long appointments with a behavioural psychologist. I imagine his job was to sieve out possible speed freaks (free stimulants … yay!!); or those with other mental-health issues, before passing the more likely candidates on to a psychiatrist. He asked similar but more probing questions about my childhood and whether I had any school reports that might back up what I told him. I did have a few that showed I wasn’t exactly attentive in class or achieving what teachers thought I was capable of: could do better/daydreamer/disruptive/easily distracted and so on.
At the 2nd appointment I mentioned my dad has also suffered from clinical depression, and that he’s similarly super fidgety, forgetful and restless. Overall he felt the case was pretty strong, so referred me on to the man I now thank for changing my life so much for the better, Dr Pipireddy. (I know this might sound over dramatic, but that’s exactly how it feels to me.)
A Few Basic Facts First
ADHD is real. It’s caused by an imbalance/disfunction of neurotransmitters in the brain. In most cases (75%+) it’s genetic, so you have it from birth. Other factors can contribute to how badly it affects you (smoking or use of certain prescribed drugs during pregnancy is thought to be one possible factor). But for the remaining minority it can be caused by a head injury or premature birth. And while some children are able to cope with symptoms at school and remain ‘under the radar’, it can sometimes be in adulthood that ADHD really begins to manifest. This is when the stresses of grown-up responsibilities, serious relationships and work come into play.
In the Psychiatrist’s chair
Only a qualified psychiatrist can give an ADHD diagnosis and the process is quite involved. At the 1st session I was initially asked fairly open questions about my life experience and behaviour patterns in various situations. There were no leading questions or any ‘helpful’ information given at this point. And, while I knew a bit about the symptoms and how familiar they seemed to me, I suddenly felt overwhelmed in attempting to provide specific examples to illustrate my concerns.
The hyperactive-brain aspect of ADHD has been brilliantly described as like having 30 tv channels going on at once inside your head, but someone else has the remote. And that’s exactly how this felt!
He was patient though and waited for my thoughts to become clearer. He asked how old I was when these issues began (7 or 8) and about my time at school, my experience in relationships (with parents, partners, friends and colleagues etc). Also about my working and other habits. I was given a pile of questionnaires for me, my parents and partner to complete with about 60 ‘on a scale of 1-5’ type evaluation questions on each form. All this in relation to both the past and present. He finally asked if I could bring someone who knew me well to the next session, so I brought my partner to that.
The others had filled in their questionnaires straight away. I’d done mine on the morning of my next appointment. Of course, I realised I’d left them all lying on the kitchen table as soon as we entered the consulting room. Not a great start to the session but probably another tick in the ADHD symptoms box.
So minus completed questionnaires the doctor spoke exclusively to my partner, which was very revealing but also uncomfortable at times – for me and her. He asked probing and personal questions about my behaviour in various settings and circumstances. “What’s he like on holiday?” proved particularly fruitful! I think along with the questionnaires that this was the most valuable part of the process in helping to diagnose me. It also gave me much food for thought and a lot to work on.
I had a final session where I was positively diagnosed with ADHD. He’s since told me it was a clear cut case, and this is backed up by the positive effects of the medication I’m now taking. There’s no talking therapy available for adults on the NHS, but there are lots of very useful websites, books and Youtube video resources out there. So self study and an effort to address some thought and behavioural patterns would form part of my treatment. We discussed the merits of medication and the possible side effects. I decided to give it a go. Initially an 18mg dose of Concerta XL (a slow release form of Ritalin that lasts 12 hours). I described how well the meds have worked for me in the last post.
The whole process has been truly transformative. I went back for review after a month and we decided to double the dosage, which is probably the right level for me (although this will be reviewed monthly for a year or so).
Along with the meds, learning more about ADHD (see below for some excellent Youtube videos) and just knowing it has been the real issue all along has been a huge factor in my moving forward positively.
Medication is not a panacea for all ADHD symptoms, but it’s helping me to to focus on tasks and to think with a clear and calm mind like I never knew possible. I haven’t suffered any side effects and each morning I awake feeling refreshed and ready for the day ahead. And that’s before taking a pill! I’m also much more productive now and in so many different (and finally organised) ways.
And finally …
It’s thought around 5% of children are born with ADHD, 50% of whom go on to have it as adults. So chances are you know at least 1 or 2 folk who might benefit from a diagnosis if they haven’t already had one. I’d personally hate to think of people struggling along with this, not knowing that there’s possibly life-changing help to be had.
Please feel free to get in touch if you want to ask about anything I’ve mentioned. Here’s a link to a helpful Additude magazine article on ADHD diagnosis.
These videos are all well worth watching, even if none of the above applies to you. It might to someone you know …