Later in life ADHD / Neurodivergent Diagnosis
Its Dyslexia Awareness week 3-9 October with a theme of ‘Breaking Through Barriers’. Its Dyspraxia Awareness week 9-15 October so I going to blog about ADHD. Well actually about later in life diagnosis for a neurodivergent condition through lens of ADHD. While the specifics might be ADHD the broad strokes apply for other presentations of neurodiversity. Like much of my writing this might be long and rambling with several scenic detours so grab a brew.
I was recently diagnosed with ADHD. Its hardly surprising. From Professor Kirbys research the fact I have a diagnosis for one presentation of neurodiversity means I am statistically quite likely to get a diagnosis for a second neurodiversity. From those that know me, especially out of work where I can be myself more, my vast collection of hobbies, my constant interrupting, my forgetfulness, see sawing between ninja level procrastination and intense productive bouts of work are all tell tails. The fact that it took over a year from deciding to get an assessment to getting a diagnosis should have given me time to come to terms with it. But it still hit me hard. This blog will share that journey and also highlight where you can get help and support if you are considering getting a diagnosis.
Last spring (2021) I was having a tough time. I felt like I was struggling to perform at my best. I was not concentrating at work and not sleeping at night. I spotted that I was in a feedback loop. A vicious cycle. I wasn’t sleeping because I was thinking about work. I wasn’t on my A game at work because I was tired. So I wasn’t sleeping because I was worried I wasn’t doing my best. So the cycle deepened. I decided I needed help.
Problems concentrating, distractibility, challenges effectively prioritising work are all problems with executive function. Executive function is like the exec assistant in your brain keeping you on track. Pepper Potts for Tony Stark. Executive function is a common dyslexic deficit. I was diagnosed as dyslexic and dyspaxic aged about 20 in university. So I reached out to an ND professional.
They went through some strategies for executive function. Many of which I teach on my Personal Productivity for ND Folks workshop. I had a gap, a chasm, between knowing what I should do and actually being able to do it. I was told I had a number of ADHD traits that might be worth exploring. They also recommend I counselling to manage my anxiety. That hit me hard to. I know I have my emotional and mental ups and downs but anxiety felt so clinical.
After 6 sessions of counselling I was in a much better place. In the final session the counsellor helped me form an action plan of next steps. This was when I decided I wanted to pursue an ADHD assessment. Knowing if I was ADHD would impact my route back to my best self. Counselling and coaching for ADHD people is different. Cognitive behavioural Therapy for ADHD people is different from normal CBT.The route to (an NHS funded) ADHD diagnosis is through your GP. With the Right to Choose legislation you can be referred to a provider of your choice to minimise waiting times. I’ll blog more about this on another occasion.
It took me 3 months to book a GP appointment. That is to say it took me 3 months to pick up the phone. Part of this is because my procrastination skill set is next level. Part of this is because, like many ND folks, I hate the phone. But if I am really honest part of it was because this would set me on a path to opening Schrodinger’s box. It would lead to an assessment that would determine if I had ADHD or not.
What if I didn’t have ADHD? What if I’m just an odd balance of lazy with sporadic bursts of productivity? What if… Thoughts raced through my head but I eventually made the call and got an appointment and I got a referral.
During this time buoyed up by some executive coaching (another item on my post counselling to do lisy) I also decided to apply for a promotion at work. So I had a lot on my mind as the pre-assessment forms landed. For my Dyslexia/Dyspraxia assessment the format was no prep work and just a 4 hour session where I had to perform a number of tasks to assess my skills with verbal reasoning, visual reasoning, sequencing, memory, etc. The ADHD assessment has prep work to do. Oh how I love filling in forms. These forms involve describing childhood and adult experiences of things aligned to the diagnostic manual. It’s a bit like a job interview question – can you tell me about a time when you acted impulsively. At times it felt like the route to getting an ADHD diagnosis was design to be as ADHD unfriendly as possible.
I had a pretty normal childhood. Actually counting my privileges I had a good childhood: white, male, middle class ish, no trauma. But when you fill in 4 sets of forms about childhood experiences about not paying close attention, difficulty listening, following through on instructions, fidgeting, etc you start to wonder about why it wasn’t spotted sooner. About what could have been if it was spotted sooner. All while looking at Schrodinger’s box – if I was ADHD it would explain a lot, if I wasn’t then what next?
In the book Getting Things Done David Allen talks about open loops. An open loop is something you have started thinking about but not completed or terminated. On a PC is’t all the running tasks if you open task manager. Leading up to the assessment I hit peak open loop. In addition to my day job I was applying for a promotion that was taking longer than expected and had an ADHD assessment looming at some unspecified future date. Many ND folks struggle to cognitively suspend a task and not think about it. If we have an important meeting later our brain enters the get ready for that meeting state and crowds out cognitive bandwidth to do other things. It’s an open loop chewing up processing cycles. I also changed line managers. Fortunately I was changing from one amazing manager to another amazing manager the net result of which is I felt doubly supported.
The assessment was a relaxed affair but it did have its emotional moments. I was reassured to have such an experienced Consultant Psychiatrist because that give me confidence in whatever verdict he would reach. In one example of forgetting and loosing things I described how as a child I would frequently lose my keys. My older sister finished school later than me and my parents both worked full time. When I lost my keys I’d have to sit on the doorstep, sometimes for hours, until my parents or sister returned. I explained how, looking back, I don’t get why the reinforcement of sitting on the doorstep didn’t teach me to not loose my keys. Sitting still is torture for me. He asked why I thought it would. Massive incentive not to lose keys – sitting on the step and getting shouted at. He explained that since I wasn’t intentionally losing keys it wasn’t a decision I was making. My brain is wired such that I forget things and need to have some self-compassion (a phrase a heard a lot in counselling). That was a bit of a tilt moment – why do I beat myself up for stuff I can’t control?
The assessment concluded that I had ADHD. Almost as if to counter my next question he went on to say that even if he discounted behaviours that could be attributed to dyslexia or dyspraxia I’d still meet the DSM-5 criteria for a diagnosis. So quite conclusive. As a child I scored 9/9 for impulsivity and 9/9 for hyperactivity which might explain why I was so often in trouble at school. In work I spend a lot of energy trying not to be impulsive or hyperactive.
After the assessment its back through the Kubler-Ross change curve again. I didn’t have denial (though I did have self doubt as I approached getting medication – what if they don’t work, what if I don’t really have ADHD) but there was lots of frustration, dashes of depression and then some experimentation. From making the initial decision to starting meds its been 12+ months of bouncing around the K-R curve.
As I start my new role (I got the promotion) and I start my ADHD medication I am getting to the decision and integration part of the K-R curve. It’s been a bumpy journey and I’m now wise enough to know its not plain sailing from here. But I am hoping to get back to being the best me, and with the learning I’ve done and the support I’ve had over the past 12+ months that best me is on a new, higher, baseline.
If you are considering an assessment for dyslexia, dyspraxia, autism, ADHD, etc then think about what support you can get to help you along the journey. Speak with your line manager, a mentor, a coach, a friend, a mental health first aider, the twitter ND community. There is a lot of help out there and you don’t have to go through it alone.