How ADHD Has Affected My Life, Nursing Studies and Career
Until now, I hadn’t given much thought to writing about what it’s like to live with Attention Deficit Hyperactivity Disorder (ADHD). It’s something that has always been a part of me, even before I received a diagnosis. I was born in 1973 with congenital hypothyroidism, which was not detected until I was about seven months old at a Well Baby Clinic. The impact of my inactive thyroid function on neurodevelopment in relation to ADHD, before medication was started, is still of idle curiosity to me.
“Abnormal thyroid function can have a range of behavioral effects, ranging from severe neuropsychological deficits in children with congenital hypothyroidism [2], hyperactivity associated with hyperthyroidism, and impaired concentration arising from hypothyroidism. The etiology of primary ADHD is yet unknown.” [Newborn thyroxine levels and childhood ADHD , Clin Biochem. 2002 March ; 35(2): 131–136.]
I underwent educational assessments from grades 3 to 5 (1981–83) at Memorial University of Newfoundland. These assessments were conducted due to my tendencies to be easily distracted, having a short attention span, and struggling with completing classroom work. Follow-up assessments were also carried out in grades 4 and 5.
The report summary concluded that during the initial two assessments, I exhibited a developmental delay in motor skills. However, by grade 5, I had largely caught up to my peers in this area. Throughout all three assessments, it was noted that I had difficulties with motor speed and production, as well as a somewhat short attention span.
According to my parents, both during my formative years (and to this day, to be honest), they have observed that I can become fully absorbed in activities that interest me, such as reading, story writing, cross-stitching, and other hobbies. However, they have also noticed that I show little interest when I am required to do things that do not capture my attention. In these situations, they say that I have a “short attention span,” do not listen carefully to instructions, and am easily distracted. Distraction and frustration also arise when I have to work under pressure. (They are correct on all counts).
Skipping ahead several years, when I was 26 years old and in my third year of Nursing School, I encountered difficulties with clinical rotations. The increased level of responsibility and attention to detail posed challenges for me. In 1999, I sought assessment at the University of New Brunswick’s Learning Centre. I specifically struggled in the following areas:
- Difficulty being concise, clear, and fluent during oral briefings in clinical and when expressing myself orally in class
- Lack of speed and fluency on physical tasks in clinical
- Lack of organization in thinking and writing when under pressure for “on the spot” performance when I do not have time to proof my work and use a word processor.
- Short attention span.
I failed my clinical rotation that year and had to repeat it. During that time, I focused on improving my clinical motor skills by working with IV bags, tubing, syringes, and other equipment in the Skills Laboratory. Additionally, I worked with case studies to enhance my clinical decision-making abilities.
There were multiple tests the Learning Centre used to assess my abilities. They include:
- Kaufman Brief Intelligence Test
- Wide Range Assessment of Memory and Learning Developmental Test of Visual-Motor Integration
- Rey’s Complex Figure
- Visual Search and Attention Test (VSAT) — [A Compendium of Neuropsychological Tests: Administration, Norms, and Commentary
- Amen’s General Adult ADD Symptom Checklist (Updated since original assessment done)
- Wide Range Achievement Test — Revision 3
- Peabody Picture Vocabulary Test — Third Edition
- Oral and Written Language Scales
- Test of Written Language — 2
- Detroit Test of Learning and Aptitude — 2 (Oral Directions subtest) [DTLA-5 is the current edition]
- Wechsler Adult Intelligence Scale — Revised
The assessor noted, “Lynn also completed a self-report measure for attention deficit disorder, Amen’s General Adult ADD Symptom Checklist. Lynn’s score on this measure indicates a tendency towards predominantly inattentive type of ADD. She experiences difficulties in the following areas: erratic attention span, easy distractibility, daydreaming, disorganization, impulsive speech in social situations, and difficulty with sustained attention.”
I perform well in academic written assignments when I can organize my thoughts and write or type them out. I find it especially helpful to revise and proofread my work. However, I struggle with less structured writing or speaking, which continues to be a challenge for me. Additionally, I sometimes have difficulty paying attention to oral directions, especially if they are not interesting to me. To cope with this, I have developed cheat-sheets and routines for specific tasks at work. The assessors also noticed other signs of attention deficit disorder (ADD) with the inattentive subtype, such as impulsive speaking, disorganization, daydreaming, and being easily distracted.
At the time, it was determined that I didn’t need pharmacological assistance because I had developed workarounds and methods for skills and continued learning over the years. Looking back now at the age of fifty, and having only been medicated for the past two years, I feel that I would have benefited from such help earlier. It could have helped me focus my thoughts not only for work but also in my personal life.
I ended up leaving the Bachelor of Nursing Program in my final year due to the overwhelming stress of meeting all the program requirements. Instead, I applied my knowledge and information from my university nursing courses and clinical rotations to the community college’s Practical Nurse program, which was a two-year program. Due to my previous studies and clinical practice, I completed it in a shorter period and received an Honours Certificate. In January 2004, I wrote and passed the national exam for Licensed Practical Nurses.
During my twenty-two years of nursing experience (two years as a student and the rest as a Licensed Practical Nurse in geriatric long-term care), I have continuously improved my clinical planning, documentation, medication delivery, skills, and routine tasks. However, I still occasionally face challenges with time management when I’m distracted, such as when attending to residents who require extra attention due to falls, illnesses, palliative care, or behavioral changes. These situations can disrupt an otherwise routine set of tasks.
Regarding the issue of using medication to help with my ADHD, a few years ago I visited my Nurse Practitioner. I was experiencing significant challenges with my executive functioning due to the constant work changes caused by the COVID pandemic, as well as worsening symptoms of perimenopause. My attention levels were even more scattered, and my mood and sleep were consistently disrupted. Although these issues still persist, they are somewhat alleviated with the medication. However, I may need to discuss adjusting the dosage of my ADHD medication with my Nurse Practitioner during my next appointment, as Hormone Replacement Therapy (HRT) is not a viable option for personal health reasons.
Occasionally, I still have grand ideas about things I would like to do. However, I often struggle with follow-through, whether it’s due to procrastination, lack of funding, or the inability to take time off work for educational courses that could enhance my skills. Since I work full-time nights, finding coverage for a night shift can be challenging. In fact, I have been denied permission to attend a course in the past because my shifts couldn’t be covered.
In recent years, I have been exploring strategies to better manage my ADHD symptoms and improve my overall well-being. This includes implementing a structured daily routine, utilizing organizational tools such as calendars and to-do lists, and finding ways such as exercise and relaxing to enhance focus and reduce stress. Additionally, I have found support and online communities to be valuable resources such as ADDitude Magazine, CHAAD (Children and Adults with ADHD) , Medium neurodiversity writers for sharing experiences and learning from others who also live with ADHD.
