How I Came To Understand My Adult ADHD
For the most part, my childhood was a lucky series of happenstances that conspired to preclude a timely attention-deficit/hyperactivity disorder (ADHD) diagnosis.
I demonstrated early reading ability (thanks, mom!); had outstanding public school teachers uninterested in teaching to the test, who encouraged rather than stifled activity and creativity; developed athletic ability at age five; and was interested in creative pastimes like creating my own imaginary world in the backyard and making my own audiobooks with a cassette recorder. I was performing well by all measurable standards, so some now obvious symptoms were ignored by the adults in my life. By the time I turned 19, I was convinced I could achieve any academic goal. That made “hitting a wall,” the phrase I used at the time, during my sophomore year of college with a midterm GPA that would have cost me my scholarship a shock that led to a 15-year self-blame spiral.
It would take well into my 30s to realize I wasn’t experiencing a failure in willpower. I had unknowingly set myself up with a perfect storm of ADHD-nightmare classes, and my neurobiology was finally catching up to me. According to the doctors I have now, I simply had been outsmarting my disorder. My brain is a mixed bag of privileges and challenges, and I needed to crash and burn a few more times, and experience another series of lucky happenstances, to understand how much of what I was feeling physically, mentally, and emotionally was due to my missed diagnosis.
I’d always felt a lot like Alice making her way through Wonderland. I intuitively read the rules of my surroundings and was highly adaptable, and I never seemed to quite fit in anywhere. Discovering alcohol after I hit the wall in sophomore year and couldn’t get things done — basic things, complicated things, important things, mundane things — was a revelation, and I became Alice completely; I now required substances to become bigger (caffeine) or smaller (alcohol or pot or some combination of the two) to blend in with the size, or speed,of my surroundings. Then I started working in bars, the only job I could find during the hours I wasn’t already at an existing job, and the alcohol was free and handed to me to no end. We were expected to drink, and so why wouldn’t we? It instantaneously became the way I self-medicated, trying to placate the feeling that I was constantly coming apart at the seams, like a doll haphazardly stitched together that’s being pulled in multiple directions at once. Some days I even felt like my stuffing was falling out, unable to do much besides put one foot in front of the other.
I finally woke up out of necessity in 2011, following what easily should have been a fatal bender, and I was relatively stable from an outsider’s perspective. I had two decent jobs and only worked between 50 and 60 hours a week. I could afford the one-bedroom condo I rented and had paid off my credit cards as well as my car. I was also utterly miserable. I moved halfway across the country in October 2012, then again in April 2013. As I was chasing down a career, or job, I could perform without picturing the doll metaphor, I landed in Brooklyn and found myself at a friend’s book signing in May 2013. I went to support her, but it would be her helping me out.
“Is it weird that I want coffee right now?” I said to my doctor-friend as we sat down. A few of us had gone out after the book signing ended at 7:30 p.m.
“Will you be able to sleep later?” she said, casually perusing the menu.
“Oh, yeah. Caffeine doesn’t affect me that way; my sleep issues aren’t coffee-related.”
She began to subtly doctor me the way some moms can subtly mother you, giving advice without seeming imposing or preachy.
“How does coffee affect you?”
I paused. I’d never had to describe it. I hadn’t considered that coffee, or anything, really, might affect me differently than it did other people.
“I guess, mostly, it tones down the white noise in my head,” I said.
“Hmmmm,” she responded. “How many cups of coffee would you say you drink in a day?”
At this point I’d caught the doctoring, but I trusted her not to be unnecessarily intrusive or shame me about my survival strategies. I wanted to know what she was thinking, so I answered her questions. I drank six to eight cups of coffee a day, all I could get down before I had to leave for my dog walking job. I’d done well in school, graduating with a 4.3 on a 4.0 GPA scale thanks to honors and advanced placement classes. I added that I did hit a wall in college, but still graduated with two degrees in four and a half years, both with A-averages while working full time.
When she asked what classes I was taking when I hit the wall, my response elicited deeper murmurs and a knowing nod. French, statistics, and anatomy all required extreme memorization and almost no information synthesis or analysis. And memorization requires serious concentration, a kind I’d never had to perform at this level.
“Get screened for ADHD,” she recommended. “I hit a similar wall in medical school and the diagnosis was life changing.”
I didn’t understand how my mom, a paraprofessional in an elementary school learning disabilities class for two decades who was charged with testing kids for these conditions and said she had ADHD herself, could have missed it. I’d assumed I was the opposite of ADHD because I required rather than hated background activity to get things done. Turns out, that’s how ADHD works. As Susan Tschudi, marriage and family therapist and author of Loving Someone with Attention Deficit Disorder, would explain to me two and a half years later for my article “Is ADHD Hurting My Dating Life?” ADHD is basically an allergy to boredom. My brain requires a minimum level of activity to function comfortably. Since my mom described her challenge as the inverse of this, I’d never explored it as an explanation for my challenges.
When I asked how this was possible, my doctor-friend hit the nail on the head without looking up from her menu: “You were performing well, so no one asked you how you felt.”
While it is true that my friend knew me fairly well, there are many ways that ADHD presents and so these myriad symptoms can be easily missed in various people. But my friend wouldn’t have to know that much to hit that mark. Discomfort is a serious issue with undiagnosed ADHD kids and adults as we try and conform to neurotypical culture and its requirements.
I spoke with Tschudi about the discomfort and whether my experience is typical. “If you escape childhood and you get to adulthood [without a diagnosis] and then it’s catching up — like you said, you can’t run from it anymore,” she explained, “then you suffer a lot of anxiety and a lot of depression. And so you go to a therapist or a doctor and say ‘I’m depressed’ or ‘I’m anxious,’ and that’s all they see.”
Most of us who end up being diagnosed with ADHD in adulthood, or misdiagnosed with anxiety or depression, complain as I did about coming apart when trying to start or complete certain tasks. We deal with it for years or decades and hit some sort of breaking point where we ask for help for the symptoms, not realizing their source.
As Tschudi explained in our interview, there are only a few diagnostic criteria for ADHD in the Diagnostic and Statistical Manual of Mental Disorders (DSM) — the book containing the “diagnostic classification, the diagnostic criteria sets, and the descriptive text” for every recognized disorder. And they’re all geared toward children. That means the disease is often misdiagnosed in adults.
“Not a lot of therapists really understand it for adults, so they miss those words or phrases that, for me, I pick up on because I know so much about it,” she told me. “Because usually the symptoms show up pretty early on [in life] in one way or another,” said Tschudi, “anxiety creeps in very early and it just becomes a way of life. And then the depression too.”
After living with the symptoms for so long, people with undiagnosed (and sometimes diagnosed) ADHD adopt a fatalism about what they often see as their habits and failings, not realizing that they’re in the roughly 4% of the adult population — or one of 8 million people — who has a powerful neurobiological condition that affects executive brain function.
“It’s a neurobiological condition that is thought to affect certain neurotransmitters in our brain,” said Tschudi. “These neurotransmitters run through our brain. This is like a Disneyland explanation, like electric circuitry. These neurotransmitters go through little relay stations and they sit in the relay stations until they get passed on to the next relay station.”
She explained that it’s thought that people with ADHD have poorly regulated norepinephrine. Essentially, there aren’t sufficient resources for the brain to “address the skills known as executive functioning skills — [tasks] such as organization, planning, prioritizing, activating for starting something, finishing through.”
Tschudi debunked several of the inaccurate causes our culture believes contribute to the development of ADHD: bad parenting, too much television, video games, diet. “It’s not too much red dye in your food,” she said as we both rolled our eyes.
“In essence, it’s not anything that’s created; it is neurobiological,” she said. “It’s highly genetic, so chances are nine times out of ten, if someone has that diagnosis it’s because someone in the family somewhere has it also and it just gets passed on.”
Even though I was diagnosed on the record almost two years ago — after the passage of the Affordable Care Act (#ThanksObama) and a move to California put basic mental health care within reach — I still have a lot to learn about how ADHD affects me. Even with treatment, I have definite rough days, and I’m dealing with decades of negative self-talk as well as comments from others.
I still sometimes think ADHD tendencies of mine are personality defects or a lack of willpower because I haven’t finished sourcing them properly. Until I began researching for this series I had never attributed my impulsivity or fluctuating interest in certain tasks to my ADHD. Because understanding our tendencies and where they come from are an important part of alleviating the kind of self-blame that can prevent us from moving forward with tasks, relationships, and goals, I was excited to explore more and shed some light on a poorly understood disorder that affects millions of people — many without their realizing it.
Like others with ADHD, I struggle with co-occurring disorders, spent years self-medicating symptoms, and worried I wouldn’t be believed when I finally was able to seek care. I’ve also had to carve out a space for myself where I can flourish in my career and personal life. In the next installment, I’ll explore more of what the symptoms look like and why we self-medicate, as well as what you can — and should — expect from a medical professional when seeking an evaluation.
Adults often have to be their own expert initially to find the right doctor. I hope that this series makes that process less stressful, reduces self-blame for those who have yet to get an accurate diagnosis, and helps provide the loved ones of adults with ADHD a window into what goes on in our heads. My advice, of course, isn’t medical advice and can’t substitute for a doctor’s evaluation; I merely want to empower people to advocate on their own behalf. I was lucky enough to have a friend do that for me, and it changed my life. It seems only right that I do the same for others.