Late for appointments, missed meetings, burnt offerings for dinner, emotional dysregulation, rejection sensitivity – do these words sound familiar?

Almost every day there is an article, video or some form of imagery on social media in relation to Attention Deficit Hyperactivity Disorder (ADHD). More and more people are realising that their symptoms could be linked to undiagnosed ADHD.  

Adult ADHD was not formally recognised until 1987, when it was included in the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM III). Prior to that, Dr David Woods explored the fact that there was a residual type of ADHD which suggested that ADHD continued through into childhood, rather than magically disappearing. He wrote in a paper for the Psychiatric Annals: 1

“First, the adult must have a history of ADD in childhood as defined by DSM III.

“Second, the adult must have both attention and motor abnormalities plus two of the following five traits: poor impulse control; mood lability; short or excessive temper and/or irritability; poor organisation with poor task completion; and low stress tolerance with over-reactivity.” 

In essence, Dr David Woods was validating that adults can, indeed, have ADHD.  

Between 1980 and 1989 a multitude of research studies were carried out to discover more about this condition. They included: the possible causes, efficacy of medication, the impact of social inequality, diet, overdiagnosis, the biopsychosocial perspective of ADHD and brain functioning with Transcendental Meditation, to name but a few!

Obtaining a late diagnosis can bring on a flurry of emotions:  

“Why was I missed as a child?”

“What do I do now?”

“How do I tell my friends and family – employers even?!”

Some reactions are very different:

“I now know why I found school so challenging.”

“I understand why I struggle to finish projects.”

“At least I know what I’m dealing with!”

There is no right or wrong way to respond to a new diagnosis. It is normal to feel resentful and angry. Some people have felt grief at the years spent previously, struggling without understanding they had ADHD.

Linda was diagnosed with combined ADHD at the age of 46. She was urged to get assessed after family and colleagues were concerned about her inability to bring projects to fruition and her hyperactive tendencies. After completing a short screening test with her GP, he referred her for a full assessment. Her diagnosis occurred two years later, after further tests and a meeting with a psychiatrist, with a further nine months to start the titration process for ADHD medication.

She recalls her secondary school experiences:

“In our school, forty years ago, you never heard ADHD mentioned. I don’t think the teachers even knew what it was. We had a Remedial Unit. That’s where all the kids went who couldn’t learn. Some of them were proper tearaways. Always running out of class, bunking off or disrupting the class.” 

She goes on to describe how her ADHD portrayed in school: 

“I loved school. I’d have gone at weekends if it was open. I flourished in the regimen of the structured day. I struggled, socially, though. I didn’t make friends easily and was considered ‘quirky.’ I wasn’t accepted by my female peers and spent the majority of my time in the library. I preferred the company of older people so being the youngest in my family really helped.”

Treatments for ADHD vary. The National Institute for Health and Care Excellence (NICE) 2  guidelines recommend that, as well as supporting medication as the first-line treatment for ADHD in adults:

“…the treatment may include elements of or a full programme of CBT and should include a structured, supportive, psychological intervention focused on ADHD, with regular follow-up and information.”

A multi-modal approach to treating ADHD may help a newly-diagnosed adult understand the challenges that accompany their diagnosis, but it can have further reach. Gaining insight into ADHD is essential for someone on their ADHD journey, but it is just as important for their family, friends and colleagues.

The Royal College of Psychiatrists 3 (RCP) provides some advice on how you can help manage your ADHD symptoms:

  • You may find it hard to organise things so that you get things done you really need to.
  • Make lists, keep diaries, stick up reminders, and set aside some time to plan what you need to do.
  • Find ways of letting off steam, like exercise, dance, sport
  • Find ways of relaxing – like music or relaxation techniques.
  • Set yourself realistic goals.
  • Remind yourself about the things you can do well.
  • Avoid things that make life more difficult. These could be arguments with other people, using drugs and alcohol, and pressure at work.
  • Don’t spend time with people who encourage you to drink too much or use drugs, or who create stressful situations.

Upon her own diagnosis, Linda took it upon herself to discover as much as she could about the ADHD brain:

“I attended conferences on ADHD, listened to podcasts and joined forums as well as a support group, near where I live. They’ve all played a part in helping me come to terms with how my brain works. I have been able to explain to my family what does and doesn’t help me and they’ve been so supportive. Since starting ADHD medication it’s been like wearing a brand-new pair of glasses. I’m more focused, productive and happier. I feel validated.”

Unanswered questions, relating to your past, may be forgiven upon a late ADHD diagnosis. Appreciating the earlier challenges, faced at a time when ADHD may not have been understood or acknowledged, is testament to the resilient nature of people affected by ADHD.  

References:

1 https://psycnet.apa.org/record/1987-16145-001

2 https://www.nice.org.uk/guidance/ng87/chapter/Recommendations#medication

3 https://www.rcpsych.ac.uk/mental-health/problems-disorders/adhd-in-adults

Written by Beverley Nolker, Education Development Officer for Psychiatry-UK and the HLP.U Clinics.