Hidden in Plain Sight: A lifetime plus one year with ADHD

Hello there! My name is Keith, and I have ADHD.?

I’m also a Doctor.

Doctors are all very wary of the diagnosis that seems obvious in hindsight.

Huge chunks of our training are dedicated to avoiding this situation, but despite our best efforts, sometimes the simple truth of the situation can be overlooked, misdiagnosed or missed altogether. There’s a few things that contribute to this, including work pressures, burnout, or overfamiliarity. It’s part of the reason we avoid playing the role of doctor to friends and family: our range-finder and critical eye fails to function quite as sharply.

When it comes to oneself, things get even more unclear. Many a physician that has ignored signs or symptoms that would have jumped out at them had they been attached to a patient in the room, but seem innocuous or explicable when personally affected. Again, we are trained to avoid self-diagnosis, and encouraged to register outside our practice for our own care.

What if something affected you your entire life, and you never realised it was unusual? The subjective experience of consciousness is possibly the biggest set of blinkers anyone can wear, as there is almost no way to gain an objective assessment. You rely on others, and hopefully have an open mind when they speak to you. And so it was for me and my ADHD.

When I tell people about my diagnosis at the age of 49, they respond in two main ways. The first is one of sudden clarity:

“Of course you are! You’ve always had a mind like a box of frogs”

or the more common

“So that’s why you never put the dishes away”.

The second type of reaction is one of puzzlement.

“I thought you’ve known that for years?”

I’ve always been restless and inquisitive. At school I was constantly looking for the next thing, fidgeting, getting pulled up for not reading the question, and being asked to quiet down and not disturb everyone else. Yet I was smart and studious, and so it was put down to boisterousness. I cruised through exams on what was probably some natural talent.

When university arrived I was suddenly much more challenged, and found it an immense struggle to read and retain everything I was given. I got through, but I really can’t say I enjoyed the experience. At work I found it frustrating to deal with other people at times because they seemed so slow. I had all the energy in the world to get things started, but that energy vanished when it came to finishing things off.

As my career continued I learned different ways to manage these issues, and gravitated towards roles where it was beneficial to be so driven and creative. Within medicine this is a slightly smaller space, but I did everything I could to find it. In fact, I did far too much of the things I liked, which didn’t quite overlap with the work I was doing. Unsurprisingly this led to burnout when I simply overwhelmed my ability to cope with my seemingly unending list of jobs. (See previous posts for more on that fun excursion into mental illness - [1 ])

As I recovered and settled into my new job at Babylon, I was introduced to a much more positive and diverse work culture. I joined the mental health and wellness group, and became supportive of the neurodiversity community within the company. I learned more about the lived experience of colleagues with Autism and ADHD. I started to hear things that sounded very, very familiar.

Perhaps it was the changing attitudes, knowledge, and awareness of adult ADHD that coincided with these conversations, but all of a sudden ADHD seemed to be everywhere for me. My wife spoke of clients she was seeing who had been diagnosed as adults, and who exhibited behaviours that she found very familiar. I remember Lee Mack, the comedian, talking about how he experienced what others thought of as quick wit as an internal monologue that felt quite slow and obvious and why on earth are they taking so long to answer that question I think I’ll just answer it for them now why are they angry with me?

The real moment of clarity came in summer 2022 when I heard from a work colleague who wanted to thank me for helping them start on their own journey to diagnosis. Thanks to the relentless pace of technology, it’s another first for a platform - in this case Slack. The person in question got in touch saying they had been referred to see a psychiatrist by their private GP, and that they just wanted to say they would never have done it if I hadn’t been as open about my own ADHD.

“…but I don’t have ADHD”, I replied, puzzled.

“What do you mean? It was they way you described yourself that made me realise I had been having the same symptoms, just much less severely”

That’s odd.

In the days after that interaction I thought about things in more depth. I spoke to my wife about whether she thought I might have ADHD. I started to look at things I thought everyone did as being much less common. Surely everyone plays with a Rubik’s cube during zoom meetings to stay focussed? Who doesn’t stand up and walk around the room when the call gets a bit dull? Why would you not want to start reading journals when you get up at 6am at the weekend?

Maybe that isn’t what everyone does though? My wife doesn’t. On reflection, almost no-one I know does it, apart from all of those people with ADHD in the neurodiversity slack group. Hmmm.

I decided to seek some help, but quickly realised that wasn’t going to be easy. Certainly not on the NHS, that is. With local referral waits measured in years I decided to self-fund and see a psychiatrist I knew from my days working as a local GP. Over several appointments and a few diagnostic questionnaires, some of which my mother and I completed over zoom, I worked towards the formal diagnosis of something that was, in retrospect, bloody obvious. I have ADHD.

My doctor offered me a chance to try medication. In my case it was Lisdexamfetamine aka Elvanse, a stimulant that is well understood to have a paradoxical calming effect on those with executive function disorders such as mine. I can still remember that first dose, or at least 45 minutes AFTER that first dose. The volume went down in my head. The conveyor belt of ideas slowed down to a crawl. I started to properly notice what other people were saying and maintain eye contact for more than 10 seconds. I was even able to sit and look out of the window and do….nothing. It was incredible.

Over the past year I’ve titrated up my medication to a dose that suits me, which I take during the week. It keeps me calm and focussed for most of the day, and has converted my work from a scaffold of notes and reminders into a smooth stream of delivery. My wife has noticed an enormous change in me, which persists on the days off. I’m patient, and fizz with less energy. I listen when she speaks. I complete tasks instead of getting half way and starting something else. I can relax.

It’s also helped mend some family issues that had persisted over the years through misunderstandings of why I appeared distracted. There’s still work to be done, and balancing days on and off the medication has been interesting. I have a new appreciation of the wild benefits and costs of having a brain that runs on fast forward most of the time.

I’ve also had to navigate the NHS again. Fortunately, my GP has agreed to participate in shared care, so between him and my psychiatrist I'm jointly managed. The recent drug shortage has been fun, as has running the sceptical gauntlet of some pharmacists as I request a controlled drug. Compared to some others I’ve been very lucky.

This is why I’m so passionate about working with Ai-Ling W , Colin Wright , and the rest of the amazing team at Noetic . My journey to diagnosis was long and troubled at times, and even once I had an idea of what I needed to do, even as a physician, the path was complicated and disjointed. The wider world still has a long way to go to accepting neurodiversity in adults too, judging by how often I’m told that “everyone struggles to focus on things”, and that “everyone would get more done if they were just given some speed”.?

My colleagues at Noetic are working towards changing this attitude, not just for those with ADHD, but across the neurodiversity spectrum. We offer comprehensive screening for a range of neurodivergences, including ADHD, autism, dyslexia, and dyspraxia, and pair this with personalised guidance from clinical experts, neuroscientists, and neurodiversity advocates. We’re also building an active community dedicated to supporting individuals in their careers, relationships, and overall well being.

It’s estimated that 1 in 7 of the population, around 15%, are neurodivergent [2 ]. There is a huge range of impact too, from those very profoundly affected, to others who may function very well without any assistance at all. From mental and physical health, to the workplace and society in general, the neurodivergent have poorer outcomes than the neurotypical.

There’s much that can be done to raise awareness and make supportive changes for all. After all, with diversity there is great strength, as well as the opportunity to improve all of our lives and relationships. I’d say that the need to do things better is obvious, and we need to charter the way forward.

References

1. https://www.sodexoengage.com/blog/reaching-and-recovering-from-burnout/ [Accessed 23 Oct 23]
2. https://adhdaware.org.uk/what-is-adhd/neurodiversity-and-other-conditions/ [Accessed 23 Oct 23]