My silent struggle and quiet crisis with adult ADHD

I once joked with a friend, “I have the opposite of ADHD (attention-deficit/hyperactivity disorder). I have Over-Ambition Disorder. I’m blessed/cursed with too many exciting ideas. I can’t finish one project before having another idea to work on.” She politely informed me, “You realize that is just ADHD, right?”

My only interactions with people with ADHD had been classmates who got bad grades, didn’t listen to the teacher’s instructions, and disrupted everyone else’s learning. That wasn’t me. I was a straight-A student, beloved by teachers, and always a first pick for group projects.

Imagine my surprise when my therapist referred me for an ADHD evaluation at age 38. I had sought treatment for anxiety. The pandemic reactivated my illness anxiety (formerly known as hypochondria). Putin’s invasion of Ukraina caused me to ruminate on the possibility of WW3. Five years of professional dissatisfaction pushed me to the edge of burnout. And yet, after talking through these timely concerns, my therapist identified a potential underlying source of anxiety. An official diagnosis of ADHD validated her suspicion a year later.

Gifted &
Talented &
Neurodivergent &
Irony1

The first time I remember feeling proud of myself was in first grade. The school librarian allowed me to check out an extra book each week and gave me access to the “big kid” book stacks. Hooked on Phonics really had worked for me. I learned to read at 4 years old and books held the answers my insatiable curiosity craved.

My middle school placed me in a gifted and talented program. Teachers nerd herded the intellectually advanced kids into a special class when the other students enjoyed their free play day in gym class. I missed being outside with my friends on those days, but I also enjoyed working on the long-running science projects and the exclusive attention of adults made me feel special.

By high school, advanced academic classes replaced the stimulating, experiential learning program. Keeping one’s special status required maintaining a perfect grade point average, scoring well above average on standardized tests, and leading activities appealing to university admissions reviewers. The coursework challenged me and consumed my daily routine. I pushed myself hard because adults had determined my intellectual ability to be capable of enduring it. The gifted and talented program validated perfectionism, fostered all-or-nothing thinking, anchored self-worth on achievements, and normalized anxiety.

In one way, the gifted and talented program worked. I got into university on a half-tuition academic scholarship. In every other way, the program failed me and kids like me. The most common sentiment I hear about gifted and talented programs from people my age is the psychological damage they caused. The anecdata correlation is strong between gifted kids and adults with ADHD and/or anxiety disorders.

Examining the values ingrained on my developing brain and unlearning related habits took years of therapy as an adult. I don’t know how schools should accommodate intellectually precocious kids, but I know the program I experienced did more harm than good. Perhaps the best action for kids identified as gifted would be to get them into therapy early on.

Twice exceptional

When I received my ADHD diagnosis, I also learned I had a high IQ.2 The psychologist explained I was “twice exceptional” (2e). This might sound like a humblebrag. It is not. I am both intellectually gifted and learning disabled.

It felt like, “Congrats! You’re smarter than the average bear, but your brain’s executive function is shit. Enjoy lifelong irony!”

Psychologists only first researched this combination in the 1990s3, when I was in elementary school. I forgive my well-intentioned teachers for missing the signs. Humanity was only just then learning there were signs to be missed.

My intellectual ability hid my struggles. I kept up with other students in the advanced academic classes by brute-force willpower. When I struggled, teachers told me to try harder. Fear of their rejection because of my personal failure motivated me. I met expectations by sacrificing my free time and general wellbeing.

Masking is a learned behavior to compensate for ADHD symptoms in response to external expectations. These coping mechanisms help people with ADHD survive, but fail to address the underlying cause. Many 2e ADHD kids are exceptional at masking, making them even more difficult to detect.

ADHD is a lifelong condition. My psychologist spent much time investigating aspects of my childhood. At the time, I felt this minimized my present-day struggles. However, discovering the ADHD symptoms of my childhood helped me connect beliefs and behaviors hindering me as an adult.

Here are some of the neuroatypical signs the adults of my childhood should have noticed and investigated:

  • Stimming. Self-stimulatory behavior such as popping my joints, bouncing my knees or wiggling my ankles when sitting, and teeth-grinding are my form of physical hyperactivity. These were not disruptive to a class, but were irritating to adults sitting beside me. I got teased as Jermy-squirmy.
  • Clumsiness. My balance is below average and I bump into things often. Up to half of kids with ADHD have motor control problems. Gumby was a disparaging nickname for me in a tumbling gymnastics class I took for a few years as a tweenager due to my flailing somehow not resulting in injury.
  • Sensory overload. I have texture sensitivity with food and clothing. As a kid, I disliked any tough or chewy meat, like steak or pork chops. A single piece of gristle would kill any appetite I had. (I eat a plant-based diet today.) I disliked pizza because the cheese often was difficult to chew. I refused to wear clothing with tags I could feel. I couldn’t touch corduroy. I didn’t wear jeans until I was 17 because I couldn’t deal with the stiffness of denim on the back of my knees. I begged my grandmother to not make me walk into malls thru perfume-filled department stores. High-pitch sounds other people seemed to not hear immobilized me.
  • Short-term memory discrepancy. I frustrated my mother with my freakish ability to recite back entire conversations word for word when I listened attentively while also forgetting to do things I didn’t want to do until there was a negative consequence triggering memory recall. I have some form of (undiagnosed clinically) phonographic memory/hyperthymesia where I can play back audio I have heard. My strong recall of sound is not connected with comprehension of the sound. For example, I don’t have song lyrics memorized, but I can play back the sound of a song and repeat the words I hear in real time.
  • Emotional dysregulation, specifically rejection sensitivity. Any criticism, even when lovingly and constructively given, hurt. Adults said I had a tender heart. One time, I lost the card game Old Maid. This was not a high stakes game, but I had to fight the urge to cry. I didn’t want to cry because crying was embarrassing. Not being able to control the tears negatively reinforced the burst of emotion. Crying made my aunt feel bad and then I felt even worse for making her feel bad resulting in a flood of tears. I started avoiding activities I enjoyed, but was not skilled at, and avoided trying new activities involving competition.
  • Daydreaming with a wild imagination. My 4th grade teacher tried to hold me back a year because she felt I was immature. My grades were excellent, but she disliked the way I played during recess, often creating elaborate stories with toys and speaking them aloud to myself. She complained my art projects had more words and thoughts than substance. She also did not like that I helped other students with their work when I finished mine much sooner. The feedback devastated me (rejection sensitivity) and I recalled it with precision (hyperthymesia) regularly throughout 5th grade. Mrs Tomlinson saw a difference in my behavior compared to other kids and that feels worth mentioning. Perhaps if she followed her observation with curiosity instead of judgement, she might have had a different recommendation that could have actually helped me.

Adulting challenges

burnout = expectations > ability + masking + support + brute force - (exhaustion × years)

So how did I get to 39 without an ADHD diagnosis? I worked professionally in an area of innate interest. I sacrificed my free time to compensate for my inconsistent work performance. My resilience, optimism, support network4, and luck prevented my many failures from becoming a prolonged crisis. Until they didn’t.

Here are some of my adult ADHD symptoms:

  • Time blindness. My perception of time passing is poor. A minute can feel like 10 minutes when waiting and 10 minutes can feel like 1 minute when playing a game. Many people have experienced this at some point. I experience it with every interaction in the day.
  • Inner restlessness. The physical fidgeting of my childhood turned into an internal feeling. People with ADHD often describe feeling like they are driven by a motor and must always be doing something. It’s an inability to relax, even in the most relaxing environments. It’s an inability to be fully present in a moment because my mind is always jumping between at least 2 concurrent thoughts in addition to the present situation.
  • Poor memory recall. I remember information, but often not until a negative consequence is imminent or realized.
  • Poor sleep. I am a night owl. I need a full 8 hours of sleep to feel my best. This requires being in bed at least 10 hours to account for the hour I need to fall asleep and the hour I will be awake in the middle of the night. I rarely have difficulty getting up because my inner motor is always ready to go go go. (I have tried every technique you could possibly suggest. Please don’t.)
  • Task paralysis aka the “cold start” problem. I can be aware a task must be done, understand its priority, have the skills to complete it, schedule time to do it, and yet be unable to start or complete the task.

My ADHD symptoms resulted in these consequences:

  • Anxiety about forgetting important information. I rely on checklists, notes, and reminders/alarms. I arrive at appointments extra early or become preoccupied with when I should leave that I cannot focus on anything but waiting to leave on time.
  • Low satisfaction in completing tasks. Many tasks were never completed. Completed tasks were exhausting, rushed, and failed to meet my quality expectations. Also, dopamine reception in ADHD brains is worse.
  • Negative self-talk. “I’m lazy, undisciplined, a charlatan, and unworthy. If I weren’t, then I would be able to do this thing everyone else seems capable of doing without the struggle I’m experiencing.”
  • Social relationship strain. I could not spend time with friends because I was working overtime. I failed to be an equal contributor in household responsibilities with my husband.

Getting well

The last year of medication and occupational therapy has been transformative. I finally understand what being present in the moment means. I still struggle with the symptoms, but less so and without the negative consequences. I truly had no idea how much I was suffering. Life is much more enjoyable. I lost decades to needless difficulty. That realization might anger me if I were not so satisfied by the effectiveness of my treatment.

If you identify with the symptoms and suffering I have described in this post, I encourage you to seek psychological care. If you end up being diagnosed with ADHD, medication and behavioral therapy can help you. If you aren’t diagnosed, you still will benefit from better understanding yourself. It’s a win–win.

Postscript

This sounds like autism…

My investigation also included evaluations for autism, obsessive-compulsive, traumatic stress, depression, and bipolar disorders because of the high comorbidity. My psychologist first presented why I did not (also) have those before concluding with why my symptoms must be ADHD. I appreciated learning a little more about them in case I ever did see myself in those descriptions.

“Everyone seems to have ADHD now! It’s so trendy!”

This sentiment is dismissive of people’s suffering.

ADHD has been underdiagnosed due to limited availability of mental healthcare and limited understanding of the disorder. General awareness of ADHD has increased as people now feel more comfortable sharing their mental health challenges. Researchers have learned more about the variety of symptoms that can indicate ADHD, which has expanded the number of people who can identify the cause of their suffering.

In some places, ADHD has been erroneously diagnosed. One source is a well-intentioned but incorrect attribution of symptoms. A thorough investigation and follow-up care during treatment are necessary to differentiate between disorders with many overlapping symptoms. Another reason is the profitability of medical malpractice in giving deceptive patients access to stimulant medication. Both of these are problems, but these problems are not worse than many more people suffering from ADHD and not receiving the care they need.

Navigating the Swedish mental healthcare system

Demand for mental healthcare increased during the pandemic in Sverige, like many other countries. My primary care physician told me the wait time for care would be long, as my anxiety-related problems (correctly) would be triaged lower. I learned of a private care option benefit from my employer and used it. When I used all of the benefit, the psychologist referred me back to the public healthcare system for an ADHD evaluation.

The first psychiatrist I met in the public healthcare system told me, “ADHD is a child’s problem in Sverige.” I bit my tongue for a moment and tersely replied, “It must be wonderful to grow up in a country where children have access to mental healthcare. I didn’t in the US.”

Several of the doctors I met with seemed skeptical of diagnosing ADHD in adults. The country’s healthcare system was setup to identify and treat ADHD in children, so that they need minimal support as adults. Some interactions felt like an interrogation of how someone could reach adulthood without being diagnosed if they truly had ADHD. At times, I felt like I needed to convince them I was not self-diagnosing from TikTok (a legitimate concern for someone with illness anxiety disorder) or an addict wanting stimulant drugs (a legitimate concern based increased substance abuse in society). My suffering and symptoms felt secondary to their skepticism. At one point, it bordered on gaslighting and I questioned if my suffering was really real.

I was put into the ADHD evaluation queue and told to expect a year wait time. My mental health continued to decline over the months. I dismissed the cost of private care as too expensive. My husband lovingly suggested, “We would spend €3,500 without questioning it if you broke your leg and that was the cost of surgery. Why is your mind any different?” His logic was valid. I paid for a private care evaluation with Cereb and had a diagnosis 3 months later. This has been the best money I have ever spent on myself.

Footnotes

  1. This is a reference to bandpersand t-shirts . ↩︎
  2. I unfortunately did not get an official score, as I was not able to complete one test that was only available in Svenska. ↩︎
  3. Dawn Beckley, University of Connecticut. “Gifted and Learning Disabled: Twice Exceptional Students” ↩︎
  4. My friend John joked in his wedding vows to that his husband Laurie was, at times, his executive function. I deeply felt that. ↩︎

This post was published as part of WeblogPoMo2024.

Post image created using DALL•E with prompt “create an illustration of mind map layered on top of a brain” and then further edited by me.