Making sense of my brain: Late-life ADHD diagnosis and the integration of a neurodiverse identity
‘ADD is not an excuse, but it is a powerful explanation.’ Edward M. Hallowell, MD.
In this thoughtful personal exploration, a recently-qualified therapist considers ADHD in the context of therapeutic theory and practice, offering insights from their own experience as a client.
In Summer 2020, I was diagnosed with combined type Attention Deficit Hyperactivity Disorder (ADHD). For me, the diagnosis explained many behaviours which originated in early childhood. I experienced it as quite a relief.
What is ADHD?
The British paediatrician, George F. Still, first described twenty cases of children with a ‘defect of moral control as a morbid manifestation, without general impairment of intellect and without physical disease’ in his 1902 paper, ‘The Goulsonian Lectures’, published in The Lancet. He found that, ‘some affected children could not control their behaviour the way a typical child would, but they were still intelligent’ (Still 1902, p.1008). Dr Still could have been referring to me as a child.
ADHD is described as follows (NHS 2018):
- ‘Attention deficit hyperactivity disorder (ADHD) is a behavioural disorder that includes symptoms such as inattentiveness, hyperactivity and impulsiveness.
- Most cases are diagnosed when children are six to 12 years old.
- The symptoms of ADHD usually improve with age, but many adults who were diagnosed with the condition at a young age continue to experience problems. People with ADHD may also have additional problems, such as sleep and anxiety disorders.’
The ADDUK.ORG website has produced a timeline for ADHD (ADD UK, 2020). When I was young, the condition was rarely recognised:
1980 - the DSM-III was published, including Attention Deficit Disorder (ADD) with three
sub-types: ADD with Hyperactivity, ADD without Hyperactivity, and ADD Residual type.
1987 - the DSM-III-R: the name was changed from ADD to ADHD. The subtypes are not named. I was fifteen years old and received school reports about my lack of focus, emotional outbursts, and struggling to engage with my upcoming GSCEs.
1990s - it was recognised that that ADHD can continue into adulthood.
2000 - the DSM-IV-TR renames the three subtypes of ADHD as ADHD predominantly Hyperactive/Impulsive type, ADHD predominantly inattentivetype, and ADHD combined type.
I left school at 16 in 1989. I don’t believe any of my teachers were aware of ADHD, were patient with me, nor took time to consider what caused my behaviour. They thought I held agency over my conduct and penalised me for this. I was given the identity of a naughty schoolgirl.
How has ADHD affected me?
There are two ways I can look at this:
First, as a neurological disorder.
Second, as a result of early trauma.
Below are some of the key symptoms displayed in people with a combined type of ADHD,
inattentive and hyperactive, taken from the book ‘Everything You Need to Know About ADHD’ by Dr Denney Erin (2020):
- Having trouble focusing or concentrating on tasks
- Being forgetful about completing tasks
- Being easily distracted
- Having difficulty sitting still
- Interrupting people when they are talking.
Of course, most of the population can relate to some of these behaviours, but for someone with ADHD, these traits inhibit their ability to function at home, at school, at work or in social situations. Adult ADHD can cause trouble managing time, forgetfulness and impatience, which can cause problems in all types of relationships (Erin 2020).
My mother told me that I was a ‘difficult’ baby, a screamer, and she desired to shake me at times, but my father stepped in to help. As a toddler, I would bang my head and give myself visible injuries. This type of behaviour is sometimes suggested as being linked to neurological disorders such as ADHD or autism. Whilst I don’t remember the headbanging or screaming, I have memories of being sent out of class daily for talking at primary school. My secondary school reports all followed the same theme: I was easily distracted, unfocused and more interested in fellow students than the lessons.
During my psychotherapy training, I received feedback from tutors regarding ‘disproportionate emotional reactions’ and how I could become ‘distracted and lose alertness’. I had a profound ‘sense of urgency’, was ‘uncontained’ and ‘busy’. The following words were used to describe me by peers: ‘disruptive’, ‘aggressive’, ‘distracted’, ‘disinterested’, ‘anarchic’ and ‘emotional’; all of these could be defended as ADHD traits.
I have always been aware of my struggle with attention to detail. This brought up feelings of shame, as I didn’t understand why I had such an aversion or inability for dotting the ‘i’s and crossing the ‘t’s. I have since learned to be highly organised through note-taking and planners, and I have adapted to compensate for my limited internal memory and distractedness.
Advantages as well as disadvantages
I am curious about positives to ADHD as well as negatives. I am encouraged that two of the experts working in the field are diagnosed themselves, Dr Gabor Maté and Dr Edward Hallowell.
I am easily side-tracked and forgetful, but I am also an ‘out-of-the-box’ thinker. I am great at getting things done quickly and looking for new ways of working. People with ADHD are often pioneers and risk-takers. The act of creating an environment that works to your advantage is also referred to as ‘positive niche construction’ (Armstrong 2010, p.21). It is about making choices that complement strengths and weaknesses.
For 25 years, I had a career in television and immersed myself in social activities, keeping very busy. However, this didn’t help with the shadow side of my ADHD around being unboundaried, emotionally unregulated and having addictive behaviours. I also had bouts of depression and issues with food and substances, which are common co-morbidities to ADHD.
Maté writes about passive and active attention. Passive attention is an activity such as watching television or playing a game, which can allow the brain to operate on auto-pilot. The ADHD brain struggles when directed towards something of low interest and can switch off (Maté 1999, p.24). When I felt bored, I struggled to the point of falling asleep at work and in school.
Losing focus doesn’t seem to apply in the therapeutic environment; I feel connected to the
client and I can go into a state of deep concentration. Hyperfocus is an enviable trait of those with ADHD and is an ‘ability to focus the mind for hours on a single topic’ (Armstrong 2010, p.41). Such an ability to focus has been considered an attribute of an exceptional mind for many centuries and was called ‘The Great Work’, by Maria Montessori (Armstrong 2010, p.46). In the New Atlantis, Rothstein (2012, p.106) states that, ‘people with ADHD seem inattentive and restless, they also often possess an ability to focus for hours on specific activities or tasks that greatly stimulate or interest them’. I have never fallen asleep in my own therapy or when talking to someone one-on-one in any environment.
A causal link between ADHD and early trauma?
When I was born, I had a low birth weight (around 3lbs) and spent the first few weeks of my life in an incubator. Did anyone hold me? Did I have any skin-on-skin interaction with my mother? Last year, Andrew Meltzoff and Ruth Feldman presented research on how babies relate through touch from their first days (Korte, 2020). The data suggested that the absence of early touch could lead to difficulties with emotional regulation, sleep and other physical ailments in later life. Could this relate to my ADHD diagnosis? It’s widely accepted that the first few hours and days of a baby’s life with the mother are crucial to bonding and developing a secure attachment style: ‘the most significant variable predicting differences in maternal bonding was the length of time a mother had been separated from her baby during the hours and days after their birth’ (Bowlby 2005, p.17). I bear in mind that although I believe my mother loved me very much, she struggled to cope after I was born and was temporarily absent due to my period of incubation.
Schore (2001, p.312) states that ‘the functioning of the “self-correcting” orbitofrontal system is central to self-regulation, the ability to regulate flexibly emotional states through interactions with other humans’. It is widely believed that the orbitofrontal cortex is still developing during those early months and years of life. Misalignment between my mother and I could have led to restricted brain development and a less than optimal ability to self-regulate. This deficit could explain my later addictions, ADHD diagnosis and capacity to handle stress. These characteristics could affect how I am with therapy clients, and I have learned to detect early warning signs using techniques based on grounding and breathing. For example, I now notice when I am holding my breath, lifting my feet off the floor, or my cheeks are flushed. I can monitor these signals and work on grounding myself.
Dr Gabor Maté offers a view that ADHD results from trauma and environment, arguing that ‘it is obvious that brain/mind problems such as ADHD are far more likely to develop in families where the parents are struggling with dysfunction or psychological problems of their own’ (Maté 1999, p.50). I believe my mother suffered some post-natal depression, and my father had been through the war and bottled his emotions up. I don’t think I learned from my parents how to regulate myself. My father died when I was 12 years old, and although I exhibited ADHD traits before then, I wonder how much of an impact this had on me neurologically. My secondary school reports reflect my decline in focus after his death. Then just over a year later, I lost both maternal grandparents in the same week. Did these bereavements exacerbate my symptoms? It was not until years later that I sought help for my grief.
Impact of my diagnosis
Kubler-Ross writes about the five stages of grief: denial, anger, bargaining, depression, and acceptance (Kubler-Ross, 1969 & 2014). Interestingly, there can be a similar cycle to receiving a potentially life-changing diagnosis of neurodiversity such as ADHD. Acceptance is the final stage; Solden and Frank (2019, p.1) write, ‘acceptance means fully knowing who you are – all of who you are – and using that awareness to build a successful and fulfilling life, whatever that may mean for you’.
When I was first diagnosed, my feelings were sorrow for the little girl inside me. Diagnosis at an early age could have been incredibly damaging in the early 1980s, and I probably would have been put into a special-needs group at school and, perhaps, medicated. If diagnosed early, I may have given up all ambition and accepted some externally imposed limitations. Maybe I would have suffered in my education because I was in the top set and bright despite my inattentiveness. As it was, I remember feeling that I had the potential to do whatever I wanted. Would I have blamed all my bad behaviour on ADHD? During my struggles with my addictions, I was very unreliable and often emotionally dysregulated. If I had this diagnosis, could I have excused myself when acting out and absolved all responsibility?
The term neurodiversity was coined by sociologist Judy Singer and New York Journalist Harvey Blume in the late 1990s, initially referring to autism. The term is now in everyday use and encompasses many neurological conditions, including ADHD, autism, dyslexia and dyspraxia.
I am wondering about being categorised as ‘neurodiverse’, alongside those with the other conditions grouped under this label? In the past, I wondered if I was autistic; my brain seemed to be different to others. I once had a boss say they didn’t understand my brain, which was incredibly shaming. But my personal experience of ADHD has been relatively contained. I haven’t experienced the difficulties that perhaps dyslexia would have presented at school, or autism in social situations. Still, I have felt the impact of being misunderstood since I was young.
Do I consider myself to have a hidden disability? As referenced at the beginning of this article, Dr Still’s experience of children with ADHD was ‘without general impairment of intellect and without physical disease’ (Still 1902, p.1008). I am able-bodied, but am I ‘able-minded’? ADHD is a neurodevelopmental disorder, and whilst it is not considered a learning disability, its symptoms can make it harder to learn and function in daily life (Erin 2020, p.47). In the Oxford English Dictionary, the definition of a disability is a ‘physical or mental condition that limits a person's movements, senses, or activities’, which I would say my experience of ADHD fits into. This ‘disability’ can be framed in a different way, however: in the Times newspaper, Hilary Rose writes that Dr Camilla Pang refers to her neurodiversity as a superpower, explaining that ‘everyone moves through life differently and neurodiversity can shed a light on that. It’s OK to be a weird shape’ (Rose 2020).
Therapy can help someone see things through a different lens, but the therapist needs to be careful not to impose their own biases or lived experience onto their clients. I have experienced feeling unheard and perhaps being approached from a neurotypical perspective was part of that. In the past, I didn’t know why I thought so differently from other people. When I was diagnosed, my therapist appeared hesitant to join me in my jubilance, which I found hurtful. In this context, I wonder about disclosing my ADHD as a therapist? It has been helpful to read Maté and Hallowell’s accounts of their struggles and self-doubt, but would disclosure be for my benefit or the client’s? Writing about psychotherapy with adults who have ADHD, Gentile et al. (2006, p.31) state that ‘a skilled therapist can assist the patient to understand and work through past experiences and improve functioning’. In cases where I am working with a client who has ADHD, perhaps sharing that I also have ADHD could be part of that process.
The conclusion of Schrevel et al.’s (2015, p.47) qualitative research study for the article ‘Do I need to become someone else?’ is that, ‘the symptoms of ADHD in themselves were not seen as a problem by most of the participants’. Although coping with ADHD was a struggle for some, ‘ADHD appears to become most problematic in the social environment with symptoms, self-image and social environment all playing central roles’. Since I have understood more about ADHD, I feel more confident in my abilities and my neurodiverse brain. I may have dropped out of my training without it.
As well as their negative experiences, the participants were incredibly proud of their creative, ‘out of the box’ thinking. It was further suggested that the participants ‘highlighted the need for positive acceptance and recognition of personal strengths (and) possible paths for research which focuses on person-centred therapies’ (Schrevel et al. 2015, p.47).
On being a client
Speaking from my own experience as a client, especially before I was training or qualified as a therapist myself, the psychodynamic approach felt punishing and rejecting. I didn’t understand the ‘rules’, and I needed someone to let me know I was safe. A humanistic or person-centred approach felt less punitive, and I could open up. A big part of ADHD is an inability to manage emotions. I have found that the therapist needs to keep an eye on the client’s window of tolerance, tracking their breathing and other psychical responses as their fight or flight response could kick in unexpectedly. In a psychodynamic setting, there was something around not being able to read the therapist, which was scary to me. I avoided eye contact, and an ADHD person will be probably able to talk non-stop for 50 minutes and be incredibly animated. It can be helpful for the therapist to gently bring in a pause to recentre the client, remind them to breathe and bring back the connection. Essentially, when an ADHD person is bouncing off the walls, be their anchor, not a judge.
My ADHD diagnosis has been life-changing. I believe that there are many contributing factors and that my condition is a co-creation of my parents’ and my trauma from birth and through the critical losses in my life. Post diagnosis, I want to continue developing my self-awareness and investigating which parts of my psyche inform my decision-making and personality. Which part is ADHD, trauma, environment, genes, blood sugar levels, etc.? I will never be able to assign each attribute to specific explanations, but I can begin to understand and forgive myself as a whole and finally learn to lean into my strengths.
The author has chosen to withhold their identity.
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