Antoinette Muller: ADHD in Adults: When accomplishments feel like accidents
ADHD in adults – especially adult women – is far more common than anyone realises. As a grown-up just recently diagnosed, it’s been a rollercoaster of a journey.
A few weeks ago, I did something so utterly daft that I thought I’d finally lost the plot. I left my house keys either in the lock of my gate or on the pavement right outside. When I returned, a very good soul had left the keys neatly inside the front porch. Or maybe that’s something I did. I have no idea. Focus (or lack thereof) has always been an issue – thank you to the long-suffering Daily Maverick subs and editors figuring out my half-finished paragraphs and sentences. But this incident was notable. It felt like it required help beyond the usual “healthy diet and regular exercise”. I did all this stuff already. All the time. My GP suggested a trial dose of methylphenidate, often sold under the brand name Ritalin. I was dubious, but desperate. Everything I had been taught about ADHD didn’t fit my profile. This is a disorder for kids – usually hyperactive, troublemaking boys. And it doesn’t exist in adults. I was completely wrong. The first dose of that medication changed everything. It was like the static in my brain had finally been tuned into a channel where I could listen to music without disruption. It was like putting on glasses for the first time. I had never felt so normal. The change was remarkable, but confusing. For years, I put my inattention, forgetfulness and anger outbursts down to a quirk of my personality. I thought that when I covered an entire Test match, writing several reports and analysis but not being able to recall what happened a week later was simply one of the quirks of the job. Or that “working better under pressure” – when a deadline looms – was just one of those things that was an asset to me. Until I started researching. Turns out, ADHD is both over-diagnosed and chronically under-diagnosed. Women – and girls – fall in the latter category because symptoms present so differently. A Quartz piece from 2016 noted how failing to recognise the symptoms in young girls has led to a “lost generation” where women’s struggles morph into self-loathing, with many simply seeing themselves as failures instead of recognising that there is something neurologically wrong with them. The piece notes: “Anxiety and depression turn into low self-esteem and self-loathing, and the risk for self-harm and suicide attempts is four-to-five times that of girls without ADHD,” 2012 research shows. As Angela Aguirre writes in her poem about her symptoms: I am a fraud. If only they knew that my accomplishments feel a lot more like accidents. As if the universe sometimes makes mistakes Like a glitch in the solar system; a data error. Someone, somewhere, must have spelled my name wrong. I hope no one notices Writing for The Atlantic in 2013, Maria Yagoda tells similar anecdotes of being surprised when she was diagnosed and how symptoms often worsen in girls as they hit puberty. Some research even suggests that the onset of symptoms occur much later for girls. The underdiagnoses are further complicated by the fact that girls and women with ADHD have a higher risk of self-harm and even suicide. The condition often co-exists with some sort of anxiety or depression, or other co-morbid conditions. This is all further complicated by the fact that despite ADHD being well-researched, it can often be diagnosed as another condition – often bipolar, especially in women and girls. As The Cut noted in in 2016: Much like with autism, early research on ADHD focused heavily on young white boys; just one percent of research focuses on girls. As a result, it is frequently misdiagnosed. The “hyper-active” personality might be seen as mania that exists in bipolar patients. If “depressive symptoms” such as self-harm, lack of interest or substance abuse are present too, mistakes are often made. It is an enormously complicated thing – best served by a psychiatrist who is a specialist in the field. Which is exactly what I have done. There are people who still believe that ADHD is not real. That it’s an excuse. That “naughty children” should be treated with smacked bottoms or prayer. When these symptoms persist into adulthood, they can be detrimental. Many of us develop coping mechanism or self-medicate. Some survive. Some even excel. Far too many don’t get treatment or even a diagnosis, in part because of the stigma, but also because mental health in South Africa can be expensive and inaccessible to the vast majority of people. Those who do get diagnosed will go through a cycle of emotions: relief – finally, so much makes sense. Anger – why did nobody pick this up and how different could my life have been if it had been diagnosed earlier? Doubt – do I really have this thing? Eventually, acceptance will come. Treatment options vary. Medication is not a cure-all, but it can be a huge relief and life-changing when it is coupled with the awareness that an official diagnosis brings. It might take weeks, months or even years to know what part of you is just you and what part is your ADHD. But a baseline of functionality where simply existing becomes less exhausting is part of the process. DM Note: The South African Depression and Anxiety Group (SADAG) has a helpline for adults who think they might suffer from ADHD. You can call them toll free on 0800 55 44 33. Or visit their website for more information.