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How an ADHD diagnosis completely changed my life…

The old me…

This time a year ago I had just submitted my dissertation (which was nothing short of a miracle). Although the end was in sight and I now believed I may actually make it to the end of my degree (something which had seemed near impossible just a couple of weeks earlier), I was still hating my life, struggling with even the most basic tasks it seemed. I struggled to focus and would get distracted by anything and everything, my mind was constantly racing, my mood and energy levels fluctuated like crazy going from one extreme to the other in a matter of minutes, I was easily overwhelmed, I had to read things over and over again to actually retain any of the information, and when it came to things people said to me or tasks I needed to do or my memory wasn’t even a sieve, it felt like a full on black hole, whereby anything said to me or a task that needed doing would immediately vanish, never to be seen again. Useless facts however seemed to somehow avoid the black hole and stay cemented in my brain, majorly overstaying their welcome.

I felt permanently exhausted, napped near enough every day and felt like a constant failure. Even being awake seemed too difficult for me to manage, let alone anything else. Yes, I had made it this far (somehow) and done reasonably well but I just wasn’t sure I was cut out for the ‘real world’ and being an adult and holding down a real job. I felt like I was barely functioning and hadn’t been for years.

I think many of the issues I struggled with had been present throughout my years at school, but they had simply been less noticeable at school as I was able to get by with ‘natural ability’, repeated nagging from teachers, very supportive/helpful friends and a LOT of last minute cramming for exams. But as I progressed through uni I could feel these struggles starting to impact me more and more. The last minute cramming seemed just about sufficient for my first year, but after this I felt it becoming increasingly less effective. My mental health had been awful for years, significantly impacting my every day life, but I think so much of it was internal (spending hours a day repeating things over and over in my head) and had gone unnoticed by others (and been completely dismissed/minimised by doctors/counsellors). I think my ‘natural ability’ unfortunately masked the impact of many of my difficulties and so, although I felt like I was struggling so much, the true severity wasn’t outwardly obvious. When I started uni it started to impact on my life even more, as the academics became harder and I had to become more independent. Certainly by my second year of uni the impact on my grades was beginning to become more apparent, and by my final year I really doubted whether I would finish my degree. I thought it would probably just finish me tbh.

By my final year I was barely even functioning, walking round in a constant zombie like state, not really knowing what was going on. I was physically present, but mentally I was nowhere to be found. It seemed like everyone else was managing but I was just failing miserably. I felt like a complete and utter failure at life. But I thought it was probably my fault and I just needed to ‘try harder’. Surely if everyone else was managing then I should be able to as well!? I couldn’t understand how I seemed to do so little and be so ‘lazy’, yet still be so exhausted. My brain was just so worn out from the constant repetitive thoughts that it didn’t have the functional capacity for anything else. My head was a complete and utter mess and I had no idea how I would ever hold down even a basic job when I could barely even function whilst doing relatively little.

In case you hadn’t already guessed, uni was not an enjoyable experience for me – I HATED it. I thought about dropping out near enough every day. Sure, there were good bits, like the nights out and the amazing friends I made. But this was somewhat overshadowed by my appalling mental health, as well as the constant feeling that I wasn’t reaching my potential or should (and could) be doing better. And when I did well, I never felt like I deserved it and always attributed it to ‘luck’. I almost felt guilty or ashamed a lot of the time when I did well because I felt like I was just ‘lazy’ and hadn’t worked hard enough. These were feelings that had been present for most of my life, having been drilled into me from a young age and continually reinforced throughout my school career. It was repeated comments like…

‘Alice COULD do well if she tried harder…’ or

‘She has so much POTENTIAL, but currently isn’t reaching it…’.

A constant feeling of falling short of expectations and disappointing people, but also that it was unfair and I didn’t deserve it when I did well – feelings I struggle to escape even now. This was understandably pretty exhausting and has been very detrimental to my mental health over the years, significantly impacting me since my early teens. Although not always outwardly obvious due to my loud, outgoing nature, I struggled with extremely low self-esteem and a lot of self-doubt, much of which I think stemmed from this constant feeling that I wasn’t good enough. I never really made the connections between my poor mental health, low self-esteem and the repeated negative comments growing up. I always just laughed and joked about these comments, but I think deep down it was having a very harmful effect and this was evidenced in my extremely low opinion of myself and my abilities. It is only really in the last year that I have realised how much everything links together and things have started to make more sense. I think many factors have contributed to these realisations but there was one defining event that made the puzzle pieces suddenly fit together – my ADHD diagnosis.

22nd May 2020 …

Not a particularly significant day to most, I’m sure, but to me this is the day that completely changed my life and everything finally started to make sense. Just 4 days before my last exam of my undergraduate degree and my 23rd birthday, I was diagnosed with ADHD. I expected the diagnosis may affect my future but I didn’t realise quite how big of an effect this would have on my perception of past experiences. It was as if I had been living with blurred vision for years and I’d finally been given glasses. My whole perspective changed and suddenly I felt like I was looking at my whole life, both present and past experiences, from a whole different angle. I began to question my whole perception of myself. Maybe I wasn’t this useless, lazy, disappointment, who simply needed to try harder, like I’d always thought? Maybe it wasn’t all my fault that I never quite met expectations or achieved as well as I could/should have? Maybe I had been putting in a lot more effort and dealing with a lot more than I, or anyone else, realised? Suddenly there was an explanation for so many things and my life finally made so much more sense! My apparent inability to reach my so called ‘potential’ wasn’t simply due to a character flaw and perhaps I wasn’t inherently lazy like I’d always been made to believe. There was help available and even just knowing that it wasn’t my fault, and that I wasn’t a complete failure or disappointment like I had believed for so long, felt amazing. It was like a huge weight had been lifted off my chest and I could finally breathe. Maybe there was hope for me? Maybe I could get a job and actually succeed in life? Maybe I could not be permanently plagued by exhaustion and have the constant need to nap?

Obviously simply being told I had ADHD wasn’t going to make all my problems simply go away and there was still a lot of worry about whether I would cope in the real world post uni, but for the first time ever I finally had a bit of hope that things might get better. I had found out a week earlier that I had been offered an interview for the NHS Scientist Training Programme (STP) – a highly competitive graduate training programme. A job that sounded perfect for me, but I was unsure whether I would be able to cope, were I to be successful at interview, considering I was barely functioning at uni. However, the ADHD diagnosis did give me some hope that things could get better and that I could become a functioning human being.

Medication

A week or so later I started medication to help with the ADHD and also successfully interviewed and was offered a place on the STP! I was so excited to be offered a place, however there were still a lot of doubts in my mind about whether I would be able to cope, especially considering it required me moving half way across the country, working full time and undertaking a part time masters. The thought of this was obviously daunting, especially considering how much I had struggled with my undergraduate degree, when I only had about 8-10 contact hours a week (half of which I was asleep for…), and I worried about whether I would realistically be able to cope with the demands. But the STP was such an amazing opportunity and something I really wanted to do so I knew I had to give it my best shot and I still had a few months before I started to try and sort myself out somewhat.

It was hard to know at first whether or not the medication was working. I had just finished uni and was no longer drowning in work with no motivation or mental energy to complete it. Sure I felt a lot happier and I wasn’t napping everyday like I used to, but was this simply down to the fact I had finished with uni and was back living at home with very few responsibilities?

The new me…

Fast forward to September and I was moving 150 miles away to Maidstone ready to embark on the STP, including a (very intense) 6 week block of online lectures to start and then working full time whilst simultanoeusly trying to stay on top of competencies and uni assignments. This would be the real test! Would I be able to cope?

It certainly hasn’t all been plain sailing and I have certainly questioned at times whether or not the medication is working (usually at times when I’m feeling a bit tired or stressed). But then I remind myself that it is completely normal to feel like this sometimes, particularly when undertaking a programme like the STP, which is known to be a lot of work! Also, I am aware that medication isn’t meant to magically cure everything, but just make things easier and hopefully allow you to find and implement strategies to help yourself. But when I sit and properly reflect, I realise that there has definitely been massive changes. I am now able to focus better, I feel more motivated, my head feels clearer, my sleep is better, I don’t feel constantly exhausted and need to nap everyday, and I feel like I can function reasonably well. Whereas before I was barely functioning at all. Now I feel like I’ve got my spark back. When I was at uni my spark would come and go as my mood constantly switched between happy and excitable to depressed and exhausted, but I now feel like it is there a good proportion of the time and more people are getting to appreciate my bubbly personality without so much of the depressed, grumpy part of me.

I am now just over 7 months into the STP, and whilst there have definitely been ups and down, I have coped reasonably well with the demands of the programme, working full time, whilst staying on track with my competencies and completing the required uni assignments/exams, and I actually haven’t been that stressed on the whole!! Compare this to a year ago where I struggled to make it through a single lecture without falling asleep, was constantly exhausted and barely functioning. I am a completely different person now. It’s crazy to see how much my life has changed in a year and I believe so much of this is due to finally getting that ADHD diagnosis, it really did change my life for the better. Of course I do still struggle with my mental health a lot and my memory is still absolutely shocking, but these are things I’m learning to deal with and I now actively look forward to getting up and going to work in the morning, a stark difference to when I was at uni and all I’d ever think about was when I could next sleep…

Happy 1st Birthday to my ADHD diagnosis…

22nd May 2020: Only 4 days until I finished my undergraduate degree, an experience I had hated a lot of…However this is not the reason why this date is significant.

This is the day things started to change for the better. The day my life finally began to make sense. The day I was officially diagnosed with ADHD.

It’s my ADHD diagnosis’ first birthday today. Whilst it is actually also my birthday in 4 days, that feels like a much less significant event for me…

Some people may think it’s stupid to be celebrating, or even talking about, such a thing, especially as the ADHD itself obviously wasn’t new, it had always been there, I just finally got a label for it, an explanation for so many of my struggles and ‘quirks’. I know that ‘labels’ shouldn’t matter and people’s struggles are just as valid, regardless of if they have an ‘official’ diagnosis or not, and that goes for all mental/physical health problems/differences. However, it feels important to me to recognise this milestone. It’s not so much a celebration of the diagnosis itself, rather a celebration of how much my life has changed and improved as a result of it.

I think the ADHD diagnosis honestly saved my life. A year ago I was super depressed and anxious, had no motivation to do anything, and spent a large amount of my time sleeping. I rarely managed to make it through a single 2 hour lecture without falling asleep, and on the occasion I did I would then go straight home and nap. I felt like a zombie a large proportion of the time, walking round in a constantly spaced out state. My mood and energy levels constantly fluctuated, going from one extreme to the other in a matter of minutes. I was either loud, bubbly and excitable, or I was a depressed zombie, often with my head on a table, essentially dead to the world. It was nothing short of a miracle that I made it to the end of my degree and it took a LOT of support, motivational speeches and a global pandemic for it to happen!

Truthfully, I dread to think where I would be now if I hadn’t got the ADHD diagnosis and I definitely would not be where I am now! I had no idea what I would do after university. I highly doubted whether I would realistically be able to cope with a proper, full-time job, considering the mental state I was in. I remember finding out last year that I had been offered an interview for the STP, and whilst I was very excited, I knew that if things didn’t change significantly then there was very little chance that I would realistically be able to cope with the demands of the STP. Yes, I had got that far in life and seemed to cope sufficiently well in life, being relatively ‘high functioning’, but it had taken such a huge toll on my mental health, and I was acutely aware of the stark difference between 8 contact hours a week at uni (some of which I’d usually be asleep for) and working a full time job (which I would quickly be fired from were I to adopt the same approach…). I tried not to think about this too much and focused the very minimal amount of brain capacity I had on dragging myself through the last few weeks/days of my degree. I was barely even a functioning human being at this point, with even the most simple tasks seeming insurmountable. I was so mentally exhausted and it felt like my brain had been running on its last 1% for a long time now. It seemed only a matter of time before it shut down completely and I wasn’t sure if it would ever be revived again…

However, fast forward a year and here I am on a highly competitive training programme, holding down a full time job (that I absolutely love!), alongside undertaking a part time masters , having moved half way across the country. Not only am I ‘coping’, I am actually kind of thriving. I’m ahead of target with my competencies for the STP, I have done well in my uni assignments so far, and I’m actually enjoying my life! Yes, I do still struggle a lot with my mental health and I definitely have good and bad days, but most of these struggles stem from past issues and their effects on me now. I am however actively trying to come to terms with, and move on from, these past experiences and the damage they have caused me, through therapy which is helping and I am definitely making progress. Having a job that I really enjoy and actively look forward to going to each day, as well as lovely, supportive colleagues, has certainly helped deal with these bad days as well.

It makes me emotional reflecting on how much my life has changed since then. I will admit that I am sad/angry/frustrated/disappointed that I spent so many years struggling and not knowing why and at the damage it caused, but I think this is only natural and these feelings are all a part of the healing process. However, I do also feel so lucky to be where I am now and so fortunate that I finally got my ADHD diagnosis last year, as this was without a doubt the catalyst for the enormous change in my life over the last year.

It’s scary to think I nearly didn’t get diagnosed because my GP said she ‘didn’t really see the point’ when I asked for a referral to a psychiatrist…However, after reading lots of information and talking to people on ADHD support groups online, I related so strongly to their experiences and I saw the difference it made in so many of their lives and therefore the potential it could have for me and my life. I was fortunate that my parents were supportive and I was able to directly refer myself for a private assessment.

I have been dismissed by so called ‘professionals’ so many times over the years when it’s come to my mental health, and I am so glad that I didn’t let the GP’s negative response stop me getting my ADHD diagnosis. I think this is part of the reason I want to share my experiences openly, so that others who may be struggling with undiagnosed ADHD might relate and seek a diagnosis. As you can see, a diagnosis really can dramatically change a person’s life!

Here’s to many more years of understanding myself better and continuing to improve and thrive ❤

End of 2020 STP reflections: Why the chaos of COVID-19 and the STP might just be the best thing for my ADHD brain…

Having unfortunately spent the majority of December in self-isolation and spending just 6 days at work this entire month, I have had a LOT of time to reflect on my experiences of the STP so far and the highs and lows. Whilst these weeks spent in isolation have been extremely difficult and have no doubt seen me reach some very low lows, it has also allowed me to reflect on and appreciate some of the real highs I have experienced so far so here goes…

I feel this warm fuzzy feeling in my stomach as I write this. That mixture of adrenaline and dopamine that my ADHD brain often so desperately craves and this need is finally being met. I feel a genuine sense of excitement as I go into work, not knowing what’s in store for the day ahead. I don’t just sit there all day clock watching, counting down the hours until I can go home. I arrive home from work and collapse on my bed, often exhausted, but with a real feeling of contentment. I feel like my brain has been thoroughly fed and nourished. I will often feel mentally exhausted when I get home in the evening but I liken this to that ‘food coma’ you get after a huge meal. You may not be able to move now and will most likely spend the next few hours laying on your bed/sofa, but you feel so happy and content. My brain seems to experience a similar thing. I arrive home from work, and my brain goes into its own form of ‘food coma’, but the ‘food’ is the excitement and stimulation of the day it’s had. So satisfied and content but it may have possibly slightly overindulged and now needs some time to rest and digest.

I feel like my brain is and always has been hungry for knowledge but being sat in a classroom/lecture hall was not an effective way for my brain to absorb this knowledge. Being talked at for hours simply sent my brain to sleep and did not allow it to absorb the knowledge it wanted to in an effective way. I thought maybe I just wasn’t interested enough in the subject and that was why I found it so hard to sit and learn about these things? But at the same time I was so sure that I did find these topics interesting, hence why I had chosen to study the degree I did at uni. I was so confused as to how in theory I felt so interested in the subject but in reality I would sit there bored, with no apparent motivation, and struggling to even stay awake for an entire lecture/seminar…

I now realise that it wasn’t the content that was wrong for me, it was the method of delivery. Long lectures that involved me being sat down and talked at for hours on end were not an effective method too feed me the knowledge I was so hungry for. It’s kinda like someone trying to eat soup with a fork (please hear me out lol). To an outsider simply looking at the bowl of soup and seeing it still almost completely full it may look like the person just wasn’t hungry and was choosing not to eat it. However, it’s not that they don’t want to eat the soup, it is simply that most the soup has slipped through the fork before it reaches the person’s mouth because they have not been given the correct tools with which to eat. I feel like this is what has happened with me and my learning. It wasn’t that i didn’t want to learn, it was simply I wasn’t given the correct tools to learn, However, I feel like this has changed now I am on the STP, learning hands on in a hospital environment by seeing and doing, rather than being sat down and talked at for hours on end. I arrive at work everyday hungry for knowledge and excited to learn more. I have the opportunities to see how things work, to put my knowledge into practice and understand how what I am learning is relevant to the job and real world applications. I get to see and hear a range of different perspectives from colleagues and patients. I get the opportunity to move around, rather than endlessly fidgeting in a lecture hall chair, and my brain feels like it can actually remain focussed without getting tired and falling asleep. It really does seem like some sort of miracle! I feel like a completely different person. Rather than being the ‘lazy’, ‘unmotivated’ person that I, and many other people, have always seen myself as, I now realise that this is not the case. I was simply trying to eat my soup with a fork, rather than a spoon, and wasting a lot of energy in the process!

I won’t lie, the anxious part of my brain definitely had (and still does have) worries about the lack of ‘structure‘ and the high levels of uncertainty with what will happen with my training, due to the chaos of COVID, and the wheres, whens, whos and hows of it all, but the ADHD side of my brain is kinda loving the excitement of it all and the surges of dopamine and adrenaline it brings. For example, one week last month I started off in cardiology, as I had been for the previous 2 weeks. However come Tuesday, I was being sent home within 30 minutes of getting to work, due to a COVID-19 outbreak amongst some of the staff, and told that my cardiology training was being temporarily suspended. At this point I did have a slight sense of disappointment and worry that I was would be stuck at home bored for weeks to come. However by the end of the day I had received a negative COVID swab and been invited to spend the rest of the week back in the respiratory department. My brain was kinda loving the excitement and chaos of it all!

One of my favourite things about the STP and working in the hospital is that every day is different! Such a cliché but it really is. Even if you are doing the same sets of tests each day, every patient is different and the experience of doing the same tests can be differ greatly. Whilst in respiratory I have seen patients with severe COPD, who struggle to walk even a few metres, but also fit and active people with very few limitations, as well as patients experiencing the effects of ‘long COVID’ six or seven months on from being infected. In cardiology I have seen patients ranging from six months old to those in their late 90s. Every patient and every day is different and I LOVE it!

Admittedly this post is a bit messy and all over the place (an accurate representation of the inside of my brain…) and is a bit of a stream of consciousness rather than a coherent, logical post. But hopefully you’ll at least partly understand what I am trying to get across and why the STP may be the perfect scheme for a person like me and why am I so grateful to have been given this opportunity.

How are you REALLY doing?

So I’ve spent a lot of time in self-isolation this month which has given me way too much free time to sit alone with my thoughts. This has definitely been a struggle and has unfortunately resulted in a huge deterioration in my mental health. However, it has also allowed me to become more self-aware and reflect on things. For example my apparent inability to be truthful when someone asks how I am feeling…(deep isolation thoughts lol)

This is something I’ve become very aware of over the past couple of weeks. Every time I’m asked how I am doing/feeling, I always seem to give the same untruthful answers of ‘fine’, ‘okay’, ‘alright’, ‘I’m just tired’ and these are so commonly just believed and accepted. Deep down I probably know it’s not true but yet that’s still the response I give. WHY??? Stigma? Not having the right words? Suppressing my true feelings? Probably a combination of all 3.

I think to some extent even I myself believe what I’m saying when I give these responses. I’ve kind of just learnt to suppress my feelings over the years and I don’t think I even know how I am truly feeling a lot of the time. I’ve learnt to simply ignore these feelings. I’ve had my feelings dismissed so many times that I think I just started to doubt them myself. If these so called ‘professionals’ were repeatedly telling me I was fine then I guess they must be right? They made me doubt my own feelings and distorted my perspective of how I viewed emotions…

Everyone has always just kinda accepted it and moved on when I’ve told them I’m ‘alright’. But recently my manager has actually been calling me out on it, saying my response ‘doesn’t sound convincing’. I think she knows me better than I know myself…She has made me stop and re-evaluate how I am actually feeling which I really appreciate. Maybe I am hurting a lot more than I realise but I’ve learnt to bury these emotions or consider them to be ‘not that bad’ because that is what so many doctors/counsellors led me to believe. I have been making an effort to try and be more honest about how I am feeling but I don’t think I’ve intentionally been lying for all these years. Perhaps I didn’t realise just quite how dishonest I was being, my perspective is just so distorted and I’ve been conditioned to see a moderate level of depression as feeling ‘okay’.

I’ve actually spent time after conversations recently reflecting on my feelings and why these classic responses seem to automatically leave my mouth, even when they do not at all describe how I am truly feeling. These responses don’t really mean anything to me, they are simply words, there to fill a silence, and allow the conversation to move on.

I think so often when people ask the question “how are you feeling?” they don’t really mean it, it’s simply a question society has made us ask regardless of whether we actually want to know. A lot of the time it seems the only acceptable response is a positive one. As such, we are so often faced with the difficult dilemma of whether to lie and say we are fine, or be truthful and run the risk of being called ‘negative’ or told to simply ‘cheer up’. It’s sort of a lose-lose situation really. You’re either a liar or you’re seen as negative, and the former is often seen as the more desirable option, especially as it is likely your lies may well be believed and no further questions asked. However, perhaps sometimes it would be better if further questions were asked. Sometimes these questions are needed to establish how someone is truly feeling and assist them in getting the support they need to work through these problems.

Whilst I’ve been particularly noticing it recently, this is something I’ve been guilty of for as long as I can remember. Despite often wanting to tell people how I’m truly feeling so they can help, the dreaded “I’m okay” always seem to slip out before I have a chance to stop it. This is something I really want to change, not just on a personal level but also more generally in society.

We need to NORMALISE BEING HONEST ABOUT OUR FEELINGS!!! People are not mind readers and therefore can’t help unless they know how you’re really feeling? And if you’re only willing to hear a positive response then maybe don’t bother asking because you’re clearly not willing to help.

ADHD? Isn’t that just a fancy word for naughty/ hyperactive little boys?

No.

This assumption highlights several of the common misconceptions surrounding ADHD:

  1. that it only occurs in boys,
  2. that you have to be ‘hyperactive’ to have ADHD
  3. that people with ADHD are just badly behaved/lazy and simply need to try harder to behave/get stuff done
  4. that it is only present in childhood

These assumptions and the lack of awareness about ADHD can be very detrimental to those who have it and can lead to them being made to feel worthless and a failure. In this post I am to delve a little deeper and provide information and evidence to dispel these myths.

MYTH 1: Only boys have ADHD

Both boys and can girls can have ADHD. It had previously been reported that males are much more likely to have ADHD, with population studies reporting male to female ratios of around 3:1, whilst clinical samples suggested ratios of between 5:1 and 9:1 [1,2]. However it is thought these findings may not be completely accurate, owing to factors such as referral bias, differences in symptom presentation and symptoms being attributed to other co-morbid conditions, such as anxiety or depression. This is already highlighted by the differences seen between clinical and population based studies, supporting that females are much less likely to be referred for clinical diagnosis. More recent reviews have suggested a much closer gender split, with ratios of around 1.6:1 in adults (Figure 1) [3]. However it is likely that split could potentially be even closer than that as ADHD still tends to be diagnosed much more often in boys. This is likely due to the fact that hyperactivity appears to be more prevalent in boys than girls, and girls tend to be less disruptive and are more likely to present as ‘daydreaming’ or being generally distracted, indicative of the inattentive form of ADHD [3]. Females are also more likely to be diagnosed later in life compared to their male counterparts as they are often misdiagnosed, with their symptoms often being attributed to other conditions, such as depression and/or anxiety [4]. Additionally, it is thought that females may be better at developing coping strategies that mask their symptoms [4].

Figure 1: Male:female ratio of adults with ADHD, developed using data from Willcutt EG. Neurotherapeutics 2012; 9: 490-499. Taken from “Gender in ADHD Epidemiology | ADHD Institute” (2020) [5].

MYTH 2: People with ADHD are always hyperactive and full of energy

Hyperactivity is one symptom of ADHD, however not everyone with ADHD will experience it. As mentioned above, for example, hyperactivity tends to be less common in girls than boys.

There are actually 3 different types of ADHD; hyperactive-impulsive type, inattentive type, and combined type (see previous post on ‘What is ADHD?’).What is ADHD?August 11, 2020IntroductionJuly 11, 2020Why I started this blog…and how it relates to baths!?July 14, 2020

This image has an empty alt attribute; its file name is adult_add_symptoms-1.png
https://bestwoldofknowledge.blogspot.com/2015/03/adult-add-symptoms.html

MYTH 3: People with ADHD are simply ‘lazy’, ‘unmotivated’ and ‘need to try harder’

A common experience for those with ADHD is being labelled as ‘lazy’ throughout school and their school reports being filled with phrases such as ‘needs to focus more’, ‘needs to stay on task’, ‘easily distracted’, ‘needs to apply his/herself more’, ‘not reaching his/her potential’, ‘must try harder’, ‘bad attitude’ etc. However, people with ADHD are not intentionally being lazy , in fact a lot of the time they are trying as hard (if not harder!!) than their neurotypical peers to pay attention. But they find this extremely difficult, not because of problems with their attitude, but rather due to how their brains work. ADHD brains tend to have lowers levels of the neurotransmitters dopamine and norepinephrine, which are associated with the pleasure and reward systems in the brain and with executive functions such as attention, planning and working memory[6]. This explains why ADHDers may have difficulties with tasks they find boring or repetitive, such as those common in classroom environments and office jobs.

This image has an empty alt attribute; its file name is fact.jpg
https://www.additudemag.com/adhd-is-not-fake/

MYTH 4: ADHD is only present in children

Similar to the boys vs girls myth, many people don’t believe that adults can have ADHD. Whilst it is thought to be true that you can’t develop ADHD in adulthood, and DSM-5 guidelines state that symptoms must have been present before the age of 12, many people (again particularly women) do not get diagnosed until well into adulthood[7]. This can be due to managing to ‘mask’ symptoms well or succeeding at school despite their difficulties due to ‘natural talent’, however it is likely the symptoms were in fact present from childhood. Symptoms in childhood can also often be attributed to other causes and many girls in particular are diagnosed with anxiety and/or depression during their teens, when in fact these symptoms may be, at least in part, caused by difficulties linked to their undiagnosed ADHD and the struggles associated with this. For example constantly being told they are not trying hard enough or are underachieving, despite putting in a lot of effort, which can severely impact self-esteem and contribute to mental health problems (e.g. depression and anxiety).

This image has an empty alt attribute; its file name is adult-adhd.png
https://www.verywellmind.com/adhd-symptoms-4157281

I know I for one held some similar beliefs to these for many years. Often wondering if I may have ADHD due to my inability to stay focused and constantly being distracted, but also thinking I could not have ADHD as I so often felt completely exhausted and seemed to spend a large amount of time napping, including at school…, the apparent complete opposite to being hyperactive.

I have obviously experienced first hand the damage these stereotypes can cause in terms of preventing diagnosis and the detrimental and long lasting effects this can have on an individual’s self-esteem and mental health. As such, I am very eager to try and help raise awareness of and bust these myths and increase knowledge of the truth about ADHD and how it can present. Particularly the contribution of such myths to the low levels of diagnosis in young girls. More needs to be done to ensure schools and higher education institutes, as well as parents, are more aware of the potential signs of ADHD, particularly in girls, so that early identification and intervention can occur. This would allow more support to be put in place to help them at an earlier stage in their life, which would help minimise the detrimental impacts this can have on emotional wellbeing, academic achievement, relationships and employment prospects.

[1] Gaub, M., & Carlson, C. L. (1997). Gender differences in ADHD: a meta-analysis and critical review. Journal of the American Academy of Child & Adolescent Psychiatry36(8), 1036-1045.

[2] Skogli, E. W., Teicher, M. H., Andersen, P. N., Hovik, K. T., & Øie, M. (2013). ADHD in girls and boys–gender differences in co-existing symptoms and executive function measures. BMC psychiatry13(1), 298.

[3] Willcutt, E. G. (2012). The prevalence of DSM-IV attention-deficit/hyperactivity disorder: a meta-analytic review. Neurotherapeutics9(3), 490-499.

[4] Quinn, P. O., & Madhoo, M. (2014). A review of attention-deficit/hyperactivity disorder in women and girls: uncovering this hidden diagnosis. The primary care companion for CNS disorders16(3).

[5] Gender in ADHD Epidemiology | ADHD Institute. (2020). Retrieved 8 August 2020, from https://adhd-institute.com/burden-of-adhd/epidemiology/gender/#:~:text=ADHD%20is%20more%20commonly%20diagnosed,years%20and%20over%20(Figure).

[6] Logue, S. F., & Gould, T. J. (2014). The neural and genetic basis of executive function: attention, cognitive flexibility, and response inhibition. Pharmacology Biochemistry and Behavior123, 45-54.

[7] https://chadd.org/about-adhd/overview/

ERROR: Your problems are invalid

tHE Damaging EFFECTS OF emotional INVALIDATION

(or maybe they’re not that bad…)

What is invalidation? Dictionary.com defines it as “to render invalid; discredit; or nullify”. I’m sure everyone has experienced some form of invalidation at one point or another, and normally we just learn to deal with it and move on. But what about when this invalidation is in regard to something particularly personal, such as your thoughts and feelings?

Emotional invalidation is when your feelings/emotions are dismissed, minimised, rejected or ignored. You are made to feel like your problems are not serious enough, that they are not important. This can be considered a form of emotional abuse and consequently can be very harmful to a person’s self-esteem and self-worth. This can be particularly damaging when that person is already in a vulnerable position, such as when disclosing mental health difficulties.

How about when this invalidation comes from a so called ‘expert’, someone you would expect to trust? For example a doctor or counsellor. Imagine plucking up the courage to go and speak to someone about your mental health difficulties to then be completely shot down and your struggles made to seem insignificant. A storm of emotions crash over you; anger, despair, upset, confusion, shock. This is unfortunately the case for many people, myself included, and it can cause some pretty damaging, and long-lasting effects, particularly if the experience is repeated more than once.

Seeking support – what happens when it causes more harm than good?

We are constantly encouraged to reach out for help if we’re struggling, reassured that we are not alone, that people want to help. But what we don’t talk about enough is what happens when you try and seek support but are instead dismissed and your problems invalidated. When you ask someone for help but they don’t listen or understand. What happens then? What are you meant to do now?

It seems to be often assumed that you ask for help and you get it. It’s that simple. No one seems to talk about the occasions where no help is offered, the damaging effects of being shot down after you’ve mustered up the strength and courage to seek help. Spending hours mentally psyching yourself up for an appointment, meticulously planning and rehearsing what you will say, allowing yourself to feel one small speck of hope that things might get better. However, all this work ends up being for nothing. Your hopes of a better life are shattered in the space of 10 minutes. That soul crushing disappointment as you realise all your energy was wasted. You have received no help, and in fact now feel even worse than you did before as you come to realise that this could be your life forever.

I know I have certainly felt this way. I had never heard much about others’ experiences of being dismissed by medical professionals and as such I felt very alone. I wish it was talked about a bit more publicly because I am sure I am not the only one who has gone through this and when your feelings have been invalidated all you want is some reassurance and external validation, confirmation that your problems are real and important and that you matter!! I struggled to find this anywhere and I longed for something to help me feel a little less shit about it all. I think even just having the knowledge that I was not alone and other people had similar experiences would have at least slightly softened the blow and reduced my self doubt slightly.

Experiencing this invalidation from medical professionals once is bad enough, but how about when these experiences are repeated several times over a period of many years, and by different people? Whilst an unpleasant experience, you think perhaps you were just unlucky the first time, you maybe got unlucky with the doctor you saw and there may be some hope were you to see someone else. However, when this experience is repeated by a range of so called ‘professionals’ over several years, the damage can be severe. Over the space of 5.5 years I was dismissed by doctors at my GP surgery on 3 separate occasions (as well as booking and subsequently cancelling appointments at the last minute a couple of times due to fear of being dismissed again) and again by two different counsellors through my university’s wellbeing service before I was finally listened to. And to be honest, that was only because my mum came to the doctors  with me and pretty much insisted they let me try medication (so wasn’t really me they listened to…).

During these visits I had one doctor write on my consultation notes ‘clear she is not depressed’, another write ‘feeling low but not depressed’ and had a counsellor tell me to my face that I was ‘definitely not depressed’. Now, whilst I’m not a ‘qualified’ medical professional (not sure how useful that is anyway…), I can say with pretty high levels of certainty that I was severely depressed on each one of these occasions, but unfortunately my feelings were completely dismissed and invalidated each time. One person denying you’re depressed isn’t great, but it’s feasible they may have got it wrong (although it is still extremely crushing to be told you’re essentially fine when you’re sure you’re not). However, having three separate professionals tell you this does really make you start to question yourself. Maybe I really was just making it up?

Additionally, another so called ‘counsellor’, in response to me telling her about my repetitive thoughts, asked me ‘have you ever tried not repeating them?’*. I don’t think she could have made my problems sound anymore insignificant if she tried and the only thing she successfully achieved in that appointment was making me feel like an absolute idiot for seeking help and sharing my problems with her (i honestly questioned if i had the word ‘MUG’ tattooed on my forehead).

*(in case you were wondering…surprisingly, yes, during the 7+ years I’d been experiencing these repetitive thoughts it had crossed my mind to try and ‘simply not repeat them’ but it had unfortunately proved unsuccessful on each and every occasion)

Every time I sought help, I was dismissed, my feelings invalidated and minimised, made to feel like I wasn’t important and that no one cared. Not only did this cause me emotional distress but it also prevented me from being honest with other people about how I was feeling. When people asked how I was or what was wrong I felt I couldn’t tell them I was depressed or had anxiety or OCD because I’d feel like a fraud. I felt like the doctors/counsellors had made it pretty clear that they didn’t think I had any of those conditions (whilst also offering me no alternative diagnosis) so even though I was certain that I fit the diagnostic criteria, I’d be lying if I said I had them. I really wished I could give an honest response when people asked but I just couldn’t find the words to explain without feeling like a liar. So instead I always resorted to the classic “I’m tired” or making a joke about my mental health. This was my coping mechanism. I wanted so badly to tell people how I was really feeling, but I feel like ‘depression’, ‘anxiety’, ‘ocd’ etc. were these ‘protected titles’, saved only for those who had been ‘officially’ diagnosed. I didn’t ‘deserve’ to use these terms to describe what I was going through and if I did use them to describe myself I would be a liar and it would be disrespectful to all those who really are struggling with those problems (although I obviously was too, but the constant dismissals had filled me with a lot of doubt).

Now I totally understand that doctors don’t want to prescribe medication straight away, and I completely agree with this as I think it is important to try other things first. But handing out some shitty leaflets to useless websites that I’ve looked at countless times already and suggesting meditation and mindfulness apps isn’t going to cure me or anyone else who has been suffering for this long. I completely support the use of such things but it is unlikely to really solve your problems unless they are only mild and/or acute. I recognise the benefits of mindfulness/meditation (and do try to incorporate such activities into my life)  but trying to treat my mental health problems solely with this seemed like the equivalent trying to treat a broking leg with nothing more than some paracetamol, i.e. it might help a tiny bit, but some more substantial treatment is definitely necessary as well.

I felt stigmatised by the doctors/counsellors – that my problems didn’t matter and I was making a big deal out of nothing, that I could fix it all with a couple of leaflets, meditation and self-help, that I could (and SHOULD be able to) do it on my own, but I couldn’t, I needed help from someone else, I couldn’t do it alone and I wish that the doctors had understood that (or at least made some sort of effort to try and understand). I was not okay and no matter how much I wanted to or tried to help myself, I didn’t have the tools to do it alone. It takes a lot of strength and bravery to admit that you need external help (not just self-help) so to have that rejection is absolutely soul destroying and leaves you drowning in a sea of hopelessness.

Thankfully, I am now on medication which has helped somewhat, I had some CBT which was quite useful, and I was diagnosed with (and subsequently medicated for) ADHD, which explained a lot of my difficulties (and the medications have helped with some of those symptoms). But honestly I’m still not in a great place and would probably benefit from some therapy. But the main reason I feel I require this isn’t so much to deal with the original problems I sought help for, but rather to address the psychological damage caused by being constantly dismissed and invalidated when I have previously sought help. I have a lot of unresolved feelings regarding my experiences and I see the impacts of this constant invalidation in my life everyday, manifesting in my low self-esteem and a reluctance to express my needs and ask for help.

The painful irony is that my quest to get help for my MH difficulties has left me so mentally scarred and traumatised that I now need even more help (but I’m also scared to get help in case it happens again…). It has left me so broken and exhausted that I still can’t function properly, even though my original problems have been addressed and shown some improvement. I am sure many other people have has similar experiences.

These experiences have left me feeling a lot of different emotions.

SADNESS, ANGER, RESENTMENT , DESPAIR , FRUSTRATION, DISAPPOINTMENT.

I’m just so ANGRY at the doctors/counsellors that dismissed me. I had several friends say to me “why don’t you try meds”? I know they were just trying to help but this was the opposite of helpful (they obviously weren’t to know this). I would have loved to try medication. I know meds are not always the answer and you shouldn’t rely on them, but I was desperate at this point. I had been struggling so badly for so many years and nothing I tried seemed to help! I was going to the gym almost every day as it was the only thing, other than sleep, that offered any form of relief for me. And even then the effects were very short lived, often having worn off by the time I arrived home from the gym. I was napping most days because I was constantly exhausted and mentally drained. If only it was that easy for me to try meds. I heard several stories from friends about how easily they were prescribed them, but this was the complete opposite to my experience. Every time I went to the doctors I felt like I was dismissed, made to feel like there was nothing wrong with me and fobbed off with nothing more than a leaflet (with a sprinkling of psychological trauma and distress). Fair play to them, every time when I was sure my mental health couldn’t get any worse, that I couldn’t move any further towards the cliff edge without falling off, they managed to push me that little bit further. I’m angry at myself too, maybe I wasn’t trying hard enough to get better, maybe it was my fault, maybe I wasn’t standing up for myself enough. But I know I did try, I went on those shitty websites that offered no real help. I kept revisiting every so often, hoping that by some miracle they’d updated the website and I might actually find something useful (unfortunately pigs don’t fly). 

I’m SAD and FRUSTRATED about all the damage they’ve caused me and how much my life has been impacted. It’s impacted my mental wellbeing, my social life, my academic performance, my work and literally every other aspect of my life.

I’m filled with RESENTMENT at being treated so poorly and hurt so much. I resent the doctors/counsellors for treating me this way. I also resent how easy it was for other people to get medication or support. I hate that I feel that way, I shouldn’t be angry about other people receiving better support than me or an adequate level of treatment, I should be happy for them, and deep down I am, but I am also filled with DISAPPOINTMENT that I did not receive the same level of support.

I have spent years with a constant feeling of DESPAIR, a complete loss of hope. A loss of hope in myself and my ability to succeed and be happy, a loss of hope and confidence in the ability of the GPs and my university to effectively help me or other people. A loss of hope for life in general.

I don’t want to feel this way, these are not attractive qualities, and it’s not enjoyable feeling this way. I want to be able to move on, but I feel like in order to move on I need to actually talk about and acknowledge the feelings I have and not just keep it all to myself. I think bottling up these feelings has been preventing me from moving on. I think writing down my thoughts and sharing them with others is the first step in this process.

All I want is to be able share how I’m feeling with someone else and for them to just listen, acknowledge and accept my feelings as valid, rather than instantly dismiss them. Surely that’s a reasonable request? Surely everyone deserves to have their feelings listened to, respected, and accepted? Everyone’s feelings are VALID and personal to them and should be treated as such.

If your feelings have been invalidated, don’t let it deter you or stop you getting the support you need. Reach out to another source, whether that’s seeing a different medical professional, or simply speaking to a friend or family member, there will always be people out there to listen and support you. Or even using mental health helplines such as Mind or Samaritans or Shout (a text messaging service). There will always be someone available to listen. Never underestimate the power of a listening ear and judgement free love and support. No matter how many times you get knocked down or dismissed, remember that YOUR FEELINGS ARE VALID. Keep pushing until you get the support you need and DESERVE.

Mind – 0300 123 3393; Samaritans – 116 123; Shout – Text SHOUT to 85258

If your feelings have been invalidated, don’t let it deter you or stop you getting the support you need. Reach out to another source, whether that’s seeing a different medical professional, or simply speaking to a friend or family member, there will always be people out there to listen and support you. Or even using mental health helplines such as Mind or Samaritans or Shout (a text messaging service). There will always be someone available to listen. Never underestimate the power of a listening ear and judgement free love and support. No matter how many times you get knocked down or dismissed, remember that YOUR FEELINGS ARE VALID. Keep pushing until you get the support you need and DESERVE.

What is ADHD?

So what is ADHD? Most people have heard of it but much fewer have a good understanding of what it is. When the term ADHD is mentioned I’m sure many people’s minds immediately picture the classic stereotype of hyperactive, naughty little boys who are constantly full of energy and get distracted by anything and everything. Whilst it can sometimes present in this way, this does not describe the large majority of people with ADHD and someone does not need to be hyperactive to have ADHD. In fact ADHD can lead to many different symptoms and difficulties that differ greatly between individuals. In particular symptoms can present very differently between sexes and between adults and children. This post aims to outline the different forms of ADHD and highlight some common symptoms, beyond the typical ones that everyone has heard of.

There are 3 types of ADHD:

  • Hyperactive-impulsive type
  • Inattentive Type (formerly known as ADD/Attention Deficit Disorder)
  • Combined type
https://bestwoldofknowledge.blogspot.com/2015/03/adult-add-symptoms.html

Symptoms of inattentive type include (DSM-5 criteria)1:

  • becoming easily distracted
  • trouble holding attention on tasks or play activities (i.e. getting bored quickly)
  • poor attention to detail or making careless mistakes in schoolwork, at work, or with other activities.
  • avoids, dislikes, or is reluctant to do tasks that require mental effort over a long period of time (such as schoolwork or homework).
  • difficulty organising thoughts, tasks and activities
  • losing things, e.g. keys, phone, pen, homework etc
  • often appear not to be listening when directly spoken to
  • forgetful in daily activities
  • often does not follow through on instructions or fails to finish tasks

People who are impulsive or hyperactive often (DSM-5 criteria)1:

  • fidget, fiddle with things or feel restless
  • struggle to sit still or often leave seat when remaining seated is expected
  • talk too much and/or too quickly
  • have trouble engaging in quiet activities
  • are constantly “on the go”
  • are impatient and have difficulty waiting their turn
  • act impulsively without thinking about consequences of actions, e.g. doing something dangerous without thinking about potential for injury
  • blurt out answers and inappropriate comments
  • interrupt people when talking

May also (not included in DSM-5 guidelines):

  • struggle to process and remember new information or large amounts of information at once
  • have difficulty focusing on a single task, often switching between many different tasks
  • be overly sensitive and/or have exaggerated emotional responses
  • often appear to be ‘zoned out’ or daydreaming

People with combination type experience many symptoms from both lists.

To meet diagnostic criteria you must experience at least six of the nine key symptoms for a specific type of ADHD (or five or more if aged over 16 years)1. To be diagnosed with combination ADHD, you must show at least six (or five if 17+) symptoms from each group (inattention and hyperactive-impulsive behaviour). Additionally, symptoms should have been present before the age of 12, occur in more than one setting (e.g. home, school, work, or with friends), and significantly impact everyday functioning, e.g. work or school performance or socially. Finally, the symptoms cannot be better explained by another mental disorder.

Hopefully this post has helped deepen your understanding of ADHD slightly and highlighted that not everyone that has ADHD is hyperactive and that there are many other everyday difficulties associated with ADHD, such as memory, processing and organisational issues.

[1] American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub.

Uni Results Day: The Most Underwhelming Day of my Life…

Thursday 23rd July 2020. What significance does this date have? Not much to be quite honest. This was the day I received my final university results and degree classification. The culmination of 4 years of hard work and struggles. Surely  a pretty significant moment in my life right?? WRONG! Despite being just a few days ago (4 days at the time of writing), I have little memory of this day. In fact it felt so insignificant that I had to look up the day/date whist writing this because I could not remember. To me it was just any other day of the week. A pretty boring morning. I remember opening an email with my results around 8.45am, seeing my result, sending a screenshot to my parents and then swiftly laying my head back down on the pillow to go back to sleep. The only miniscule sign of emotion was a split second of relief that I had got the 2:1 I needed to meet the conditions of my job offer. But this was very short-lived, lasting less than the time it took me to take the screenshot. Beyond that I felt emotionless – just a deep pit of nothing. Not even a hint of happiness or excitement or anything of the sort. Neither did I feel any disappointment or sadness. I simply felt indifferent. There was a complete disconnect between me and my results. I knew the grades were a result of work that I had submitted and spent hours and hours doing, but yet there seemed to be no emotional attachment there. I was there, the results were there too, but we didn’t know each other, we were strangers.

I thought perhaps the reality just hadn’t quite sunk in yet and that soon I would experience some sort of delayed response. After all, I had worked towards this day for 4 years – surely I should feel something!? Or perhaps the effects of COVID-19 and the disappointment of not being able to finish university in person or have a graduation ceremony, as well as the ridiculous amount of time between finishing exams and receiving results, had been so mentally draining and had exhausted all my emotions so much that there was nothing left to give when the event finally came around.

My parents soon came into my room, smiles on their faces, expressing their happiness and pride, but still I felt nothing. And here I am 4.5 days later still yet to feel any real emotion regarding my results. All I wanted was to go back to sleep (yes, sleeping is still my primary coping mechanism lol). When other people asked if I was pleased, I almost felt obliged to say yes, but in reality this was a lie. I wasn’t unhappy either. I just felt, and still do feel, so indifferent. Everyone else seems so happy for me but I still felt nothing. Nothing could have prepared me for how incredibly underwhelming the experience was.

Why I started this blog…and how it relates to baths!?

Well…the first, and main, reason I decided to start writing this stuff was as a form of ‘therapy’ for myself. My mind was constantly racing with millions of thoughts quickly passing through, jumping from one thing to another, with no structure or coherence. This gave me minimal time to process and understand each thought and left little to no mental capacity for important tasks that I needed to do, such as writing coursework and revising for exams.

Over the last few months I have found writing to be a great outlet and release and has allowed me to organise my thoughts in a much more structured and coherent way than what I am able to do in my brain. Getting things out of my head and down on paper (or screen) has provided me with a sense of relief, somewhat relieving the pressure building up in my brain. My brain was like a bathtub with the tap stuck on, constantly overflowing (see image below), and pulling the plug out didn’t help as the water was still flowing in quicker than it was emptying. The water flowing out the bath represented all the important things I had to remember slipping from my memory, or my ideas escaping from my brain mid-sentence, making me lose my train of thought. I could not focus on tasks and kept forgetting things as everything was overflowing out of my mind, never to be seen again.

How to Handle a Bathroom Flood

By getting some of the thoughts down on paper/screen it almost felt like the tap had been turned down slightly, not completely off, but enough to stop the overflowing and allow the bath to gradually empty to a more acceptable level (see below image; a slightly more relaxing, less hectic experience than before…). Writing things down allowed my brain to finally start emptying slightly, freeing up space in my mind, allowing me to focus on things for a bit longer, without getting so distracted, without losing or forgetting key information part way through.

An oval bathtub filled with bubbles in a … – Buy image – 11396864 ...

Now I hadn’t originally planned on sharing any of this stuff I was writing, it was simply just a strategy I was using to vent and free up some space in my mind for more important things. (DISCLAIMER: This is definitely NOT a ‘feel sorry for me’ thing at all and I don’t want people thinking that!). I was hesitant to make this public for that exact reason. However, whilst talking about it with a mentor I’d been seeing, I thought maybe sharing what I’d written could be beneficial, both for myself and others. I thought perhaps if people read it, they would not only understand me more, but it could help raise awareness and understanding of neurodiversity and mental health conditions and encourage people to seek help. I hoped that maybe such increased awareness could also allow people to be more understanding and accommodating of friends, colleagues and acquaintances, in workplaces, social situations etc. If this could help even one person, it would make it worth it.

Finally, I hope that increasing awareness will aid in busting myths and misconceptions surrounding ADHD and associated mental health problems. For example, people being labelled lazy, rude, stupid, useless etc. I hope this will make people stop and think before labelling someone as such and consider whether there may be underlying issues or that the environment might just not be right for them (yes, I’m looking at you school classrooms and 2 hour long lectures!!) and adjustments may need to be made to accommodate for this.

Introduction

Hi I’m Alice, a 23 year old, recently diagnosed with (ADHD). I enjoy exercising, napping, complaining, making people laugh and impulsively doing reckless things…

Welcome to my blog “I need a nap”. Why is it called this you ask? Well, firstly, anyone who has lived with me or knows me well probably knows that this is one of my most commonly used phrases haha so I thought why not make it the title of this blog. But also because this blog is going to be centred a lot around my mental health struggles which, as anyone who has experienced MH struggles themselves will know, can be extremely mentally and physically draining and can leave you feeling constantly exhausted and in need of a nap.

Naps have always been an escape for me, no matter how I am feeling. Sometimes it’s physical exhaustion, others it’s mental, and sometimes I’m just bored, whilst at other times I just feel overwhelmed by everything and simply need to ‘switch off’ for a bit. Therefore “I need a nap” seemed a fitting title. The main focus of this blog will be ADHD and associated mental health comorbidities, such as anxiety and depression, which often go hand in hand with ADHD.

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