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20 May 2023

The real problem with how we deal with ADHD

My brain is weird and maddening, but I think I’m finally getting the hang of it. It should be society’s turn to catch up.

By Marie Le Conte

I was going to start writing this column but then I realised I was singing “Armadillo! Here I roll again!” in my head, to the tune of Abba’s “Mamma Mia”. The little song had come out of nowhere but obviously meant I had to think of what a children’s cartoon based on a little armadillo would look like. Would I get sued by Abba if I decided to make it? I probably would be – or would I? Weird Al Yankovic exists for a reason.

I was going to start writing this column but then I thought of what “Weird AI Yankovic” would be like. You could probably get ChatGPT or a similar website to write parodies of songs, and the bit would tire itself out quite quickly but it could be funny for a little while.

I am now going to start writing this column by explaining that, just over two years ago, I had an attention deficit and hyperactivity disorder diagnosed. Some people only have the AD or the H; I have both. Annoyingly, you do not get a prize for collecting all the letters.

During the winter lockdown of 2021, I talked about myself on Zoom and the psychiatrist cut the appointment short because my case was so clear cut. I kept forgetting to breathe because the words couldn’t come out of my mouth fast enough and I was sat like a pretzel. I scratched my head, bit my nails, touched my eyebrow, vaped, rearranged my shirt, licked my lips, vaped, cracked my knuckles and vaped some more.

The diagnosis was an anticlimax. It felt like walking into a room and being told, with fanfare, that my name is Marie Le Conte. The only reason it’d taken so long was that my attempts to get an appointment via the NHS had all ended in failure. One particularly memorable conversation ended with a GP saying, “I’m sorry, I have no idea what you should be doing.”

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In early 2021 a friend recommended a healthcare provider working with the NHS, meaning that I could get a diagnosis for free, and without waiting to die of old age. The waiting list was only three weeks long; it is now so gargantuan that their website says they can no longer provide an “appointment timeframe”. I got lucky.

Had I not received this well-timed tip, I probably would have been one of the people spending half a grand on getting assessed by a private clinic. The BBC recently aired an investigation on them, in which an undercover journalist got an ADHD diagnosis three times despite not having it. The backlash has been intense. People with ADHD have long struggled to explain that the disorder isn’t a fad or a con – had Panorama wanted to be helpful, it could have focused on the NHS’s appalling quality of service instead.

[See also: There are concerns around ADHD overdiagnosis. But what about misdiagnosis?]

Still, I found it hard to get angry. In most cases, an ADHD diagnosis is shortly followed by a prescription. As my assessment ended, I was told to send in some basic information about my body – weight, heart rate, and so on – after which I would be sent medication to start taking every day. It freaked me out. I had not spoken to a single person face-to-face; there were no plans for me to have regular check-ups once medicated. “Pop your pills and off you pop” seemed to be the way it worked. I told them I didn’t want the meds and left it at that.

In the months that followed I did my best to fill in the gaps in other ways. I read about the myriad ways in which ADHD symptoms can manifest, and how they ought to be dealt with. I learnt about the problems that can be solved, the ones you can sometimes work around, and the ones you just have to live with. I talked to other people with ADHD about what it was like for me, and for them, and how we felt about all of it.

It made me think of the bit in video games when you learn a new skill – flying, say, or double-jumping – and return to previous levels to try and figure out what you’d missed. I was still living inside the same head, but I had better equipment. Two years on, I feel more at peace with myself.

That doesn’t mean my ADHD has stopped being limiting. The idea of having a 9-to-5 desk job still horrifies me; I am still an insomniac, and will probably never stop doing stupid things on a whim. Mostly, I’ve learnt to manage my expectations.

It isn’t clear to me that I would have done this work on myself if I’d been handed pills on day one. This doesn’t mean that I believe all people with ADHD should refuse medication, of course – I have seen what treatment has done to friends who’d been struggling and it has been a joy to witness. I am just not convinced that one size fits all, especially when patients are handed prescriptions then expected to go it alone.

This, I think, should be the conclusion to draw from the Panorama investigation. Obviously, the NHS should pour more funding into ADHD assessments; obviously, dodgy clinics should be stopped if they are assessing people in an unprofessional manner. In the longer term, however, we should aim to build a world in which medicating neurodivergence isn’t seen as the first port of call after a diagnosis is received. My brain is weird, maddening, and too fast and too slow at the same time, but I think I’m finally getting the hang of it. It should be society’s turn to catch up.

[See also: What’s fuelling the rise in adult ADHD?]

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