Do you have ADHD?
Emily Writes Weekly
Welcome to Emily Writes Weekly. Over on my Instagram, we discuss all sorts of stuff and one thing that comes up fairly regularly is adults being diagnosed with ADHD. I’ve been asked lots of times to talk about it - so I thought I’d go for it.
Is it possible that you have ADHD? Adult attention-deficit/hyperactivity disorder is a nuerodivergency mostly thought of as something that children have. But hey! Children grow up! Amazing! Which means there are many adults who have ADHD. And many are undiagnosed.
Attention deficit/hyperactivity disorder (ADHD) is the most common neurodevelopmental disorder diagnosed in childhood. It’s talked about a lot when it comes to children, but few people understand the prevalence in adults because we just don’t seem to have the data. The best I could find was from 2016 [pdf] which suggested the worldwide prevalence of adult ADHD is estimated at 2.8% which I think is too low. But hey, what do I know.
There has been a lot written about the phenomenon of young girls and women not being diagnosed with neurodivergency (ADHD/Autism). This excellent article in The Guardian explains it well -
“The default assumption about ADHD is that it’s what makes little boys disruptive. But it can also make little girls feel like they’ll never be good enough. Statistics have traditionally shown ADHD is more prevalent in males, but recent research suggests this could, in part, be due to misdiagnosis. Unsurprisingly, ADHD in women is hugely under-researched – females weren’t even adequately included in findings until the late 90s. And it wasn’t until 2002 that we got our own long-term study.”
“ADHD presents differently in girls and boys too. Women are more likely to have inattentive ADHD, rather than the more observable impulsive type. Because of society’s gender norms, girls with ADHD are often dismissed as “daydreamers” and “overly sensitive”, as if we are a romantic, quirky caricature from a John Green novel or the Disney Princess canon.”
RNZ has also published a great documentary about how ADHD can be different for women.
Over the last decade, I’ve watched a number of my friends receive a diagnosis of adult ADHD. I’ve watched in wonder how the many things they have suffered through their whole lives have been explained, and I’ve watched them flourish with medication.
As more and more adults understand their diagnosis, they’re taking to places like Instagram to share their knowledge with others. Neurodivergent Lou and Jen has ADHD are two great accounts that provide excellent resources to better understand ADHD.
I asked my friends about their diagnosis.
In 2017, Tamsyn’s friend was diagnosed with ADHD and she suggested Tamsyn should look into a diagnosis. It took until September 2018 to get formally diagnosed. She talked to her GP first and was given a referral to Mental Health Services. During her assessment appoint she was told it was “unlikely” that she would be approved for funding for a psychiatric appointment given she was not suicidal. She was told there is funding for just 3% of all patients and she didn’t qualify.
She went private and prepared printouts of online assessments and her school reports. Her psychiatrist charged $450 an hour. Her first appointment was 1.5 hours and by the end of it, she was told she had moderate-to-severe ADHD. She then had “a few” 15-30 minute appointments to refine medication. All up, she believes it cost $1200 to be diagnosed. Her ongoing costs are around $35 a month for her repeat subscription fees at the GP and pharmacist.
She says she’s had a slow but steady improvement since diagnosis. “The meds don’t fix everything but they’re a bloody good start. They provide the foundation I can build on.”
“I have far more insight into what I truly want, and who I truly am, now that I understand why my brain works the way it does.”
Alice was diagnosed in late 2020. “It took ages - I first asked my GP about it in 2017 or 2018 and she referred me to CMHS, I waited for three months to get an initial assessment interview and then although they agreed I met a lot of the diagnostic criteria, I wasn't severe enough to qualify for CMHS services.”
After that Alice tried to find a private psychiatrist. “My regular therapist (who I see privately) also supported me and recommended I try VUW Psychology school as an option but they were totally full and not taking new patients. So it wasn't until 2020, that I was able to find a private practice that I could book with. They still had a wait list of around two months but at least could see me over Zoom (because they're Auckland based) and specialise in ADHD especially in adults and women. That was a concern for me because my experience with it and presentation of it through my life isn't the typical or traditional ‘hyperactive boy disrupting the class’.”
Meds have made a “huge impact” for Alice. “I didn't realise just how much I'd struggled with focus and executive function until it wasn't as much of a struggle. But meds aren't a quick fix and they don't address all of the ways it presents - I still need to be quite aware of the way my brain works and try to channel it constructively. And if I forget to take them, which ADHD people absolutely struggle with, my afternoon will just go straight downhill.”
“More generally, knowing there's a reason for the way my brain works, and recognising that it's a neurodiversity slash developmental disorder, not laziness or poor character, is such a huge world view shift for me. I spent decades blaming myself for feeling like a failure, not being able to do things that other people seemed to be able to do without thinking about it, and it turns out they don’t have to think about it. It also really helps having a workplace that's flexible and high-trust - they let me work in ways that work for me, instead of trying to fit into neurotypical ways of working or being.”
Alice’s initial assessment and follow-up came to around $600.
Dusty was diagnosed a month ago. “This was after my child was diagnosed last year, and followed several months of conversations with my GP about my long-standing anxiety, and the possibility that this was actually untreated ADHD. All up from being referred by my GP to my assessment and diagnosis took five or six weeks.”
Dusty says medication has been a “absolute revelation”. The diagnosis has answered a lot of questions Dusty had about how her brain works.
“I have never felt so calm and relaxed. To begin with it just made me so sleepy, but after a couple of weeks things straightened out and I feel basically back to my old self but with zero anxiety. The constant overwhelming feeling of being full of swarming bees is gone. I can sit on the couch and watch a movie and not get up fifty times.”
Dusty saw a psychiatrist privately. It cost just over $800 for the initial assessment and the follow up medication review. “This is at the lower end of the range for costs that I've heard of, but generally it seems to be around $400 per hour”.
“It's really really hard for adults to reach diagnosis and treatment, which is so sad because for many of us it can be life changing.”
What do you do if you think you might have ADHD?
Step one: Try out an online screening assessment and see what your score is. This tool does not replace consultation with a qualified professional but it might tell you if it’s worth pursuing a formal assessment. This particular one will ask you 18 questions and takes about five minutes to complete. Your responses will be rated, and at the end of the test, you'll get an indication of whether to get a proper assessment for ADHD.
Once completed, you can download your answers and score and use this to support your assessment process. If you score four or higher - you may wish to go to step two.
Step two: Book an appointment and ask your GP if they can screen you for ADHD. They can’t diagnose you, but if the screening suggests you may have ADHD they can give you a referral.
Only a qualified registered Clinical Psychologist, Psychiatrist or Paediatrician can accurately assess and diagnose ADHD.
Step three: You need to save money. The wait to get a public ADHD screening is by all accounts impossibly long. So everyone I know has saved up and gone private. You might be able to get insurance to cover your assessment - check here.
Step four: The only medical professionals who are specialised to assess and diagnose ADHD are either a Paediatrician, Psychiatrist (Child & Adolescent, or Adult), Neurologist or a Clinical Psychologist. ADHD NZ can email you a list.
Questions you should ask them before booking them (thanks to ADHD NZ)
How long have you been working with patients with ADHD?
What percentage of your patients have ADHD?
Have you received any training in the diagnosis or treatment of ADHD?
What is involved in the assessment—written tests/interviews?
Your typical treatment plan — behaviour modification, medication, alternative therapies?
What are the costs involved?
Do you accept my insurance?
It can take up to six months to get an appointment.
Step five: Here’s what you need to take for your appointment. You’ll get questionnaires that you will have filled out and sent beforehand. These will be reviewed and scored.
You’ll have questionnaires for others to fill out - like your partner, colleague, teacher if you’re in uni etc. These will also be sent beforehand. Bring a social and family history think school reports etc and/or medical, psychological, school or employment records, or the results from our self-screening tool) to the appointment.
Your first session is likely to take 60-90 minutes, and a typical assessment for adult ADHD may take up to three hours.
Note: Not every assessment will be so thorough. I went through this post with Tamsyn who said her diagnosis did not require supporting documents beyond self-assessment tools.
I’d love to hear about your experience in the comments.
There are lots of online support groups for adults with ADHD including ADHD NZ and Facebook groups.
I hope that helps.
Best of luck with your journey. Arohanui, Emily
We’re in the process of getting a diagnosis for my 10 year old. He has scored as having inattentive ADHD in the testing so far. Of course it’s all now so obvious that my late husband was exactly the same. We didn’t even know there was an inattentive type! Unfortunately, he died by suicide a few years back. Depression and anxiety took him over. I’ll never know if diagnosis might have helped.
I was diagnosed two years ago at the age of 40. It has been both liberating and heart-breaking.
Firstly to know that I am not a bad person. That my 'defective traits' are not a personality failing, that I have been actually living life on hard mode and that it doesn't need to be this way.
Having ADHD had never once occurred to me, as all of the stereotypes are focused on hyperactive boys, I had never even heard of inattentive type.
I sought help- as I was on the verge of a nervous breakdown. After having kids, my usual coping mechanisms were not enough. The juggle and drain of motherhood and the eventual return to work nearly destroyed me. I just couldn't do it. Throw in a global pandemic, lockdowns and a few other stresses and I was drowning, constantly anxious and in a deep depression. Turns out- those were all symptoms of untreated ADHD.
I could not stop crying from relief when the diagnosis was confirmed, I got the psychiatrist to go through every aspect to make sure it was correct, and booked a follow up a few weeks later just to confirm that there was no mistake.
Once I had accepted the diagnosis, I also experienced absolute heart break, with the realisation that for all of those years that I had been considered lazy, dipsy, away with the fairies, incapable of getting my shit together, an absolute failure in living up to my potential- was because I did not get the right support.
As I shared the news with a select few, their dismissive response of "well it can't be so bad if you;ve only just realised you've got it" or "Nah there is no way you've got ADHD, did you scam them to get hold of the study drugs?". Yeah mate- the medication that I can hardly remember to take. Totally.
So generally, I am not open about my diagnosis. I haven't disclosed it at work as I know it will prevent me from being considered for promotion or trusted with important work. I'm still finding the medication that works for me, after a big delay in accessing appointments.
But overall, I am happy that I know. That I can make sense of my experience, and give myself a bit of self-compassion- even if that compassion and understanding is still a bit of a stretch for others,
Posts such as yours are so important for us Emily- thank you. It really means so much to be seen, heard and understood.