Nicola Boyle was always being told off in school and made to sit in the corner, but it’s only now – almost 50 years later – that she knows why. She recently received a diagnosis of ADHD aged 56 after her 21-year-old son began undergoing treatment for the same symptoms. ‘Everyone said we were two peas in a pod. We are so alike, and I thought this is worth looking into.’
Attention deficit hyperactivity disorder (ADHD) is a genetic neurodevelopmental disorder that is characterised by inattention, hyperactivity and impulsivity. It may evoke images of rambunctious young boys being disruptive at school but, increasingly, older adults are coming forward suspecting they, too, have the condition. True, the most common age for diagnosis is between six and 12, but according to the charity ADHD Action, about 1.5 million adults in the UK have the condition. Only 120,000 have been formally diagnosed.
It’s helped that public figures, such as chef Heston Blumenthal, Happy Mondays singer Shaun Ryder and Spice Girl Mel B, have shared their diagnosis so the stigma is lessening. But what exactly is ADHD? Symptoms can be split into two types: inattentiveness or hyperactivity/impulsiveness. Roughly 20% of adults living with ADHD have trouble with concentrating and focusing but not with hyperactivity or impulsiveness.
‘At work, I was recommended to go on active listening workshops,’ says Nicola, from North Norfolk. ‘It wasn’t because I failed to listen, I just felt the urge to talk because my brain would rapidly jump to the next thing, and I would forget my original point.
‘I embraced having a busy family life and thrived in the chaos. We were the family that would turn up late to the school gate, kit flying everywhere, and we’d still be forgetting something. I just thought I was deeply scatty and distractible, not that there was anything “wrong” with me.’
That avoidance of boring or mundane tasks is a by-product of the inability to focus and prioritise, and is typical of ADHD, along with restlessness and forgetfulness. ‘If something doesn’t interest me it’s like pushing a boulder up a hill and it just doesn’t happen,’ says Nicola. ‘It isn’t that I can’t do it, something just stops me from completing the task in front of me if I do not see a compelling reason to do it.’
If this sounds like you, Dr James Brown advises using a free online symptom checker such as ASRS, found here. ‘This is about 90% accurate in predicting ADHD,’ he says. ‘Think about your past, because to get diagnosed, you must have had the symptoms since childhood. You must have moderate impact on at least two domains of your life: work, home, or social life.’
Adults with ADHD may have poor working memory, such as being unable to remember a simple shopping list, and ‘time blindness’. Nicola says making dinner can take hours. ‘I’ll make a pasta dish with sauce made from scratch. I’ll put all my focus into the sauce, only for it to dawn on me later that I never bought the pasta when I went to the shops.’
Others may also have oppositional defiant disorder, which means they often react poorly to perceived orders or rules.
‘It is important to understand that these symptoms would have been with you throughout your life,’ says Dr Tony Lloyd, CEO of the ADHD Foundation charity. Symptoms and their severity vary vastly, meaning that when people seek professional help, some are misdiagnosed. ‘I was given anti-depressants for some time, but I wasn’t depressed. I was burning myself out without knowing it, all the while masking the fact that certain tasks seemed more difficult for me,’ says Nicola.
ADHD is commonly associated with a wide range of co-existing conditions in adults, such as depression, which is almost three times more prevalent than in the rest of the population. And it regularly co-exists with eating disorders, substance abuse and anxiety. Unfortunately, there are also associated increased rates of suicide, bipolar disorder, personality disorders and obsessive-compulsive disorder. It means that a timely diagnosis of ADHD could be the key to comprehensive treatment for these conditions too.
Up to 70% of adults with ADHD also experience emotional dysregulation, which can make it more difficult to control emotional responses. ‘ADHD can put a strain on relationships,’ says Dr James Brown, co-founder of the charity ADHDadultUK. ‘The non-ADHD partner can feel that they have to parent their partner, which can damage physical and emotional intimacy. Because of the impulsive nature of some people with ADHD, the person will take risks, which can include infidelity and often financial issues.’
Caroline Shaw, from Berkshire, who at the age of 65 has just received a diagnosis of ADHD, says, ‘There is an element of regret in lots of ways – about things or opportunities that I missed and had not taken full advantage of.’ However, both Caroline and Nicola point out that ADHD can come with advantages as well as disadvantages. Nicola says that her fast-moving brain and ability to hyperfocus helped her during exams and gave her the ability to turn around work under tight time constraints. Caroline, who works as a fashion stylist, says, ‘I’m good at thinking creatively in 3D, seeing trends and knowing what people on the high street want.’
‘After that initial diagnosis, I understood the "odd" feeling that I was living with'
‘Creative thinking and adaptability can thrive in chaos,’ agrees Dr Lloyd. ‘People with ADHD are constantly making connections between their internal world and the external environment. They notice things that others can’t.’
In some ways, being diagnosed as an adult may seem futile, but it can help to understand your past and provide closure, and stop you feeling guilty or embarrassed about problems you needed to overcome. ‘After that initial diagnosis, I understood the “odd” feeling that I was living with. It didn’t mean that there was something wrong with me,’ says Caroline.
The most frequently prescribed ADHD medication is methylphenidate, also known as Ritalin, a central nervous system stimulant. Last year it was prescribed to 1.37 million people in the UK. Dr Brown, who himself was diagnosed two years ago at the age of 45, says, ‘I was medication resistant. I thought, I don’t want to take tablets because they’ll change me. But it’s changed my life and I now understand myself. I’d spent years thinking I’m lazy, I’m unreliable.’
Dr Brown also sees a specialist ADHD coach. ‘For most adults with ADHD, a combined approach of medication and psychotherapy – such as cognitive behavioural therapy (CBT) or having a coach – teaches you what ADHD is and seems to be the best way for people to have a happier, more functional life.’
Most GPs cannot diagnose ADHD, but they can refer you for a specialist assessment if necessary. ‘Just because you have made it this far without support doesn’t mean that you have to keep going without it,’ says Dr Lloyd.
It could take years for an initial NHS appointment, according to ADHD Action. Under the NHS Right to Choose, you can opt for assessment via a service such as psychiatry-uk.com. However, they’ve had so many requests from the NHS they are receiving approximately 150 referrals a day, causing a five to six-month waiting list. If you opt for a private assessment, fees can vary from £400 upwards.
That’s what Nicola did in the end. ‘I’m so happy that I spoke to a professional. I know that I’m lucky to be able to go to a private consultant. My husband says he has never seen me more comfortable in my own skin.’
Could you have ADHD?
Am I starting new tasks before finishing old ones?
Do I have trouble keeping quiet and frequently speak out of turn?
Are my organisational skills poor?
Am I forgetful or constantly misplacing or losing items?
Did my school report say I was unfocused or struggled to sit still?
Information and support
National Attention Deficit Disorder Information and Support Service addiss.co.uk; 020 8952 2800
ADHD Foundation services include online therapy for adults; adhdfoundation.org.uk
ADHDadultUK offers peer support and coaching for adults; adhdadult.uk
ADHD UK provides information and support; adhduk.co.uk