What do you do when the internet claims you've got adult ADHD? Do you seek a proper diagnosis and a prescription for medication? Read the advice of Maddy Phillipps (and send your own problems to dearmaddy@tvnz.co.nz).
DEAR MADDY: My social media feed is full of tests and quizzes designed to ascertain whether or not I have undiagnosed adult ADHD. Usually, if I'm honest, my result comes up that I do: I'm chronically late, I'm always losing my car keys, I struggle to focus and I leave everything to the last minute – always have. Usually when I'm told I have this condition I ignore the "diagnosis". I figure I've got this far in my life and career (I'm 48) without medication or help of any kind. I have my ways of managing my brain and achieving my goals. But recently I've learned that not one but two of my female friends are taking Ritalin. One of them swears by it, saying she's never experienced such clarity and focus. The other says it's too soon to tell. This has left me wondering, should I be seeking an official diagnosis and potentially taking Ritalin too? I feel quite happy in my flawed existence, but if my friend (who I never even knew had these kinds of issues) feels so improved am I turning my back on my true potential? – Kristen
MADDY WRITES: Kristen, while I can’t give you a yes/no answer about medication, your letter raises uber-topical issues, so I'll answer as best I can. Please know that what follows is not a clinical or expert opinion but very much just my personal one. I’m not yet a qualified/registered psychologist, and even if I were, I couldn’t advise someone whether to seek a diagnosis based on the results of an online quiz – those aren't exactly known for their scientific rigour. I once returned from a multi-day tramp with diffuse abdominal pain, and sought quiz-based diagnoses, the results of which suggested ailments ranging from pancreatic cancer to Crohn’s disease, when actually the problem was that I'd eaten nothing but Alison’s Choice Scrummy Mix for a week, and was well overdue for a poo.
I digress. As you’ve discovered, over the last few years adult ADHD seems to have exploded in popularity. There’s constant discussion about it online, and then there’s the proliferation of real-life diagnoses. I mean, I have an ADHD diagnosis, as does my boyfriend, my brother, virtually all my closest friends, and lots and lots of colleagues. Sometimes it feels like the prevalence of ADHD in adults these days borders on the farcical. Which begs the question: do all of us (and your friends, and maybe even you?!) really, truly, have this thing?
Of course ADHD is a very real neurodevelopmental disorder, and I know that for many, when they get diagnosed it’s a huge relief – massive validation that they’re not inherently defective, but rather that they’ve been struggling with a disorder for their whole lives, and it has a name, and it can be medicated. I get that, and I also get how lifechanging medication can be for some people, taking them from abject chaos to the kind of basic functionality that finally sees them getting to work on time, paying their bills, and being present for their kids.
But then there are the fringe cases. Consider, for example, a person who complains that they can’t focus, but then you find out that their job is utterly monotonous, their workload is absurd, and they’re a single parent of one-year-old twins who are yet to sleep through the night. Yes, maybe this person does indeed have ADHD, and maybe a stimulant will pour just enough dopamine into their exhausted synapses to keep things ticking over. But maybe the real problem isn’t ADHD, but rather that the demands on their time and energy are unsustainable, and absolutely no-one could focus under those conditions.
I do wonder if more than a few ADHD diagnoses result from people trying to work under conditions to which we are all fundamentally ill-suited, leaving us desperate, exhausted, just plain bored, or all of the above. After all, it seems unlikely that we evolved to be consistently energised, focused and motivated at set times for a minimum of 40 hours per week, but that's what late-stage capitalism demands of us, so we do our best to make it happen – and when five oat lattes a day barely keep you at baseline why wouldn’t you start wondering if you're a candidate for something stronger?
Months to wait for a diagnosis
On the flipside, I suspect ADHD often goes undiagnosed – partly because wait times to see a psychiatrist in the public system stretch for months, and partly because plenty of ADHD-ers develop effective ways to overcome distraction and get things done, to the point that it never occurs to them to seek a diagnosis. One way of doing this is finding a job that complements your personal psychological makeup, and I’d place myself squarely in this category. I remember my brief but disastrous foray into the corporate world like it was yesterday: I got up from my desk about 20 times a day to make tea, and then another 20 to pee out all that tea, and another 10 to swap out various items of stationery, because I was physically incapable of remaining stationary. Then I became a criminal defence lawyer, and was on my feet all day managing relationships with individuals ranging from delightful to demonic (I refer, of course, to the judiciary), and the consequences of a f***up would be so dire that I could actually concentrate, so the ADHD question never really entered my mind, and I was only diagnosed by chance at the age of 28. At which point I realised that the stress and constant deadlines of criminal law are basically tailor-made for the ADHD brain, because we need a higher-than-usual level of pressure to get things done – which probably also explains why so many of my colleagues seem to have it.
For me, I’m pretty sure that I’m genuinely ADHD, but I do work that suits my brain, and I choose not to take medication because I find it turns me into a socially awkward robot, so the diagnosis is interesting but doesn't have a huge impact on my life.
Ritalin isn't a silver bullet
Diagnoses and dispensation of dexamphetamine fix some problems for some people, but certainly not all problems for all people – and for others, they actually create problems, because like all drugs, stimulants can have side effects, and of course they can be addictive too. Ultimately, choosing not to maximise your focus and productivity every minute of every day by sticking with your brain’s original software isn’t a moral failing – but nor is taking the meds if they truly improve your quality of life.
I think that when deciding whether to seek a diagnosis, you should be guided by whether you think it would be useful for you – which is going to be completely different to what’s useful to your friends, no matter how breathlessly they rhapsodise about their newly crystal-clear cognition. By the sounds of things, you’re doing great, and you have strategies to manage your brain and get sh*t done, and you’re happy in yourself – so, what would a diagnosis actually mean for you? What is the “true potential” you think might be unlocked? Is it just getting slightly more stuff done everyday, or is it some bigger goal that you genuinely feel your psyche has hamstrung you from achieving? Only you can decide but, if you do take the medical route in the public system, make an appointment swiftly – as I say, the wait times are real.
Maddy Phillipps is a barrister, freelance writer and clinical psychology student.
EMAIL your life problems to dearmaddy@tvnz.co.nz.
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