Inside the pinball machine: living and working with ADHD

[This is a post I wrote for colleagues at work, following a TEDx talk I gave about ADHD at work]

There are probably around twenty people in this organisation with ADHD: Attention Deficit Hyperactivity Disorder. I’m one of them. It’s thought to affect around 4% of the male population; slightly fewer women. These days, it’s recognised by many as a form of “neurodiversity” - a way of looking at atypical neurological conditions such as autism spectrum disorder, dyslexia, ADHD, Tourette’s, dyscalculia and others as part of a range of normal human difference.

What is ADHD?

Many people with ADHD won’t have been diagnosed; some may be working in jobs where it isn’t a problem, others may be struggling but don’t know why. ADHD is with you from birth*; it’s not created by parenting, the internet, the environment, or watching too much television. It shows itself it different ways, but there’s a common core to most people’s experience.

ADHD has come to be associated with hyperactivity most of all, but lots of people with ADHD are not especially hyperactive. I’m only mildly hyperactive (although I have to be careful around strong coffee and if I’m tired I can get very hyper, but I don’t realise it as the whole world goes into slow-mo). Even without the hyperactivity, ADHDers usually experience poor concentration, memory problems, very low boredom thresholds, impulsive behaviour and speech, punctuality issues, well-beyond-normal impatience (a queue of ADHDers can be a very tense place!) and most of all problems in trying to make ourselves do things that other people can tackle without difficulty. I do think, though, that we have a great capacity to live in the moment, to respond to the here-and-now. The low boredom threshold often leads us to innovate, unreliable memories mean we are not always tied to past ways of doing things, and lack of interest in detail means we can be good at dealing with the bigger picture. We can be very creative and entrepreneurial, even as we grapple with the challenges of organising our work and meeting deadlines.

The latest thinking about ADHD sees it as a problem of “executive function”: we can’t make ourselves concentrate, we can’t force ourselves back from distraction, we can’t resist that impulse - however much we want to and however much we know that we should. To anyone who hasn’t experienced it, it probably sounds rather weird; we all know that we have to do things and how to make ourselves get on with them. But it’s a bit different with ADHD. This can look like a failure of willpower, and indeed telling someone with ADHD to “just try” isn’t going to get you very far. The concept doesn’t mean much to us.

Counterintuitively, there are some things we can hyperfocus on, spending hours and hours obsessively on one particular activity. But we can’t turn it on or off - the executive function problem. A friend of mine, a successful entrepreneur in the hotel business, is typically ADHD almost all the time, but can vanish for hours into building complex financial analysis models in Excel. The logic and intricacy fascinates him–as it does me–partly because it’s a self-contained world into which the outside world only intrudes if we let it. My real hyperfocusing abilities are reserved, appropriately enough, for editing photographs for printing using Photoshop. Hyperfocus is another way in which the ADHD difficulty with time and time management shows itself: most people have a pretty good sense of whether five minutes have passed or an hour; ADHDers often don’t.

Growing up with ADHD

These days, ADHD is often detected in childhood. No-one had identified it as a condition, though, in the 1960s when I was growing up and I was finally diagnosed in my early fifties after reading about it at a friend’s suggestion and thinking “wow, does that sound like my life…” At primary school, I was the archetypal dreamy child: bright and responsive when engaged, but spending a lot of time just staring out of the windows, absent-minded, very easily distracted, and very easily bored, unable to concentrate for more than a few minutes on anything that didn’t enthrall me. Bright enough to get by without any real problems and pass my 11-plus (yeah, I really am that old). But then came secondary school, and that meant… homework. To be done by myself. To a deadline. You can fill in the next few years. The pleasure I always had in learning just leaked away under the doors. Even today, a lot of intelligent, articulate children aren’t diagnosed until they hit the homework barrier, when life can go upside down.

After that, my ADHD and I kept bumping quite hard into the more solid bits of real life, often bouncing off them like balls in a pinball machine and with about as much sense of direction. I was luckier than many and I managed to make ends meet and to support my partner of the time, and eventually work out a way of earning a living that sort-of accommodated my still-undiagnosed ADHD. On the way, I had a lot of different jobs, met all kinds of people, and had to do many new things. That’s the thing I’m most grateful for; being unable to focus, I had to keep moving on, changing, above all learning. A surprising amount has stuck: especially how multi-faceted, diverse and non-binary the world really is. It’s made me more compassionate, and given me an empathy with other people who don’t quite fit and whose way of being collides with the world rather than flows with it. I often also found myself in a position where the most positive side of my ADHD, the ability to come up with new ideas and solutions because I wasn’t tied to the past, was an advantage, especially if I had people around me who could help me follow through to implementing them. I learnt that distraction can have its benefits, too: while procrastinating in the face of a deadline, I have come across wider ideas and valuable information that I wouldn’t have done if I’d been fully-focused on the task in hand.

Living with ADHD

So to today: how does my ADHD affect me? The problems with procrastination, distraction and concentration are always there, and a lot of things still get done at the last minute: I panic in the face of deadlines and frequently work long hours to get things done on time. I’m pretty much hard-wired to think that things that go wrong are my fault, mainly because ADHD leads to low self-confidence, but also because I often can’t remember the details of conversations and meetings. I’m not good at large amounts of detail. I’m impulsive and often can’t hold back from speaking my thoughts out loud when it would be better not to. Long meetings can be hell; not only because of the concentration threshold, but also because I literally can’t sit still for more than about ten minutes before acute physical tension sets in.

One of the most trivial but frustrating aspects for me is losing anything that isn’t tied on or nailed down. In my hand one moment, who knows where the next. Just why are my car keys in the box where we keep the flea treatment for the cats?

At the other end of the scale, like almost everyone else neurodiverse else I know, and most people with unusual or uneasy minds, navigating through a world of standard expectations is not an easy thing; there are days and weeks when you are sideways-on to everything, and those solid bits of real life have really sharp edges.

Like a lot of people, I take medication for my ADHD and find it helpful. Most people have heard of Ritalin, which is one of the most commonly-prescribed medications for ADHD. There are lots of misleading ideas floating around about Ritalin so please don’t believe everything you read in the papers–it’s effective and safe, and non-addictive. It helps many people get back control of their lives, but like most other medications there are people it doesn’t work for or has side-effects and there are some newer alternatives.

I realise there’s an obvious contradiction between saying that ADHD is part of the normal human range of experience but taking medication for it: that’s a long philosophical discussion that I don’t have the space to go into here. Let’s just say that for the time being I’ve come to terms with living with the paradox.

One alternative for many undiagnosed people with ADHD is, unfortunately, self-medication through alcohol and unprescribed drugs. I’ve got quite an addictive personality and would have gone that route myself if a strong sense of self-preservation hadn’t kept me (and still does) well away from alcohol other than the occasional glass of sherry. For that I’m very grateful.

With ADHD, not surprisingly, come other problems–normally described as “co-morbid” with ADHD. ADHDers often have to deal with dyslexia; like many people who have had to live with undiagnosed ADHD, life has been difficult from time to time and I’ve had periods when I’ve been treated for depression. When I was diagnosed, though, a weight lifted and things became much clearer. I always thought I was struggling with study and work because I was depressed: now I realise I was depressed because I was struggling with work and can name the beast when its shadow falls.

I very much welcome that as an organisation we are starting to consider neurodiversity as part of the whole landscape of diversity. That’s far-sighted, and welcoming neurodiverse people into the organisation for some of the special things they bring will strengthen us as a collective and make us a much more interesting place as a culture.

Final thoughts

Some words of thanks; to all my colleagues (and especially those in my team) who put up with the impact of my ADHD with understanding and grace; to C, whose courage and openness about her own life inspired me to give the TEDx talk that led to this blog post; and to everyone who has written openly and bravely here about their experience of mental health issues, of difference and survival. I’m always proud that I work here, and an important part of that is working in an organisation where I feel safe in the knowledge that so many people just… get it.

If you’d like to find out more about ADHD, then anything by Dr Thomas Brown is a good starting-point. I’d begin here: https://www.brownadhdclinic.com/the-brown-model-of-add-adhd.

* Update November 2023: there is emerging evidence that trauma at any stage in your life can also include ADHD as part of its manifold impact.