Now that I’m “some kind of expert or something”, I have met enough children and young people to realise that many spend their childhood and adolescence in an agony of self-reproach, fuelled by constantly measuring themselves against others.
In retrospect, I’m rather glad that I had an insulating layer of social obliviousness, that prevented me from concluding that my years of teasing and social exclusion were anything to do with something about me. I simply attributed it to an arbitrary quirk of fate.
But I was different, no question. I was less socially mature and more emotional; prone to outbursts of silliness, temper and tearful devastation more or less equally. I was friendly and funny (sometimes), but though I could be good company, I was never relaxing company.
I was an absolute ballache to teach, from primary school right up to the end of medical school. I lost focus constantly, and relied on my wits and an ability to hyperfocus to get through exams. I floundered horribly when continuous assessment required consistent effort. I routinely questioned and challenged the authority of teachers. This continued right up to my medical finals, when my fury at the unfair and derogatory tone of my psychiatric examiner very nearly ruined the whole thing.
Some of you will know where this is going, but to spell it out: I entered the NHS as a doctor carrying significant cognitive disadvantages. Had I ended up in pharmacy, or been somehow coerced into a career in surgery, I would not have lasted too long- I’m not meticulous enough, or respectful enough of hierarchy. But I’m energetic, creative, engaging, and able to take in a lot of information, whittle down what is important, and make decisions. So I did OK in paediatrics.
Mainstream medicine is ok, if you like that sort of thing, but what really started to grab me was child development. The process of a baby with, let’s face it, a pretty meagre skill set, becoming a fully fledged person still strikes me as the most complex and fascinating phenomenon we know of, and it’s still a privilege to work in this area.
The areas which drew me most were those related to relationships, communication, emotions and behaviour. So naturally as a paediatric trainee I started off working with autistic children, those inspiring and wonderful minds who try so hard to cope with a nonsensical, neurotypical world.
But then I was lucky enough to get a substantial CAMHS placement, and I was assigned to help in the ADHD clinic. I was hooked.
It was the energy of the kids. Their lack of filter, artifice or ceremony. You may say….”like all kids”, but these guys were turned up to 11. And they were often terribly, terribly misunderstood, as ‘impossible’ ‘unteachable’ pupils who ‘persisted in making wrong choices’. I threw myself into trying to help these children and families.
My inspirational supervisor, Dr Carsten Vogt, was an enthusiast for direct measurement of ADHD symptoms, using the QB test, essentially a highly repetitive computer game. He suggested I had a go. It was enormously tedious and created an unbearable itch at the back of my brain. My scores, of course, came out well into the ADHD range. When I told him, he was typically sanguine “well, I guess you can say to the kids that people like them can succeed”.
And that’s how I left it for 10 years.
The model of ADHD I have in my head is that really it’s the convergence of two things: firstly, a neuropsychological state of ‘brain-hunger’ whereby the brain constantly seeks out stimulation, be it tactile, emotional, visual, or proprioceptive. Secondly, there’s the impairment to the person’s life caused by their neuropsychology. So in my head there’s a graph, with brain hunger on one axis, and impairment on the other. I flattered myself that I was quite far along the former axis, but not far off the ground on the latter. I bumbled through fatherhood, training and, without really meaning to, setting up and running an ADHD service.
But then two things happened; I got a new PA- a very organised PA with no time for deference to consultants, or for my higgledy-piggledy approach to caseload management. A couple of stern looks and a comprehensive re-think, and she had me pointing in the right direction, but it made me realise how indulgent the team, and the families, had been of my forgetfulness and disorganisation.
I also, finally, after 15 years of marriage, realised what it must be like for my wife to be with me. Imagine living with someone who is constantly restless, always thinking of the next thing, who leaves dull tasks half done but has boundless energy for his own obsessive interests. Who snaps when criticised and can’t calm your equally restless children. This is not, whatever other qualities they may possess, an easy partner to have. My wife is patient and kind, and finally I began to see what she had to deal with, trying to keep loving me.
I was quite a bit higher up the impairment axis than I thought.
So I went to the GP, and after a surprisingly short wait, found myself having a delightful chat with a psychiatrist.
I told her pretty much the same story I’ve just told you, and after an hour or so we concluded that yes (and this is no-one’s idea of a big reveal) I do have ADHD.
Given that I have tried most things that we could think of short of medication (sleep, exercise, organisational props), would I like some tablets?
I must admit, as someone who has been prescribing meds for a decade, I hesitated for a few days with the prescription in my drawer. To make the transition from a person who is ‘a bit different’ to a treated patient is a big thing. I was grateful that, as far as I know, I’ve never pressured a family into making this decision, and often resisted external pressure for ADHD medications: families and young people must arrive at the decision themselves.
In the end I took the meds. This isn’t a post about how well they have worked, though. Another time.
Knowing that I’m ADHD has been… interesting. It’s made me think more deeply about what the condition actually is, and what it feels like (again, another time), and how fantastic and irritating and exhilarating and painful it can be. It’s given me insight into myself as a father, husband and colleague. And it’s made sense of the fact that for all the offers I’ve had as an ADHD specialist (talks, writing, meetings, charity trustee), the answer has always been yes. Because these are my people.
So, an ADHD specialist with ADHD, eh? Must be unique…. well, no, not really. So why am I sharing this? I think for a few reasons;
Firstly as someone with both lived experience and specialist knowledge, I hope I can make a unique contribution to the debate around ADHD, behaviour, support, medications and mental health.
Secondly, I want any potential conflict of interest to be open and transparent. I advocate for all children in my Royal College work, but I do feel that ADHD kids are one of the more neglected groups, and I want to be free to carry on making that argument. .
But most importantly, I want to young people growing up with ADHD to have an example of someone with the condition who is not unattainably cool, or famous, but has done…. pretty OK.