I find that many adults who have seen me for an online ADHD assessment, and who have received a diagnosis, have some anxiety and a lot of questions about ADHD medication. People say things like:
I'm not really into medication
I've had antidepressant medication, it's never helped
I really don't want to become dependent on medication.
Medication only helps children doesn’t it?
I didn’t realise medication might be appropriate for me. Do you think it might help?
Research studies suggest that atomoxetine and amphetamines significantly reduce core ADHD symptoms in about 75% of adults with ADHD and also improve the quality of life in the majority of adults with ADHD.
So, I thought it might be helpful to hear the reflections of Emma, a woman in her forties, who is self-employed, married and has 3 children. She was recently diagnosed and has started taking ADHD medication in the last few months. Emma had an online Adult ADHD Assessment with a psychologist, but was not assessed by me.
Here is our conversation:
How did you get on at school?
I often felt a kind of physical friction – where you want to move but you can’t and you’re not allowed to. I felt a kind of agitation. It was like if you're naughty or wiggly or you won't listen then there must be something wrong with you on some deep level. And I was like, what is wrong with me? It wouldn't have been in those exact words when I was a kid, but that was the feeling. I managed to channel some it – I did a lot of sport. And when I had to produce work for school – there was a lot of effort involved – like I was swimming upstream and trying to cram myself into a small box. Everyday tasks which most other students would find really pedestrian - I just wouldn't be able to get myself sorted, like bringing the right things to school, or forgetting stuff and leaving it behind at school.
Before you knew you had ADHD, what sort of things did you struggle with?
Basic things, like cooking a meal - things that most people find routine and easy. I could never get to grips with having proper routines. And for a long time, I thought that I was lazy or that there was something wrong with me. How come you can do this when you can't do that? I'd be having this conversation with myself and someone looking in might have said the same, well, why can you manage to do that? But you can't do this. You can focus on that thing you’re interested in, but you can't focus on this simple routine task.
So, what was it like when you were given the diagnosis?
The assessor, he told me I had ADHD. And then he said, “You're fine. You're not broken. There's nothing wrong with you”. And I was - honestly, it brought me to tears because there was a whole lot of stuff all in one go that all the frayed knots and all the question marks all got tied together in a neat kind of way. It kind of brings everything together that didn't make sense. A lot of things that didn't make sense, that seemed disparate or opposite or paradoxical suddenly made sense. Yes, it was huge.
So when you started thinking about medication as an option, what were your concerns, you know, about it prior to taking it?
I wondered if it might overstimulate me because I didn't fully understand how it works and because it seems paradoxical again that you on the one level, especially if you're impulsive or agitated, that you're going to be having a stimulant. Right? So I did think, “Oh, what if I feel like I've had 15 espressos?” But it's a short lived med, right? So it's not like you have to take it for a long time before it takes effect. I have had anti-depressant medication in the past – SSRIs, and you've got to take them for a number of weeks before it even does anything and you've got to take it every day and then it's cumulative. Whereas with this - you take it, it does the thing and then by the next day it's out of your system. So I thought, well, that's actually a low risk really in a way because even if I do feel horrific, then that's it, I've picked one and I've ditched it.
What was it like the first time you took the medication?
So, the first morning that I took one, I was like, “I'm not going to drive the car, I'm not going to do anything difficult, I'm not going to see anybody. I'm going to stay home where I feel safe in case I feel agitated”. And I just expected to feel like a drunkard double espresso or something. So the weirdest thing was, when I then took it - within under an hour, I leant back and I yawned and I never yawn! I was like, “Oh, I feel really calm, but not out of it. Like, I'm with it, I'm on the ball, I could do anything”. It's just as if I'd stepped into a warm bath and, you know, relaxed. It's really difficult to describe, but really profound. And I was like, “Wow! This is the absolute opposite of what I expected”.
It helps me take me a step back. With ADHD, I think sometimes when you're trying to do things or things are happening around you, can get overwhelmed. But with the medication, it's almost like you've taken a bit of a step back. Things are slightly further away. You can still think as quickly. It doesn't slow it down. That's what I feared too. I feared getting slow. Cognitively, I'm quite quick and I thought, “Oh, no, what if I can't think like I used to?” It's fine, I can. It's almost like I've just got slightly more of a gap between maybe this and that. I've got a moment between thought impulse; between a number of choices and making a decision. And then conversely, the bit where you can't get yourself off your bottom on the sofa to empty the dishwasher. The bit where it's difficult to start a task that you should be doing, no matter how much you berate yourself. That bit, that gap got smaller. So the gap between. “Look at the dishwasher, it's full. I should probably get up. Maybe I should make some eggs. Oh, I don't know”. So the thing I should be doing, actually getting that done, that gap narrowed
Did you think the medication was going to be a “quick fix”?
Well, when I talked to my GP about ADHD medication, she said, “It's not just about medication. It's pills and skills!” And I said, “I get it. I absolutely get what you're saying”. I didn't expect it to just be a miracle and that suddenly I'd take them and I'd be fine because I've got a whole lifetime's worth of skills to build that I hadn't had the opportunity to build. But having the medication, I am now working on the skills. Having the medication gets me much closer to actually managing to work on the skills successfully.
You said that there have been occasions when you've forgotten to take the medication. What did you notice on those days?
I realised that things were harder to do, heavier cognitively, like I was cycling uphill. It became a drag to try and do things. Since I’d been taking the medication, I’d forgotten how hard it could be to try and get myself to do things.
You also said that before you were on the medication, it would be hard to prepare something healthy to eat - it used to be harder to boil an egg and easier just to reach for the chocolate. And then after the medication, it was easier to boil the egg and also easier to step back from the chocolate?
Yes, there’s this double whammy. So with the meds,, the gap between the impulse: “I want chocolate now!” got wider. It was easier for me to step back and not just reach for the chocolate automatically. But also, being able to boil an egg – the gap between the plan and making it happen – got narrower. It was easier for me just to think, “I’ll have a boiled egg for lunch” and to just get on and do it. So I think, yeah, for ADHD, you've got two problems there. You've got impulsiveness, being too close to what you don’t really want to do, and what I want to do - a threshold of starting a good task - being too far away.
So it feels quite proactive and empowered because I think anyone with ADHD should remember that they've done an awful lot of adaptation. Some people call it masking, but they've probably developed all sorts of means, routines, ways of actually managing to do the best they can with what they have at the time. And some of that might feel maladaptive or not, but that's, that's temporary. And if they've come to a place where they're thinking about assessment and maybe medication and they're thinking, okay, there is more out there, maybe, maybe I can ditch some of these bad and find something better. And I don't know what that might look like, but being assessed is, you know, one thing. You can decide what you're going to do from there. And being found to have ADHD, wanting to try the medication, again, it's a choice.
And, I would say, actually, while I think of it, one of the other things I had feared, and this is probably a different question, but I'll mention it, was that I'm really creative and I paint and all sorts, and I was a little bit worried that it might slow my thinking down or kind of make me less creative, make me have fewer ideas and stuff like that. And it totally is not the case at all. It hasn't. It hasn't done that. So I know that's a slightly different thing.
Has taking the medication changed how you see yourself?
I think in ADHD there's a lot of self-judgement. You look at yourself and then you look at other people, and you see that other people can manage to do ordinary things like, empty the washer, do the ironing, get dinner on the table, shop, know what's in the cupboard, plan the day - people can do those things.
Things that a lot of people would think were just ordinary pedestrian tasks. And then you're faced with knowing that I can't do these things. And that is quite a difficult place to be because you judge yourself as lazy. So the diagnosis and the medication is like being released from that and someone saying to you, “You're not lazy and there's actually a reason for this and oh, by the way, we can do something about it”. Wow! How often does that happen? But to have someone look you squarely in the eye at the end of an assessment, having heard all of this stuff and say to you, “You're not broken, this is what's going on, you're not lazy”. Now you suddenly have a completely different perspective on yourself.
ADHD Adult Test
If you would like to explore booking an Online Adult ADHD Assessment with Jenny Arthern.
I can advise about how to self-refer for ADHD Medication Assessment post-diagnosis.
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