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Full transcript below

In this final episode of the ADHD miniseries Paula discusses ADHD and burnout with Dr Floriana Reinikis, a Clinical Psychologist specialising in neurodivergence, and an ADHDer herself. They discuss the connection between ADHD and burnout, including the impact of workplace environments, over-compensation, perfectionism, and emotional regulation. Dr Reinikis also highlights the importance of understanding your own unique needs to support self-advocacy at work and identify strategies for preventing and responding to burnout.

About the speaker:

Dr Floriana Reinikis is a Clinical Psychologist specialising in neurodivergence, with extensive experience in conducting ADHD and Autism assessments and providing post-diagnostic support. She is passionate about delivering neuroaffirmative care that recognises and builds on individual strengths. In addition to working directly with neurodivergent individuals, she also trains mental health professionals in the assessment and diagnosis of ADHD across the lifespan.

You can get in touch with Floriana at Oasis Psychological Services or on LinkedIn

Other links:

ACP-UK

I’d love to connect with you so do come and find me on LinkedIn or at my website and do check out the ACP-UK and everything it has to offer.

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Transcript

Paula Redmond (00:37)

This is the final episode in this ADHD mini series and its focus is on burnout. I explored this issue with clinical psychologist, Dr Floriana Reinikis, a specialist in neurodivergence and an ADHDer herself. We spoke about the connection between ADHD and burnout, including particular risk factors and vulnerabilities, as well as strategies for preventing and responding to burnout.

Paula Redmond (01:08)

Welcome, Floriana, and maybe we could start by you telling us a bit about the work that you do?

Floriana Reinikis (01:15)

Thank you for inviting me first of all, it’s really a pleasure to be here. It’s always an honour because it’s something I’m really passionate about. So I have been working with individuals who present with different kind of neurodevelopmental conditions, mostly autism and ADHD across the lifespan for over 20 years, and I just I think enjoy being with them as also I feel like I’m quite close to these individuals as in the last two years, about two years ago, I was also diagnosed with ADHD so all of a sudden everything made more sense, not only for me in my personal life, but also professionally why I felt so aligned with individuals who presented with similar challenges and differences and strengths. So yes, so that’s what I do on a daily basis. I meet for either an assessment, that’s something I do weekly, or for post therapeutic support. And yeah, that’s in a nutshell, me.

Paula Redmond (02:40)

Yeah. And you also do training for professionals, don’t you?

Floriana Reinikis (02:43)

Yeah, thank you for reminding me that. It’s something quite new. I started last October, so actually it’s been a year that I’ve been training other mental health professionals in ADHD assessment and diagnosis from a more kind of neuro-affirmative point of view, but also in post-diagnostic support. And yeah, there are a few kind of online workshops and training that currently are either being ready on the shelf and people can join or yeah, as my mind is never kind of stopping thinking, there are new ones on the pipelines as you can imagine, yes.

Paula Redmond (03:33)

Great. And I really wanted to talk to you, particularly about the issue of burnout and ADHD. And I think for me, that is the way I came to wanting to work more with ADHD is because in my work with burnout, I was finding that coming up more and more, people either kind of coming with a recent diagnosis of ADHD and really needing that to be an important piece of the puzzle in understanding their struggles with work, you know, their struggles with burnout, how that contributed and how we needed to think about recovery and getting back into work and what that needed to look like with an ADHD kind of understanding. Or in doing kind of burnout recovery work, starting to recognize things that might look like ADHD. And so that was just becoming more and more kind of prevalent and more apparent to me and felt like a really important thing that I needed to get to grips with and understand more about. And so I think it’s an important thing, particularly when we’re talking about the workplace and what it’s like to experience that as someone with ADHD. I think burnout is something that comes up a lot in that context. And I wonder if, I’d really be interested to hear Floriana about your clinical experience around that in terms of what you’ve come across in your work with people with ADHD.

Floriana Reinikis (05:23)

Absolutely. And I’m glad we’re having this conversation because I feel that the work around ADHD and burnout is just kind of starting to be understood a bit more. So I think we need to really talk more openly about the difficulties that ADHDers may encounter and how this can then lead to burnout. So I do not think we understand everything at the moment compared, for example to autistic burnout. I think there is much more research, much more clinical understanding, but we definitely need to continue this conversation. And in my experience, what normally has happened in my kind of clinics is someone requesting an assessment for ADHD at this stage or when I am working with someone already at therapeutic level, and maybe I haven’t diagnosed them, I haven’t really followed them through, so it’s the first time I start working with them. So any of these two stages, at times I’ve met individuals where I just felt it was much more than just ADHD as presenting with a level of exhaustion, mental, physical, a cognitive load, a social kind of withdrawal that felt possibly as burnout. And I feel that often we are still missing it and we are overlooking burnout in ADHDers. Therefore, it’s really important we actually consider what else is going on for these individuals in order for us then to think of how can we support them, not only therapeutically but also in the workplace. So definitely I agree with you that when you start working with someone you may start thinking something else is going on for this person. And I mean, if we think about it, we shouldn’t be that surprised because I think ADHD can really lead to burnout in many ways, not only when it’s not been even diagnosed or even when it’s been recognized as a neurodivergent condition, I think often we are missing the burnout part and we may consider it’s possibly anxiety or possibly depression or just executive functioning skills. So definitely I find that very often in my clinical practice and I can think of several individuals I have seen over the last few months. What I find is interesting is that yes, the majority are adults who talk about burnout in the workplace, but I have definitely seen several university students who as ADHDers or undiagnosed ADHDer talk about what we would consider burnout. So, yeah.

Paula Redmond (08:41)

What do you think it is about ADHD that might create more risk for people to develop burnout? What are the kind of traits that come along with ADHD that might make people vulnerable to developing burnout?

Floriana Reinikis (08:59)

I suppose if we think with the idea of what burnout in neurotypical may look like, thinking of this complete mental, physical exhaustion, withdrawal from social relationship, disconnection, cynicism, but also this inability to do tasks that in the past were easy, ability to organise, stay focused, manage. If we think of burnout in this way, and then we think of what ADHD presents as a kind of a problem with self-regulation in general where everything from attention, focus, memory, hyperactivity, impulsivity, emotional regulation. So we think of it, it’s not surprising that you are already, as an ADHD, predisposed to possibly develop burnout because your executive function difficulties are already quite taxed by an environment that possibly puts a lot of demands on you. Therefore, you may find that even normal daily tasks are for you really a challenge. And when you have done that for a long time, and that’s I think why we see mostly in older teenagers, young adults and adults, when you have done it for a long time this constant battle for some of us behind closed doors or for others a bit more evident in catching up with life, it’s not surprising that ADHDers are so much prone to burnout because they already have challenges in the areas that we would consider problematic. And I suppose the other thing we need to consider is that also ADHDers don’t just come with exactly functioning challenges, but they also come with other challenges that possibly are the byproduct of being an ADHDer. So, imposter syndrome, overcompensation, overcommitment. Many ADHDers will say, you know, I will commit to do longer hours or coming to work earlier, finishing later, taking work home because they know their attention is so dynamic, so fluctuating that during the day they cannot manage. But add it every single day, and then you go home and you still have to manage a whole house whether you have children or maybe other people to look after or even just yourself. That accumulation I think if not understood and supported, it’s likely to lead to burnout. So I feel like there is a compounded effect there between the ADHD intrinsic challenges and differences, and then the stress of everyday life.

Paula Redmond (12:23)

And do you think in your experience that burnout presents differently for ADHDers than for neurotypical people?

Floriana Reinikis (12:33)

I think there are definitely elements that are different. think the normal, if that is a word, but the typical, as I said, typical presentation of burnout, feeling so exhausted, feeling like no energy level, at a mental level or physical level, or this kind of cynicism, this kind of detachment from others. I think that is probably what is quite similar, but I suppose the differences are that all the normal differences and challenges that we encounter in ADHD are exacerbated, are magnified. So someone who neurotypically encounters burnout and may struggle with attention and concentration and remembering things and organising time, from an ADHD point of view, ADHDers will have a magnified effect of those difficulties. So things that maybe in the past they were able, tasks that they were able to focus a bit better, stay longer, and manage maybe with some difficulties but they completed, they would have much bigger problem. The other difficulties that ADHDers I feel are more encountering is for example things like hyperfocus. I think as ADHDers we are really able to give so much passion on something and hyperfocus on something at the point of maybe creating or being incredibly proactive when we are in our in our vibes, in our passion. But when you’re in burnout, that hyperfocus that generally already leads to mental tiredness and physical tiredness, I think in burnout becomes a complete forgetful of the rest of your life. So you may go hours and hours without self-care, without recognising that actually you need a break and you need to maybe eat something. Maybe without drinking any water, going to the toilet, complete withdrawal from people around you. And people, I remember several individuals I have in mind thinking, I came out of these hours of work, which probably I enjoyed it as well, but I’m so tired, exhausted that then I have to spend two days, three days not doing anything else. So I think that’s another thing that is quite typical of ADHD, the burnout. And then on top of that there is this kind of vicious cycle of then procrastivity. I prefer the word procrastivity to procrastination because I find ADHDers are never not doing something even when they’re procrastinating they’re doing something okay. So procrastivity makes me think of the fact that they are avoiding a task that they find emotionally triggering for some reason, but they are busy doing something else. So in burnout what we see is differently from neurotypical, that they may still look like quite hyperactive, quite restless, while in neurotypical we find a burnout tends to slow people down. In ADHDer we see still that kind of hyperactivity coming out but I feel almost when I speak to people about it, it almost feels like a sense of agitation. That sense of agitation that comes out in doing so many things but not doing what they need to do and in the end the complete again, mental and physical exhaustion that comes with it. Okay so these are the kind of things I think that are more typical of an ADHDer compared to a neurotypical.

Paula Redmond (17:02)

Yeah, and I guess as you’re talking, I’m kind of, you know, thinking about the people that I’ve worked with, who have ADHD. There’s seems to be, I suppose, a couple of patterns, like one, a sort of real sense of overwhelm with like this kind of administrative stuff. I work a lot with health professionals, so that kind of aspect of the work that isn’t, you know, the core reason they went into the profession, but those things that get piled on and added on and that just becomes so overwhelming. People getting behind, you know, getting disciplined, you know, it seems like an impossible task to ever catch up and then that’s never motivating. So you’re, you know, stuck in this horrible cycle. Or people who are absolutely kind of enthralled with their work, throw themselves into it and maybe don’t notice the early signs of it being too much and kind of push themselves beyond, you know, kind of healthy limits and only realize too late that they’ve exhausted themselves.

Floriana Reinikis (18:12)

Absolutely, absolutely. I think what you’re saying is really important because what normally happens for an individual with ADHD, I think normally, as become part of who they are, they’re really overcompensating and overcommitting, very often. These are individuals that are not lazy, let’s be quite clear about this idea that we are lazy or we make careless mistakes. We are exactly the opposite, we care very much. And because we are so aware of the difficulties we have with our executive functions, what do we do as a consequence? We tend to find ways to mask them, compensate for them and therefore will take on more work, will accept to do more things, will create rigidity in order to remember that I’m going to do something. But then there is the demands of a workplace, like whether it’s a mental health or a physical health environment as in hospitals or services that, you know, if you’re a doctor or if you are an anesthetist, there’s a lot of research on NHS workers that are actually constantly under stress and burning out. Now, consider the difficulties you have as an ADHDer. Being put in an environment with high demands, because these are environments with high demands, things may happen quickly, you need to be quite organised, you need to be quite able to manage time. Your resources will soon be depleted and you constantly are in this kind of hamster wheel of trying to keep up, and I think that is a problem. Trying to keep up becomes impossible. You burnout, it becomes almost impossible. And then you see people, as you said, either taking too much on, or I think the other opposite, and I suppose it’s maybe phase four or five of burnout, is going off sick and not being able to manage any more. And then when you meet them, I’ve got a client I’m thinking of at the moment who has gone off after exactly doing what we were describing. Extremely successful, because these are individuals that can be extremely successful, they’re really good at what they do. But taking on so many responsibilities, not being able to set boundaries, that’s another big problem of ADHDers, we are not able to set boundaries for many reasons, for self-management but also because we want to compensate and show that we are able to do things. So he was doing this for a long time and all of a sudden he found himself working from home, working weekends, working all the time. Consequently, his whole life became just work. So that’s, you know, again, self-management, difficulties in understanding where I finish work and when I start personal life. And relationship went through the window, his mental health and physical health. Okay, these are other big, big things in ADHDers. The physical health, you were asking me earlier about other specific characteristics that we should consider for ADHDers here but now. It’s not something we talk a lot, but we know that there is a lot of research on somatic conditions, physical health, for example, migraines, allergies, and many others. But when I think of the clients I’ve been working on, they also have additional physical difficulties that are also impacting, that compound effect as ADHDers. So I see it as a cycle. You have the executive function difficulties, then the demands of a workplace, demands of home, your need to compensate whether you become a perfectionist as a consequence or you want to just mask constantly because you want to come across as someone able, inevitably the outcome would be at some point burnout if the cycle is not broken.

Paula Redmond (23:04)

And I guess I can also think of, of kind of examples of people who actually are managing, you know, to mask very well at work. So no one at work is picking up on any problems, but you know, home is tricky because as you say, they’re not able to kind of attend to other things that are important, you know, relationships or physical health or you have to go home and go to bed at 7pm every night because they’ve used up, you know, everything at work. And so I guess it can, from the outside, not, you know, be a bit of a, I guess a spiky profile in terms of where the problems might show up that, you know, for at least a while work might look okay, but other areas might be suffering.

Floriana Reinikis (23:55)

Absolutely. And I suppose another thing about, as we are talking, I’m thinking more and more about the ADHD that I’ve encountered throughout my professional life. And the other thing we need to consider is the emotional dysregulation, which we know is a core feature, is part of being an ADHDer. And not that all ADHD become easily emotionally dysregulated, but we know many do. When we think of burnout, this emotional dysregulation is even more affected. So if we think of, in general, of how emotions will go up and down, even during the day, you know, you just, you leave your keys indoors and you have just closed the door and you think, oh why didn’t I think about it? Why didn’t I put the keys in the right place? That will already create it. And then you go to work and someone says something and you feel like, was that directed to me? Did it mean anything? So your emotions go so up and down in ADHD. Little things, we are quite sensitive. They’re sensitive people. They will still remember times when they were 12, 14 and teachers made comments and they are now in their 50s so they will hold on to these comments made to them. So that emotional dysregulation that we see as part of ADHD, when burnout kicks in it becomes intensified. So again it’s not only the frequency, it is the intensity. And as part of that, obviously the impact is also again on relationships. So very often clients will bring their partners or their husband, wives, and you will hear these narratives on how more difficult it has become to be together because everything is so easily escalating. Okay. So the emotional dysregulation is another big thing we need to keep in mind when we think of ADHD and burnout.

Paula Redmond (26:09)

And you mentioned some research that you’ve come across. I wonder if, but you also said that it’s kind of in a really emerging area, and I just wonder if there’s anything useful to add there about what the research into burnout in ADHD does say?

Floriana Reinikis (26:27)

Yes, I think we’re still very much at the beginning. I was reading recently a research on ADHD and the mediation between ADHD executive functions and burnout in employees. Okay, this was quite a recent, 2024. I can’t remember when exactly. So most of the research, which is still quite limited, is about highlighting the impact that executive functioning difficulties of self-management at work, like time management, planning, organisation have on employees who are ADHDers. So that’s the majority of the research. I feel It’s much more than just that. I feel that it’s exactly what we’ve been talking about, that ADHDers also present with all the other difficulties that we are recognising being part of it as the imposter syndrome, not feeling able, feeling like I’m always the one who, why I cannot do this, underperforming constantly, the sense of underachieving, then the masking. So these are the other kind of things that they’re not considering at the moment when they’re doing research. They’re just looking at the impact of how the executive functioning are amplified by being in a work environment where support is not there. But what about the rest? What about the other things? What about the hyperfocus? That’s something I haven’t really read about, how the hyperfocus and the difficulties when someone is in such a hyperfocus, it doesn’t recognize anymore the signal of, oh my goodness, it’s been two hours, three hours, I haven’t had any food, and then, you know, the difficulties of going on. Many of my clients will say I go on all day without eating and drinking water or going to the toilet. I don’t think research is actually yet looking at all the different layers that can affect burnout in ADHD. So I’m hoping that there will be more understanding. In your experience of working with burnout, it seems to me that you encounter lots of ADHDers in the workplace? 

Paula Redmond (28:59)

I think there’s something about healthcare that when you get it right, you know, can really be a great fit for ADHDers in terms of, you know, the passion that is needed, the kind of variety of the work and, you know, the hyperfocus that is needed at times, you know, to get through training, so I think there is something about this field that can attract people with this, you know, neurotype. And, you know, for some people that can be a great strength and, you know, find your way and a way of working that fits that, then people can really flourish and thrive. But I think there are, you know, particularly in big systems like the NHS, there are a lot of real challenges. I mean, it’s challenging for anybody, but I think particularly if your environment doesn’t support your natural way of being and thinking, then it can be very difficult. One of our listeners put in a question that sort of touches on this about the move in recent kind of years, and you know, it’s been for a long time, but I guess COVID really accelerated a move to much more digital working. So the listener kind of used the example of keeping track of things when you can’t see physical files. So everything being, you know, digital data, both, you know, tricky in terms of you keeping track of stuff, but also making it easier for people to keep track of you. And, you know, there’s a big emphasis on data collection. So that’s one part, but also, you know, a move to, again, accelerated by COVID, you know, hot desking, you know, online working, hybrid working. And I wonder what your thoughts are on how that contributes to ADHDers experiences of the workplace?

Floriana Reinikis (30:59)

I think that’s a brilliant comment and question from your listener and I agree with you that actually it’s pre-COVID. COVID just accelerated things and I remember during COVID I was already in my independent practice, so I had already left the NHS. So if I think of me in the NHS, I remember the time when we were introduced into the idea of smart working. And before that we were introduced to open offices. I’ve always had, I was lucky I suppose, I always had an office for myself and then all of sudden I had to be in an open office. So open office, smart working, online working. I loved my paper diary, and then all of a sudden I had to keep an online diary. So all of these things, remember even on myself as an NHS clinician at the time, pre-COVID, was already like, oh my God, how am I going to manage? But I have to think about it as actually there were pros and cons in the end. So for example, I found that smart working, so having a computer that I could use at home, meant even more difficulties with boundaries and even more I need to compensate because I’ve not been able to do all the things I had to do compared to my very organised colleague who managed to do everything, you know like all your emails or your paperwork or your reports, and I was like so actually having a computer to take home meant not having time for me for my family. I remember sitting in my dining room and working on it while the children were kind of playing around and saying, you know, can you please be quiet? So that definitely I felt was a problem if we were not able to set boundaries. But also expectations, because then the expectation is that you can do, maybe is self-expectations, I don’t know, the ADHDers may have, I’m going to do more, I’m going to work more, I don’t know. But that’s the kind of cons, I believe. The pros about smart working, I felt was the ability then to be allowed with some difficulties at the beginning, I think now with COVID things have been accepted, being allowed to work from home. So some flexibility in where I work. But again as ADHDers we need to be very careful because the environment where we work will inevitably make us more or less distracted, more or less focused. So being able to say I’m working from home but I’m going to work in an area of my house that is not definitely my bedroom like many people did during COVID because they didn’t have enough rooms at home, or I can work in my bed. ADHDers don’t do well with that because they get immediately sidetracked doing other things. So you can see flexibility, great, but then you have to self-manage and that’s the problem with ADHD, self-management. Once you have started, you know, self-managing that flexibility, I think smart working could work. Also, I think could work as, I remember often I had to travel between sites which created some problems again in terms of managing time. How long is it going to take me from this place to this place? Okay. And that was also part of smart working. And if you’re not good at managing thinking, I may find traffic at this time of the day, you arrive late and then you become panicky, anxious. But it means that you come to a desk that’s less cluttered. Let’s be honest. I remember having my own office and thinking, I’m just going to leave stuff here. You know, obviously not confidential stuff, not files, but my own bits and pieces. And clutter is not helpful for ADHDers. So there are pros and cons. But then other things like open offices, I loved the social part of it because as ADHDers we like that, we like being with people, we are chatty, we like the interactions, but to the detriment of then working and staying focused. Or overstimulatory – an open environment for me is often full of too many stimulation, people talking on the phone, I can’t focus on writing a report if my colleague is having a conversation and that’s not because I am curious what they’re talking about, it’s just I cannot filter so easily. So I know other people have talked to me about an open office being really hard to be in, not having enough previously when you think okay I really want to do this work, I really need to do it now but then being like a magnet as soon as there is a noise, as soon as someone comes in through the door you get immediately distracted and what is the problem? Refocusing. It’s just so hard for ADHDers to refocus. So open offices, I’ve never been in favour of open offices. So I think there are lots of cons there apart from the social side of it, which is also good. I think we need that. The other problem, for example, is out of sight, out of mind. So everything online. So I remember the time when we went on to these systems, Rio and all this system. I was like, oh my god, I’m not sure where things are, how I’m going to search for them. Well, I remember going into a filing cabinet, taking the file out and chronologically things were there. So I quite like, and I think still today, I find whenever I need to do something important, I will have a physical thing. I always talk to my ADHDer clients and say what works for you? And many of them say actually I need to see to remember. So that’s something that could be a problem when you have everything online and it’s not immediately there and also you don’t remember what you may have read the day before and you have to reopen your file and blah blah. But on the other side I find that possibly online calendar, online files could be also helpful if you are someone who tends to… let’s say an online calendar. I remember having this beautiful diary, let’s be honest many of us like our diaries and I used to buy every year a new diary, I used to love them. You know they gave it to you in the NHS, now I want that really nice fancy one because I liked it. But the problem was often writing at the same time two appointments because one had cancelled and then I had forgotten to remove it and I was thinking my goodness, or booking, double booking and then your secretary calls you and say there are two people waiting for you, I think oh my god I didn’t delete it, I forgot to delete it. Well online diaries, very difficult to do that. Now I love my online diary. So there are pros and cons. I suppose I always say to ADHDers is routines and structures are so important for us because I don’t want to rely on my brain or my mind to remember things, to do things, I need to have something external. So it’s really how we use them for our benefit. But there are definitely pros and cons for both. I remember as an NHS clinician, I used to go often to A&E to do assessment of individuals that were suicidal. And oh my goodness, I found it so difficult because the busyness of A&E with so much noise, so many things happening, people coming in, I had to always ask, can we have a quieter place? Because not only for the privacy of the person, it was also for me. I didn’t have this knowledge I have of myself now. So I think that’s what we tend to become able to self-advocate when we understand ourself as ADHDers, an environment that is conducive and supportive of our differences rather than against us.

Paula Redmond (40:03)

I was just wondering whether you think any other sort of things that people might be useful to think about in terms of what they could ask for in a workplace to help support them to prevent burnout?

Floriana Reinikis (40:17)

I think the first step, the importance of a possibly a diagnosis not because we are supporting the idea of labels and that’s a very old kind of a message I remember in the past, we don’t like labels. It’s not about that, I think it’s about this understanding of who you are and therefore stopping many things that before would be more like self-critical thinking, lots of self-critical beliefs but then strategies that were not working. And then the environment around you not knowing how to support you. So I think a diagnosis can be helpful in many ways, personally but also from a work kind of placement or education placement. So when we think about it, having a diagnosis will mean hopefully that you feel comfortable to discuss this with your manager or your employer. I still think there is a lot of stigma that goes with the diagnosis of ADHD and I know many individuals who for a long time don’t talk about it. I mean it took me a year to become open about it because I felt comfortable talking to my clients about, oh I know what you’re talking about, you know, I get it. But it was with my colleagues, with your employers. I mean, at the time of my diagnosis, I didn’t have, but still I had colleagues. And with your peers. Okay, so the first thing is, are you at that stage of having accepted the diagnosis because that I think is the first step. And then the second part is can you discuss this with your employer and then hopefully discuss a way forward. A way forward would be really in how the environment can be adjusted and I know there is a lot of criticism at times from others saying you know why should we adjust the environment to you and not to others. I totally disagree, I think a flexible environment would increase productivity, would increase loyalty, would increase the sense of I like my job. Okay. So I think flexibility should be probably applied more generally, but definitely to neurodivergent and ADHDers. So having a conversation of what works for you, what is it that could work for you? So an open office, actually, most of the time really distracts me and I don’t manage to get anything done. Can we look at another way? Can you work maybe a certain amount of hours a week? So creating even a plan. Okay, we’re not really good with planning. And I always say to my clients, find someone to help you plan and put things in place, rather than trying to do it yourself. Because if you had already tried many times, not working, just you need to change tactic, maybe someone else could help you. I remember sitting with my manager and talking about my diaries. So I was someone who will do exactly that. I will be able to see as many clients as a day, no problem, because I love that part of my job. Absolutely. I adored the idea of being in the session with my clients thinking of what they needed and the support I could provide back to back, often forgetting actually you need a break Floriana. So my manager will come and say this is your lunch time you have a break okay. I just needed someone to give me permission as well, and that’s also this part of your diary has to become admin, which I know you don’t like it, I know you find difficult, but actually when you do it, you do it really well. Okay. But I almost needed someone to help me with that. So I think discussing these things with your manager would be great. What can we do to help you? What can we put in place? Maybe if open offices are not possible because unfortunately there are some situations where, you know, there are no other offices, do you feel comfortable with noise-cancelling? I think it’s become quite fashionable these days. So it’s not really seen as a problem. So I’m hoping that people will feel comfortable to go into work and not to feel like maybe my colleague is thinking I don’t want to interact with them. And if that’s the case, can we have an open conversation with our colleague, which means for me having an environment which is neurodivergent friendly, it’s okay to have noise-cancelling earphones or headphones because I find it easier to concentrate. I also think the other important thing to consider is adjustment in terms of physically what kind of things work for you in an environment. So for example, some of my clients have been able to… I remember this research many, many years ago, even before I was aware of these things as ADHDers, some of my clients starting having standing up desks. So even things like this, think should be discussed and considered. Having a break and being able to go out of your workplace rather than staying in your workplace. I remember how it affected me remaining in my workplace because I felt I could never get out of work. So I was constantly in this agitated state of okay I’m gonna have lunch but I’m gonna be so quick, I’m gonna eat while I am looking at a report. Well if I was feeling comfortable, I almost didn’t feel comfortable because maybe it wasn’t what was happening or maybe it wasn’t what normally we did. If I was allowed to leave the building and it happened at some point, I moved to another building and we were very close to the town centre and people in that building used to take their lunch out. So I decided, oh my God, I’m going to do it. I realised that the ability to come back and refocus was so much better for me. I mean, this was pre-diagnosis for me. So even those kinds of things, again, that’s a kind of really friendly neurodivergent environment that allows people to have, you know, this is kind of, again, flexibility of what works for you. And we know research on productivity, we know that people will feel more able to give the best of themselves when they feel supported, they feel understood, they feel heard, and adjustment has been made around them. And when that is not the case, we see long-term sickness, we see people changing jobs, and I find ADHDers, maybe for other reasons, but it should again be considered, why do ADHDers change so often jobs? Could it be impulsivity? That could be impulsivity as I’m not happy here, I don’t feel supported, so I’m going to move to another job, thinking that by moving somewhere else things will change. So yeah, quite a lot to consider. I feel there is a much more open dialogue and discussion on organisations that value these things. Whether they do happen, that’s another issue. And I’m sure there are some systems that are still very rigid. So it’s exactly the opposite of what we’re saying, the flexibility against a system that’s rigid. You come to work, nine to five, this is your desk, and you don’t move, you just kind of go from one room to another, or things like that. It’s the ability for managers to think a bit beyond what culturally we have been used to. I suppose the other important thing to keep in mind is that another part of the research, maybe not specifically on ADHD, but in general on neurodivergent conditions and burnout, is that we know that the right support, the right therapeutic coaching, support for whatever the person needs, the workplace adjustments and support, possibly anything as also medication. We know that that will prevent possibly burnout or speed up the recovery. So I think it’s really crucial that organisation managers, systems understand that it’s not the person. Yes, the person may engage in a personal therapeutic journey, but when the mismatch between the environment and the person happens, so the rigidity of the environment, that’s where things go wrong. And we know the opposite is true when things are there to support the individual, even the ADHD differences are less problematic. They still exist, but the person just feels more fulfilled, feels more able to work, feels more able to be themselves, which is another important thing. And maybe even their masking, coping strategies kind of get a bit less intense and they can be dropped. So definitely a lot of work on how others can support.

Paula Redmond (51:06)

And I think that you’re right, that message around workplaces really needing to actively engage with this stuff is, you know, good for work place wellbeing, but it also makes sense for productivity and retention and sickness levels. You know, there’s just such a clear business case for know, workplaces to really actively engage with this. And I’m always just shocked and horrified that it doesn’t happen, which is, you know, a big driver for this podcast, let’s think, let’s talk about this stuff. And these issues, I think that we’ve been talking about today are relevant to anybody in the workplace, but I guess for people who have, you know, who have ADHD, face, you know, particular challenges that are not you know, it’s not, you know, the kind of accommodations and, you know, adjustments that you’re talking about are not like rocket science, you know, they don’t require huge restructuring or huge funding to put in place. You know, it’s quite straightforward, I think, you know, to just allow people to, be able to advocate for, you know, the kind of environment that allows them to flourish and you know, I don’t think it’s the huge barrier that, you know, it often feels like it is for workplaces can be quite, you know, defended against this stuff.

Floriana Reinikis (52:34)

I think because, even surely from a financial point of view, which is obviously something that the organisation system has to keep in mind. So they may think of financially what it would mean to make this adjustment. I have never seen anything written and I’m sure there’s probably something, but surely if you can prevent burnout and you can therefore prevent sickness, that will cost much less than, you know, supporting someone who is off sick for a long time. Okay. And will support and prevent, sorry, will prevent also the possible, while likely development of mental health problems or physical problems which comes with burnout ,which also would put even more strain on resources and financial commitment. I think it shouldn’t be too complicated. So I don’t know why sometimes this seems to be such a big problem that we encounter still in workplaces. But hopefully this conversation that you and I are having today are becoming much more what happens, the conversation that everyone has openly, frankly, and therefore becomes easier to accept that yes, we need to change something.

Paula Redmond (54:06)

Floriana, I wonder for anybody listening who either has a diagnosis of ADHD or who suspects they might, what advice you might have for them to help them prevent or respond to burnout?

Floriana Reinikis (54:22)

Okay that’s a very important question. Okay the first step for me is awareness, self-awareness because you may be in a stage of burnout when you’re not yet realizing. We know from the phases of burnout that have been described that some of them you’re still in this kind of drive to do things, to achieve, you feel also quite satisfied but it’s starting to become difficult. Becoming self aware is the first step. So asking yourself what is different? Is my attention, my focus, my memory, my organisation, my hyperfocus, my emotional regulation, my feelings, are they more or less the way they have always been? Being an ADHDer or there is an intensification of them? So if there is something you start thinking, something is not right with me, then you may want to start considering, could it be burnout? So self-awareness. And I suppose the next step would be, who could I talk to? I suppose it could be someone you trust and you feel comfortable, but it could also be then a professional if that needs to go a bit further whether you’re not getting anywhere and people may actually know, family and friends I think most of the time want to do the best for you and they may say you know maybe you just need to try a bit harder and maybe you need just maybe to have a holiday, take a few days off, and maybe you already try these things and if it’s still not working, I will then request maybe a conversation with someone, someone like you who specializes in burnout or a GP. But other things you think are very important you could do even before that is, for example, when burnout kicks in, we said about this kind of detachment and disconnection from life. I will say to my clients who are in that kind of phase, I actually would like you to make an effort and I know it’s going to be a very difficult effort, but an effort to even book just a coffee once a week with your friend and go out and meet, I don’t know in a coffee shop somewhere, and just talk about anything that comes to mind. Or having some time with your partner out of the house but almost regularly because I find that the more they don’t do these things the less they will be in contact with others and we as human beings we need others. So re-establish some connection. The other thing is be realistic in what is possible to achieve and accept it. Sometimes less is better rather than constantly being on, I want to do this this and this and that everything else, less is better. If you can manage your hyperfocus, so if you start realizing your hyperfocus has become so intense and you pass the whole day without leaving your room or your bedroom, your office, because it could be someone who is becoming so work-holic, they don’t leave, okay, put reminders for yourself. Work with someone in your family and your friends and say, can you help me out? Can you come and knock on my door or give me a ring and accept it as the offer of, I need to stop it, because it’s definitely not helpful. So, put some external reminders that are great for ADHD as well. Also you need to increase that, work with someone, body doubling, get someone to help you to say, we’re gonna go for a walk now. That’s the other important thing I would like to reiterate. Some self-care. Self-care is another alarming bell. If you realise that actually, even as an ADHDer, you’ve always had quite good self-care and that’s not happening, ask yourself what’s going on. So start maybe on purpose having some self-care. self-care means a lot of things, means not only looking after yourself, putting some nice clothes on in the morning, having a shower, whatever it is that is your self-care, but also means going for a walk, get some fresh air, whatever the weather, whether it shines or rains, I always say to people that will increase your dopamine, will make you feel better, will make you feel more able to come back and focus but also will relax you. So these little things. Sleep, keep an eye on your sleep. ADHDers are very renowned for difficulties with sleep. As your sleep becomes worse, so you’re so exhausted during the day but still you can’t sleep, when before actually you could at some point fall asleep. Okay, that’s another alarming bell. Maybe discuss with your GPs or anything that you can do because lack of sleep will just increase problems and have some regular meals as well. You know, look after yourself even in the very basic way. These are basic but they’re so crucial. I suppose the last thing I would like to say from a clinical psychology point of view is what can you do to help your nervous system, who is so at the moment kind of overwhelmed, to go into a state of slightly, gradually, because it’s not going to happen over a night or over a week or a month, if you’re in burnout, it’s going to take time. But what can you do to help your nervous system? And obviously all the things I spoke about will already help your nervous system. But is there any way to help you with things we know work for ADHDers like mindfulness? And I always say to my ADHDers who look at me like, I hate mindfulness, I always say, yeah, I get it, but you don’t need to sit still, you don’t need to do a very, what I call the classical mindfulness. We can do a very informal, and your informal could be go out and just feel the rain on your skin, or listening just the sound of the birds around you while you’re walking. Just mindful of how you’re walking in a different way or a different kind of place or just enjoying a cup of tea outside in your garden and just kind of very slowly having it and thinking about it and smelling it. These are exercises I think ADHDers find easier to implement because they don’t need to stop their mind which is obviously quite a difficult thing to do and we don’t want that, it’s never going to happen to anyone anyway, but you can do it as suits you and it’s more practical and feels more realistic. So these little things could become really part of your daily life and could be very helpful.

Paula Redmond (01:02:05)

Yeah, and I often think about things like, this idea of active rest. So being able to, I mean, for me, that is knitting. You know, something that, you know, you’re keeping yourself, you know, physically active, you know, tapping into a creative part of your brain, but at the same time, it’s soothing the nervous system. So I always like to have those conversations around, you know, creative pursuits that, both help with connection, you know, it’s the opposite of burnout to be able to connect to something alive and creative, but also just so good for our nervous system.

Floriana Reinikis (01:02:45)

Yeah, I like, I love that. I call them with my clients restorative breaks. And I always say restorative breaks is not about you going on your phone or going to another hyperfocus. Okay. It’s actually moving your body in some ways, whether you are knitting or I had this question, I remember with my children often when they were little, how do you know mom needs to take a break from something, maybe because she’s feeling a certain way? And I was so pleasantly surprised when they said, you go out in the garden. Okay, because that’s my way of being active, using my body to calm my mind and just being in touch and maybe doing some work in the garden, trying to pull the weeds. Actually, that is so helpful and my nervous system, I always send to my clients what is it that could be an equivalent? Okay you may not be a gardener, I’m not a gardener, I just like being in the garden, you need but what is it for you? And that’s a restorative break, yeah. So that’s the kind of things we really would advocate for. They don’t need to be a lot a long holiday, at the end of the day we, most of us don’t go on holiday every two months. No, it’s not possible. But you can do these daily things to restore your nervous system.

The post ADHD and burnout appeared first on Dr Paula Redmond, Clinical Psychologist.

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Full transcript below

This conversation explores the personal journeys of 3 NHS clincians diagnosed with ADHD as adults, focusing on their experiences with diagnosis, the impact on their lives, and the challenges they have faced in academic and professional settings. The discussion highlights the complexities of self-disclosure, advocacy, and the need for greater awareness and understanding of ADHD, particularly in women. They reflect on the misconceptions surrounding ADHD and the evolving narrative in society, emphasising the need for a more compassionate and informed approach to neurodivergence.

Speakers’ recommended resources:

Scattered Minds by Gabor Mate

Dirty Laundry by Richard and Roxanne Pink

Ted Talk by Salif Mahamane called “ADHD sucks, but not really“

ADHD Chatter Podcast

Amazing Marvin productivity app

I’d love to connect with you so do come and find me on LinkedIn or at my website and do check out the ACP-UK and everything it has to offer.

Follow and subscribe so you don’t miss an episode!

Transcript

Paula Redmond (00:37)

For this episode, I wanted to speak with NHS clinicians who themselves have a diagnosis of ADHD and to hear about their relationship to ADHD and how this interacts with their professional roles and identities. I’m really grateful to the three people who volunteered to take part and for their openness and generosity in sharing their stories. I think this is probably my favorite episode of the podcast so far, and I’m sure you’ll get a lot from it.

The three people who join me are clinical psychologist Dr MW, Dr JT, an intensive care consultant, and Dr CD, another clinical psychologist. We’ll hear from Millie first as she explains how she came to be assessed for ADHD.

MW (01:29)

So I was actually working as an assistant psychologist in a assessment and diagnosis service for children for autism and ADHD, and prior to that, I’d never really thought about ADHD at all to apply to myself. And then I think I started to notice with some of the clients I was working with who had ADHD, I’d be thinking, yeah, but I do that, like that’s very normal, you know, that’s the way people’s brains work, isn’t it? You know, and things like that. Just noticing lots of similarities. And then I never really pursued it myself actually, I was applying for the doctorate. So I was doing my application, and one of the psychiatrists was supporting me with that, and we were discussing it, and I think he kind of probably, on reflection quite bravely, kind of said to me like, you know, I noticed this and I’ve noticed these things, and he highlighted a few things about in meetings, and I think I kind of moved my face quite a lot, like visual kind of movement and activity. And he said also around the difference, I suppose, with my presentation at work versus my ability to kind of write about that in this application form. And he kind of said, have you ever thought about ADHD? And I think I was quite taken aback and initially quite like, shocked and a bit annoyed and thought, how dare they? Yeah, it made me feel, I don’t know, it made me feel quite shocked by it. But then I think on the drive home, I kept thinking about it and if anything it was just lots of things that were making sense. And I think prior to that point I hadn’t really understood the differences in women as well and some of those differences because I hadn’t learned too much about it before that job. And then the more and more I thought about it I think it was making me more frustrated because I was thinking I think he’s right. Actually I think that is, that does apply to me and obviously then I was looking at things and very kindly, he kind of said, you know, think about it, and if you wanted to, I would support you, you know, to kind of access a private diagnosis, because I think I agree, I don’t think I would meet, maybe it would take me a very long time to get it, let’s say, through the NHS in terms of this idea of you’re quite functioning, you’re quite academic, it perhaps isn’t causing you distress in a typical sort of way. But I suppose throughout my life, it definitely has, especially in the kind of emotional regulation realm. So I did pursue a kind of private diagnosis. And yeah, I got a diagnosis of inattentive subtype, which fits quite well for me, I think. And then since then, it’s yeah, it’s just been very useful. I did trial kind of medication briefly, but I didn’t particularly get on very well with it. I don’t think I really wanted to pursue it up into a therapeutic dose. And also I think because I’d got to 24, 25, I’d done uni, I’d done a masters by that point, I’d already had to develop quite a lot of strategies to manage my ADHD. I think the main impact it was having for me was kind of, yeah, that emotional reactivity, some of the inattentiveness, more in relationships and more in things like that outside of work maybe. And I’d kind of given myself quite a lot of structure in work. But for me, just having the diagnosis itself helped a lot in understanding me, how my brain works. I think my sister gave a reflection as well that it was really helpful for her just understanding it as well in that context. And then since then, I mean, I’ve always kind of known, think my parents probably both have quite a lot of traits of it as well. So kind of reflecting on that. So yeah, so it’s been really quite useful, and think even just sharing it with my family and stuff for them, I think it’s been quite helpful as well.

Paula Redmond (05:31)

And that process of kind of having a new or different lens through which you might have looked back on things in the past with a different understanding, did that kind of, was that part of it for you that you understood maybe past experiences differently with that diagnosis in mind?

MW (05:58)

Yeah, I think it’s hard almost now to think about it without having that in mind, you know, because it’s been quite a while. But yeah, definitely. Especially when I was younger, especially at school, quite typical, you know, I was described as like, oh she’s very able, but she just distracts everybody and talks to everybody. And I remember I used to think, God, I can literally talk to everyone. And the teachers would put me next to like the most quiet, most academic person, and I would somehow manage to distract them as well, just chatting or whatever. And also just to be honest, it really just made me reflect on how I coped with it strategies wise. Like, I’ve always been very energetic and active and done a lot of physical things. And I remember since reading studies about how apparently, kind of an hour of cardiovascular physical activity can have similar effects on the brain as ADHD medication. And I was easily doing that. I used to play football, you know, and also I’ve on reflection, have noticed periods in my life when I can’t do that – traits or symptoms or whatever you want to call them of ADHD being much more difficult to manage.

Paula Redmond (07:10)

Okay, so when you’ve not been able to do that exercise, you’ve noticed an impact?

MW (07:15)

Yeah. I think for me the emotional kind of liability and changeability and feeling those really intense emotions, obviously as I’ve got older that’s been slightly more easy to manage and especially with a diagnosis and understanding myself but, but yeah, there were stages in my life where I think I kind of was very desperate to know like what’s wrong with me. Like other people don’t seem to have this or feel it as intensely. And obviously that can be a real pro. I like to think about stuff, you know, I’m now on reflection and looking at other people’s brains or how they respond to stuff, more neurotypical people, I think we, or myself, I think I feel the positives massively as well, those real highs of emotion. But the downside of that is you feel the kind of crashing lows. And something I think my partner observed is that kind of recency effect where if I can kind of just feel whatever I’m feeling right now and that feels like it’s going to be forever, you know, you have less of that ability to think, yeah, but I didn’t feel like that last week, you know, and without some of that insight of why that might be and things like that, that was really tough to manage. And also I think obviously over different stages of my life, impulsivity has been a big one, like risk taking behaviors being very impulsive, especially as a teenager, which now having that lens on it is really quite useful. But at the time, I didn’t have that. So yeah.

Paula Redmond (08:44)

Is there, have you been able to be more kind of compassionate towards yourself or your past self with the knowledge of ADHD?

MW (08:53)

Yeah, definitely. Yeah, definitely compassionate and also maybe a little bit kind of sad that I didn’t maybe have some of that understanding at those times and how things might have been easier. I think it really helped the time I got it because I got it probably about a year or two before starting the doctorate. So that was quite helpful. It also made me reflect on how I’ve coped academically in terms of knowing kind of how I have to manage work and things like that in comparison to my friends at university and things like, you know, looking at yourselves and your learning styles. So I’m much more visual and verbal and take things on. Like my room at uni used to be covered in posters of things I had to try and remember. And also my working memory is quite good. So kind of relying on that instead of maybe, you know, in long lectures, I’d switch off or things like that. So yeah, it has allowed me to be a bit more compassionate to myself. I think it does make me a bit sad that it did take that long and maybe just a lack of understanding of what ADHD looks like when it’s not a kind of typical presentation. Yeah.

Paula Redmond (10:10)

Because you talked about kind of that sense of being really high functioning, not having maybe high levels of distress or real kind of struggles that may have masked some of those, the things that were more difficult for you.

MW (10:32)

I think just to clarify as well, like I suppose external struggles, like a lot of it is obviously that internal difficulty and the internal inattentiveness that I think a lot of people with ADHD work really hard to kind of mask, which takes a lot of obviously energy and resource. And I think I really dislike that term, high functioning or low functioning or that sort of level because I think that was what I think has been missing is almost this idea that if you can do well academically or you can do those things, then it’s not that. And I think I remember having a kind of disability kind of student assessment kind of thing to get some support in the student services, and they kind of said about it being a learning difficulty was the language that they used. And I kind of clarified and just said, you know, it’s a neurodevelopmental condition. And I understand that for some people it can be that level of, you know, it impacts their learning that dramatically. And I remember also once in that AP job, when I was actually going through the process of getting the diagnosis assessment myself, I went to do a school observation and a teacher kind of said to me, oh, so can, somebody have ADHD and still be like intelligent and smart? And I almost had to stop my mouth from like falling open. And I was like, yeah, and kind of just tried to provide some kind of psycho education about that. But I think that can be a pervasive kind of narrative about it. And then I think that can block people getting diagnosis, you know, in terms of, oh but you’ve been able to get to this or access this or…

Paula Redmond (12:12)

And Millie, what was it like doing your doctorate training? And I’m wondering about, yeah, that experience, whether you talked about your diagnosis in that process?

MW (12:24)

Yeah, I think it kind of relates actually to a previous question you said about the lens and can you be more compassionate to yourself? I think I always just had this view of myself as well throughout school, that I wasn’t academic, that I wasn’t able to do those things. I think I had quite a view of myself that that wasn’t where my strengths lay. So I never went to, I never thought I’d go to uni, I thought I’d just go into work and it wasn’t actually until I found psychology that I was like, oh this is how my brain works anyway, so this could be easy to go to uni. If it was another subject, I mean, certain things like maths and things like that, I really struggled with. I liked things like English. And so I think that had always been my view of myself. And then I think over time, with lots of support, I started to think maybe I could do that in this, in these contexts. And so I think that stayed with me as well, not being an academic sort of person. So then, applying to get on the doctorate I remember thinking like, my God, how am going to do a PhD? I know I have to do a thesis at the end of it. I’m never going to be able to do that amount of work and attend for that amount of time and concentrate. So I think at the stage in my life and career where it came, I’d already had to develop a lot of ways to manage deadlines, work, remembering things. You know, I’m the sort of person where if I don’t do it straight away, I won’t do it. I’ll forget about it. So in terms of organisation, that has to be kind of key. But in terms of on the doctorate, I had a bit of a journey with it myself. I think at the start, I felt quite strongly, you know, why should I need to tell them? It doesn’t affect my ability to do the course or the job or I don’t think I need to tell placement supervisors. I think there was a worry that it might be kind of stigmatized or the way you might be treated about it. And I think I just got used to just people’s such varying levels of awareness that you’re then kind of opening yourself up to that when you tell them. So the first couple of placements, I mean, I did tell the university from the beginning, I think I tried to be proactive in thinking if I need some extensions, getting that student support plan in place, just to try and manage in case to see how I get on, because obviously there’s that daunting, you don’t know how you’re going to do. And actually, I’d never apart from one time, which was due to kind of family emergency circumstances as well, I didn’t need to use it at all. But it was nice to have it there. It was nice to have that as a backup. I think what I felt disappointed about is a lot of the parts of the plan that are put in place with the student support services never came into reality. Like lecturers were supposed to send you things in advance so that you would have time to read it and it wasn’t all on your, you know, your concentration in the lecture and that never happened, certain things, which is a bit sad, you kind of just have to make do, I suppose, with that. And then I think over the time, I started to test that out and did tell placement supervisors and they kind of said, yeah, that would have been really helpful to know just as having an awareness. And so then over time, I did feel more comfortable to say in that initial meeting, you know, this is, I have ADHD and this is how I feel it kind of affects me, not really much in placement. have lots of ways to manage it, but this could be the area that it might come up or where you might observe. And I think it was a bit of a mixed bag. Some people were great and really understanding and really asked great questions like what would be helpful for me to support you with that and just kind of then did it. And then I think in other ones, it was a bit less supportive where I told them at the start of a placement, you know for me, I said it might come up in, you know, attending to numbers, especially like in cognitive assessments or things like that. I could have read something 12, 20 times and I still might miss it or I still might make an error, or like words in a report. It’s not because I haven’t proofread something, it’s that I’ve read it and my brain hasn’t, you know, paid attention to those bits. So in terms of then at the end of a placement, you know, not feeling marked down for that, like, she could take more care and attention or she could do this, you know, that would be feel, and I think that there’s a real leftover from school almost like I can’t make a mistake on that either because it means a lot more maybe for me. And then I think I had a bit of a difficult experience where then even though I discussed that with them, even though they said, yeah, and I think in terms of applying it to a client or a young person, they would have really got it. But then when it came to it, when it did happen, they were quite, you know, oh I don’t think you really paid attention to this, I don’t think you maybe checked it. And I was like, this is kind of what I was on about when I when I started. So yeah, so it was a bit of a mixed bag. But I also think in lots of ways, I find it can be a real asset clinically. And I think I noticed that on training, like reflecting, when you’re having to work with more than one person in the room, I think one of my friends on the course fed back that when we’re doing like systemic work with a family, you’re having to attend to like multiple people, and you’re having to hold in your mind like they’ve said this and they’ve said that, and then I’m going to come back to you, and she was like, you just seem to be able to do that so much easier than I can. Like I’m finding that quite overloading. So certain things, I think it was quite helpful. So there’s definitely the kind of positives for me clinically and the drawbacks, I suppose, as well.

Paula Redmond (17:57)

And what about in your work now, post-qualification? What are the things that you found helpful or unhelpful in your work now?

MW (18:10)

I think it’s pretty similar, to be honest. I was upfront with it as well, qualifying-wise in my first job qualifying. I think, to be honest, I probably don’t ask for much. I probably don’t ask for many amendments or adaptations. And I think I’ve found that really helpful reading about it, being in forums or hearing from people what they do ask adaptation-wise for work. That’s been quite helpful. Yeah, I think I just kind of have been quite upfront, you know, this is the way that it would help for me. You know, I’ve said to work if I need to write a big long report or focus on one task for a long time, I find that easier to do it at home, not in a really busy office with loads of other distractions. And, and I find, I do find shared office spaces, hot deskings, what that set up really quite difficult because if someone’s on a phone call I’m paying attention to that, I’m not listening to what I’m doing or I’m trying to do both and so and they were quite supportive you know if I need to use a separate room or an office or if I you know, and I can I think to be honest my job as a clinical psychologist I find it really does lend itself well, I like that it’s changeable, I like that you know because my worst nightmare would be sat in the same room at the same desk doing the same task for nine hours a day or seven and a half hours a day or whatever, I would just lose my mind. So the changeability that one day you might be driving somewhere with a session and then, and I just manage it. Like, I wouldn’t do a whole day doing a task. I have to kind of mix it up a bit or make it work for me. And I think because it’s quite flexible at this level, it works, that works quite well.

Paula Redmond (19:55)

Yeah, yeah, great. Thanks, Millie. I’m going to come to you now, Jo. And just maybe to start with, you could introduce yourself, tell us what your job role is?

JT (20:10)

So my name is Jo and I am a medical doctor and I’m currently working in pediatric intensive care. My background is in anesthetics and intensive care. That’s what I’ve done my training in.

Paula Redmond (20:28)

Great, and just to start with, any kind of thoughts, reflections, questions for Millie, from what you heard her say? Anything that resonates with you or, yeah?

JT (20:40)

Yeah, thank you, Milly, for sharing your kind of diagnosis and journey really through ADHD. It was wonderful to hear and certainly lots of similarities that I can pick up on with my journey as well. I think it’s amazing that you had someone at the beginning. You’d said your psychiatrist supervisor who really identified those issues. And I think very few people have that. Maybe more and more so there is awareness and people are picking up on these things. But I think it’s amazing that you were led to the diagnosis via someone who identified it. Were there any emotions or anger potentially against that person? Shock maybe to say there’s nothing wrong with me and then as you gradually learned about it you came to accept, but I can imagine you might have been a bit taken aback and quite startled about that to begin with. So just wondered if you could tell us a bit more about that?

MW (21:55)

Yeah, yeah, definitely. I think because of how I view it now, as you say, I’m very, I feel very lucky and privileged that that was the case. And also, I think, to be honest, it’s only because he had specialised in that for a really long time with, with young people, adolescents and adults that I think he picked that up. But yeah, initially, I felt very angry. I kind of thought like, what an abuse of a powerful position to kind of say that. Because it is quite hard when you’re like a band for assistant psychologists and this is kind of quite a senior member of the team. And, and so I think at the end, they were the first ones. And I remember ringing up my sister and being like, can you believe this? This is what they’ve said and la la la. And yeah, I think that is part of the stigma, suppose, isn’t it? Is that feeling of the, hang on, there’s nothing wrong with me. And, and that isn’t the case, almost wanting to fight against it. But then I think the more and more I thought about it, I think that was what was frustrating me was I was like, oh my God, I actually think that is 100% accurate. And then also feeling a bit annoyed and frustrated and angry that it took till that age of my life for somebody to sort of suggest that, I think. And I think reflecting that I think for women especially, it’s often a lot more like, it must be a mental health thing. Because I’ve done that to myself, kind of going through mental health diagnoses and thinking, does this make sense of what’s wrong with me? In inverted kind of commas or quotation marks. So yeah, they were definitely all the emotions. And then I think I did feel, following that, really grateful in terms of they provided that private assessment and diagnosis for me for free, which obviously I would never have been able to afford. And I would have waited for years on an NHS waiting list. And as they were highlighting, might not even then have met it due to somebody’s understanding about it as well. So yeah, in terms of the support they provided, then there was lot of feeling grateful and pleased that they were brave enough to raise it to a kind of work colleague.

JT (24:00)

And have you found as you’ve been, you’ve obviously had a journey for quite a number of years, during the course of the journey have you seen a shift in people’s attitudes that you’re able to now unmask yourself and actually be more free with the diagnosis around others? Or not?

MW (24:20)

Yes, yes and no. Yes and no. I think yes, just definitely since then and my understanding of it, I was incredibly like unaware. But I think also that comes from the teaching that we had on it as well, like as somebody who’d done a psychology undergraduate and like nothing essentially. And the way that it was taught was quite skewed and what you hear in the media, you know, I think even my own understanding of it as well was, was quite ignorant. So I think definitely yes, in the sense of, especially around ADHD in women, girls, there has been a shift. I’d say the no is that there is still quite a lot of misunderstanding kind of stigma, not being able to integrate it. And I think that’s what I experienced maybe on training, being able to understand it in one sort of presentation, but not being able to integrate it for a mental health professional that you work with and who also presents in different ways. I think that integration part is still kind of missing.

JT (25:24)

Yeah, and also, I mean, I think it must be really hard to focus on doing a thesis, particularly. I mean, I’ve struggled with those times of my life when I’ve had to, you know, stick to your own deadlines, use self motivation. That’s incredibly difficult, whereas I’m sure it’s easier for you, as you said, in practice, having your kind of varied job plan, no two days are the same and you enjoy that. So yeah, I think it’s amazing you obviously shared some strategies that you might have had during the course of that. But I can imagine that would have been quite a difficult time of your life and, you know, a space and place where you would have come to terms with the demons of ADHD, so to speak. Yeah.

MW (26:17)

Yeah, yeah, definitely. Just to say as well, I did have some very supportive research supervisors, which were great. Like, do you want me to check in when you’ve made these deadlines for yourself, like almost externally managing that for me, which was really great. And also I think my partner probably observed things that he hadn’t observed before where it was like, gosh, you’re very ADHD today, you know, because of all the things that I was kind of thinking about. So yeah.

JT (26:46)

And I think it’s that external validation that we can so often rely on and having someone to check in and really sort of crack the whip on deadlines and making sure that you’re sticking to them is so important. Did you find you had an ability to really hyper-focus at times, which is something I tended to do when I was doing similar and to the exclusion of everything else in your life, including eating, personal hygiene, those sort of moments, which I know can be quite typical of those with ADHD. Yeah.

MW (27:29)

Yeah, definitely. I think just generally being interested, I chose a topic purposefully that I really cared about, you know, for that reason, as you say, to be able to hyper focus on it. But yeah, there are times where you think, God, I really need to go to the toilet, like to do a wee, because I haven’t done that for ages. I’ve been sat here typing or furiously trying to concentrate and monopolize on this energy. And I think also some of that permission came with getting a diagnosis that otherwise I used to just sit there and just be like, why can’t I do it and get into this spiral of like, why can’t I focus? But some of that reflection on right today, I’m just finding it too difficult, so need to go away and do something else. And then maybe tomorrow I’ll have some of that hyper-focus or more of that ability to concentrate. Because otherwise I used to just, yeah, like, know, flagellate yourself and think like, I’m not doing it. This is terrible. You know, so I think that, that helped.

JT (28:21)

Yeah, absolutely.

Paula Redmond (28:22)

Jo, I’m gonna jump in, I’m gonna jump in, because I feel like we could talk forever. But I want to kind of come to you, Jo, and just wanting to hear about your journey to diagnosis and what that’s been like for you?

JT (28:38)

Yes, so my journey to diagnosis, I think was really based around just gradual awareness of ADHD symptoms. It was about 10 years ago that I pursued and received the diagnosis via a private psychiatrist. And it was really just the penny sort of dropping around things that I’d read. I also had a friend who had realized she was autistic and she started becoming very vocal about that on social media platforms. And suddenly this whole world of neurodiversity gradually started opening up, but it was certainly well before the current kind of atmosphere around neurodiversity and the amount of information that was on display. So I feel it was preceding the current climate of everyone has ADHD, that’s the cool thing to be. So it was well before that. Not a lot of people knew about that. I just, the more that I read, the more I said, wow, this is exactly what I have. Prior to that, I’d really thought that I had something you know mentally, I was mentally ill or I had anxiety was one of the biggest features in my life and all those kind of running rushing thoughts, your brain never feeling quiet. There was a time when I thought I had post-traumatic stress disorder after having the loss of a friend and colleague in very difficult circumstances while I was on an expedition as a medic. So I thought some of the symptoms were related to that. There was a time when I really thought I was having early dementia due to, you know, at times poor working memory. I did trial some SSRIs for a bit and, you know, it was a very bewildering time. And then as I gained access to more and more information, I thought I need to pursue this. And I got very excited about that. And then I looked up for someone with a special interest in ADHD in adults and managed to quite easily get an appointment. I went for one appointment and my second appointment he asked for me to bring my partner at the time who really just agreed with my own observations but provided some verification. And then it was at that point he said, let’s you know, let’s try all some stimulant medication, which similar to Millie, I also didn’t get on with too well. I just didn’t feel that it helped me in the ways that I wanted. And, and certainly at work, I’ve always been able to focus quite well without the use of any medication, whereas I feel it’s a lot more external to work that I might struggle and that’s usually when you’re not on medication.

Paula Redmond (31:56)

What was it like to get that diagnosis, to hear that?

JT (32:00)

I think for me it was just, I had pursued it myself, so it was very validating of what I thought. I think if it had come from someone externally, I would have, like I said to Millie, that yeah, I would have struggled with that and thought, how dare you? But because I had taken on that responsibility to pursue it, I really, I was quite happy with that. And then I, you know, I told family members and not really any close friends for a number of years and many friends don’t still know about it, but as people have become more aware I felt more confident to disclose that and of course you know, also friends that say that absolutely cannot be true, you’re high-functioning you’re academic you did well at school. And then it was reflecting on the times when it was difficult for me and certainly at the transition points through life and as you become more of an adult, figuring out that things are hard and maintaining control of all aspects of your life becomes increasingly harder, whereas school is a very structured environment and that made sense. And I think now, you know, with at that time of diagnosis and telling my parents, they were like, wow, I sent them, I sent them literature about it and they said, okay, well gosh, yeah, you’ve always had a messy room. This makes sense. There’s a reason for these things, it’s not just you being lazy or messy, there is actually a way that your brain works that is different to other people. And yeah, certainly on the most part, I think people have been very receptive and I felt certainly, I think validated is the best word that I can use. And also I’m just grateful that I managed to get that help privately, whereas now I think these days that would be very hard. There’s certainly long waiting lists and people struggle to achieve that, although I would like to pursue some more formal testing, especially, you’d said you were inattentive type ADHD, you know, just to kind of clarify things better and also to figure out if there’s any other associated, you know, not disabilities… 

Paula Redmond (34:37)

Co-occurring stuff.

JT (34:38)

Yeah, concurring things and comorbidities, which certainly, you know, anxiety can be a comorbidity and it can muddy the waters. So I think that would be helpful.

Paula Redmond (34:49)

And what’s it like, Jo, because I guess, you know, thinking, I guess, you know, Millie and Clark and I are all clinical psychologists, so, you there’s a particular kind of world that we occupy and, you know, being a medic in a different take, I wonder how, what’s your sense of, you know, whether you’ve disclosed personally or just generally discussions with colleagues, how is ADHD perceived in your context?

JT (35:19)

Yeah, I would say that we are not quite at the level we should be in terms of, well, certainly the specialties that I work in. There are a lot of clinicians that I know of via social media, Facebook groups, and speaking to them personally that do have neurodiversity, either autism or ADHD. There’s a high rate of this in the medical profession. But yet I think you know, our supervisors at work, those involved in education don’t have a massive understanding of this yet. Despite the fact that there is now a lot more neurodiversity training, I think it’s still incredibly difficult for people to recognize this when someone is struggling, particularly during postgraduate training in medicine. And I think there’s a huge amount of work that can be done. And certainly I can spot a lot of people with neurodiversity, I feel, from a bit of a long way off, or have a bit of a hunch about it. And I think there’s a lot of people struggling out there. And, you know, personally, I felt brave enough to really unmask a diagnosis in the workplace, because that’s an area where I feel it’s my safe space, where I have control, where I excel for the most part, and I would rather keep that as my space, safe space almost, is what you could say, where things make sense to me and where I can function well. And as I said, it’s more outside work where things can fall apart, which I think was previously unrecognized, was all about work and school and if you do okay there, then nothing’s wrong. But what about the rest of stuff that we need to do as an adult. And all those other extra tasks that we have to pursue. It’s not just, you know, doing the fun stuff as I’m sure you’re all well aware of as psychologists, you know, actually interacting with clients and patients and doing things and talking to people is great for us with ADHD, but it may be all the other behind the scenes paperwork, documentation, writing letters, writing reports that can be extremely hard for those of us with ADHD. And that’s where things are troublesome.

Paula Redmond (37:52)

Yeah. Yeah. So I do quite a lot of work with junior doctors, inverted commas, who, with exam support, so maybe, you know, struggling with their exams and, have, have kind of sessions to support them around that. And I’m always struck by the kind of unbelievable expectations that are placed on people to manage, you know, crazy kind of shift work, huge demands at work and study for these exams, which always seem rigged against people. And often at a stage where maybe also people are really navigating adulting and wanting to be or becoming new parents and just like the executive function load is immense. I really have so much admiration for medics surviving this time. And if you add in some kind of executive function challenges to that, it’s a lot.

JT (39:04)

Absolutely, yeah. And I think the key thing is, you know, doing something that you find inspiring and meaningful will help towards that, but it can be hugely destructive to your emotional wellbeing when you fail. And these exams are very, you know, rigorous and they require a lot of hard work. And certainly if you fall down, you can really become despondent very quickly. And as you said, there’s not a lot of awareness of the impact of neurodiversity, although I would say that is now becoming more commonplace to do a neurodiversity assessment when people are struggling with exams, as you said, via exam support. But that’s one of the issues. I never struggled with exams. And so therefore, once again, you’re not looked at in the same light as struggling. But that said, I can hyper-focus, I can study and cram in quite extraordinary ways, but that may well then be to the exclusion of many other important aspects of my life, be that health, be that relationships, be that exercise, and it can be destructive to so many other aspects of your life.

Paula Redmond (40:25)

And I guess Jo, I mean, just to let people know we’ve known each other since primary school, so I kind of have a sense, and I guess for me, I am always absolutely in awe of how much life you live. I have such a boring life compared to you. You fit more into a week than I do into a decade! And I feel like you’ve had this capacity to make work really work for you in that you found a way to, I think, you know, really navigate work so that it really works to your strengths in terms of, you know, variety and novelty and opportunities to, you know, go to, I mean, you know, I know one week, I have to always ask where you are, because one week you’re doing mercy missions to Ukraine, the next you might be planning a trip to Antarctica, you know, then you’re off, you know, on holiday. I’m like, what? I mean, does that, does that kind of fit your feeling of your work life?

JT (41:44)

Yeah, I mean, I would say I’ve definitely chosen specialties that are within the acute care side of medicine, which definitely appeals more to my brain and has a potential for constant dopamine release. And so, yeah, no two days are the same. I think people do struggle with having a rota that’s not, you know, Monday to Friday, but those of us with ADHD often do better with, you know, shift patterns. I do a lot of nights. I don’t mind those as much as other people. I actually flourish more in those environments and certainly with a lot of activity, a busy day. You know, in my day, I’m exposed to a lot of things and going out on them, retrieve, medical retrieval, dealing with a lot of information on the unit, a lot of activity, stressful situations. And it’s in those times of crisis that those of us with ADHD really start to actually excel. So I think I’ve chosen work to suit me. And yes, and then in terms of even outside work, I definitely have a passion for pursuing almost work-related things outside of my actual working day and week. And as you’ve said, it’s a lot of global health medicine that I enjoy, teaching others in countries around the world. And that’s really my passion and almost my hobby outside of work. And so it keeps things interesting. You obviously have to devote a lot of your own side time to doing those things. And then that could certainly come at the expense of just being organised, washing the dishes and doing your laundry and getting on top of your finances and doing life admin that can certainly suffer. And I know none of us, neurotypicals included, don’t like to do those things, and that will usually be the response from those people. But we really struggle with all of that management. But yes, I think with having a lot of stimulation and a lot of things to achieve that once again feeds my brain and I can organise my life and my time well because I’m stimulated by what I’m doing. And I feel that those things that I’m doing are meaningful and that really, really helps with your time management. Because if it’s something you want to achieve, you will go the extra mile to make it work. Whereas I think some people might just give up and say, this is too much to be done, I’m like this is achievable, we can do this! So yeah, it’s picking what you love, I think.

Paula Redmond (45:15)

Yeah, brilliant. Thank you, Jo. Clark, I’m going to come to you. And again, maybe if you could just introduce yourself and your work role and then any kind of responses to what Jo was talking about.

CD (45:32)

I’m Clark Davidson. I am a clinical psychologist, as you mentioned, by professional background. I currently have a role as a head of psychology psychotherapy for an adult mental health directorate, as well as a busy private practice as well. As part of that, I also do a fair bit of ADHD, autism assessment, post-diagnostic support with adolescents and adults, and I provide leadership to a neurodevelopmental team as part of one of the aspects of my NHS role. So thinking about neuroatypicality assessment and support, I think is, yeah, has become increasingly a kind of passion, I think, really. In terms of reflections on Joe, I’ve got a lot of reflections, I think, on a lot of things that have been spoken about, both in terms of points of difference as well as points of resonance in my own personal experience. I think it was interesting kind of Joe picking up on anger at the suggestion of having a diagnosis potentially. I think I’ve had kind of more anger and frustration, more generally post diagnosis actually, and thinking about others reactions to, you know, that as a label, as a diagnosis. And that is something that I have a conversation with patients about really, is that it’s very unpredictable, I think, in terms of what you’re going to get on the receiving end of that, you know, in terms of, you know, a good, bad, ugly or mixed response really, with this kind of sense of an awareness of you being different, people will change in response to that. And if you’re making changes post diagnosis, people will respond to that as well. And it can be mixed, I think. I think that the kind of thoughts in and around some of the stigma that surrounds ADHD as a diagnosis I think is also interesting and I think post diagnosis have ended up pushing more into kind of advocacy I think and kind of fighting for, you know, people who I think are at risk of being shown contempt or marginalisation. I think within the profession of clinical psychology, I think there’s some very powerful other voices there that would oppose the existence of the diagnosis itself and can be, I think, quite attacking in and around that at times, which I found difficult actually that the profession in which I sit doesn’t necessarily universally accept or accommodate it. Other reflections that I’ve had? I think it’s interesting that we’ve all had a different route into diagnosis other than the standard NHS referral and assessment. And it makes me think about the affordability of the diagnosis to some extent, you know, that some people are just going to, you know, kind of opt out because the kind of wait otherwise is too long or they can’t afford it. And certainly if I was coming to diagnosis at an earlier time in my life as a question mark, I’m not sure I would have pursued it, you know, or been able to from a financial point of view. So I was diagnosed two years ago in my forties and I think it was some of the best money I spent, but it was a costly enterprise, both the assessment, but then also I ended up going further and in the medication route, which in and of itself is significantly expensive in order to titrate up to the most effective dose. Yeah, which I think is kind of interesting in and of itself. I think in terms of support from others as well, which is something that’s been raised, I think my own journey both pre-diagnosis, which has been most of my life, and post has felt really just trying to manage and function in isolation as best as possible, actually. I’m not sure I’ve necessarily felt a huge amount of being with others in the journey necessarily. It’s you know, it’s taken a lot of work to manage these traits in the way that I do. And I’ve only realized post diagnosis just how much energy that has taken and effort and work to put that stuff together. I would say I’m probably the, or one of the most efficient, you know, people within my work kind of life. You know, that does come at a cost, I think, you know, and part of the advantage post diagnosis, I think is about, still alone, probably, but kind of being able to kind of reconsider just how much energy that needs to take. I think that that was a big advantage post diagnosis, which has helped I think. Some people have been supportive, but I think that there’s something just generally in my experience of working, I mean, maybe this is just work life generally, but certainly working in healthcare, working in the NHS, I think most of the time there’s an attitude of you just get on with it regardless of…

JT (51:27)

That’s true. Yeah, yeah.

CD (51:28)

…you know, the pressures of the job or what’s going on in your life. You know, I think that there’s a kind of, you know, kind of…

JT (51:36)

As long as you get the work done, I don’t think people are that… stigma or not, as if you’re getting the work done, just crack on and carry on.

CD (51:43)

I think this is it, isn’t it? Indeed. ADHD would just be one of those things that is noted maybe, paid attention to for a second and then it’s well get on with the work anyway, you know, it’s so I think that is difficult I think. You know, it does feel like there is this kind of cultural, you know, just kind of message around yes, that’s fine, but it can’t impact on your work.

JT (52:10)

I think the newer generation, there’s a lot more awareness of these differences and the older generation might look down on these sort of snowflakes and say just get on with the job. But I think things will change and I think that more and more people will demand adjustments to their work as they do now for family life and for other difficulties that people have there. Things will change.

CD (52:39)

I think that’s my hope. I think things have, I think there’s a lot of work to be done in this regard and I think it does take those of us that are passionate about it to advocate for people’s, to have adaptations to their work lives in a whole range of different ways. And it feels like that needs constant root, constant reminding in order to kind of help the kind of work system to be able to support staff. It needs a constant reminder. I don’t think it comes naturally necessarily. So yeah, it’s, but no, indeed, I think that my hope would be that there will be a kind of ongoing journey in that regard as there have been with other things.

Paula Redmond (53:23)

I just wanted to kind of jump in and ask you about what led you to seek diagnosis at that point in your life?

CD (53:34)

So there was someone who I was supporting to get their own diagnosis and I was recommended a private psychiatrist by the medical lead of the time that I work with. And then there was a question put back to me whilst supporting this person through their measures and those kinds of things in terms of actually, does this stuff not apply to you? And my initial reaction was no, no. I mean, you know, I’ve been able to function, you know, coming back to that word again, you know, I’ve kind of, you know, gone through the educational steps and I manage a lot in my work life, etc. And so that was my immediate reaction. You know, I can, you know, I think that it’s humbling to some extent if you’re doing assessment of others and you’re missing out on an assessment of yourself in that way. But then once I did start to consider it in a kind of different light, different perspective, I just thought, how did I not see this before? I mean, it’s just blatantly obvious, and life makes so much more sense looking at it through this lens than kind of otherwise. And then that led me through that journey really. You know, like I say, in some ways it is surprising, but I just wasn’t very attentive to this in me, really, I think is the reality. So that’s what kind of led me down that path really. And I think I kind of took it as I tried to kind of do generally with healthcare, healthcare is rubbish at being a kind of science driven enterprise, I think in the main, but I think that’s how I like to go into it. It was a kind of science based ‘test this hypothesis’ you know, and continue that process of test and learn, will this medication do something for me? You know, are there other things that might help with this? You know, I mean, what is ADHD? It’s, it’s a concept, talking to a collection of traits, but I think there’s a number of different pathways to people ending up in the position where they have this as, you know, a significant part of their neuro development I would suggest is kind of where my thinking has kind of taken me latterly. And so that is the kind of spirit in which I went into it with really was let’s just test this hypothesis out. And I think it’s the best idea of the moment probably for me.

Paula Redmond (56:11)

And what, has that led to any change in how you relate to work and how you are in work, structure work?

CD (56:21)

Yeah. I mean, yes, I think there’s a noticing these traits and being frustrated with yourself around these traits. Oh for God’s sake, you know, I’ve still not taken the bin out or I’ve been to the fridge 18 times when I could have just got it all out of the fridge, you know, in the first place, that kind of thing. It also made me reflect on just what I had done and what I’d built, I guess, really, in terms of strategies and approach to functioning, you know, and actually, as I say, kind of reviewing that and thinking, actually, can I make this work better for myself? So actually, I think I had put a lot in place, but I think it was taking a lot of energy and some of it wasn’t needed. You know, I think it kind of moved into this kind of ultra control kind of state, so actually easing up on some of that where it wasn’t really functioning in the way it was intended, I think was helpful. The kind of medication in and of itself, I think was helpful in that as well. So I was titrated to the maximum dose of eventually of dexamphetamine. And I think just on first taking it, I noticed a significant difference in terms of attention, concentration, focus. I was a lot more aware of how fatigued I was, whereas I just would just carry on, blast through regardless, you know, I can easily work 50, 60 hours a week, you know, and just relentlessly kind of driven in that way through hyperfixation and the ability to just keep going until I drop. But the kind of medication actually made that harder, made me more aware of how fatigued I was. So that then helped me, I think, to kind of slow down and pause, make different decisions and just be a lot more relaxed about it all. I felt, you know, I had courses of psychological intervention before around different issues, you know, and kind of thinking about some of the comorbidities that have been mentioned by Jo and Millie, you know, anxiety issues and kind of other things. But I just felt like there was just this napalming of a baseline of shame-based anxiety that I didn’t even know was there. And I would have never, I don’t think, got to the point of getting that same outcome in terms of a napalm of it without the medication actually, because I’d tried. I think it then helped me to work on it in other non-medical ways as well. But I, you know, and I think there are other routes to that other than medication, actually. I don’t think it’s an essential, but it helped to facilitate that in a more kind of quick, ready way, and then enabled me to kind of go backwards, kind of think, OK, well, actually, how do I now kind of work on this in a different way? So that was huge. It did open the door, though, actually, to me then reflecting back on my life and just actually being aware of another comorbidity in terms of complex PTSD, just a life lived of a lot of threat and danger and risk and, you know, kind of events that I just kind of laughed off or shoved in a box, all of a sudden, I think I was in a much better position to actually look at those new, suffer those in a different way, actually. And then, you know, then there was another task actually to be, to kind of work through that as a kind of second emerging issue, which was interesting. And I guess these things along the way impacted in terms of work being difficult to juggle alongside that journey, whilst also finding that work was able to, I was able to make myself work better for myself and that impacted usefully in work. I think clinically it kind of made me think more and differently about ADHD and other neurodevelopmental conditions. I think it pushed me a little bit more into working with that client population. And like I say, kind of advocating for and thinking about the kind of post-diagnostic support, the kind of various avenues that kind of lead to the manifestation of these traits and therefore opening an idea around what could help with that. know, so things like physical health. You know, I always ask questions now in an assessment about physical health. I’m always interested in seeing whether somebody’s had a work up of bloods, you know, and the amount of people who have then gone on to get treated for quite significant physical health issues that wouldn’t have been if I’d not asked those questions, they’d not sort out, you know, some investigation through the GP, you know, that have helped them people with the, with kind of some of the resolution of those traits, even if they do still have that kind of core concept diagnosis, I think has been quite significant and eye-opening. So it’s helped in a whole range of ways, I think, actually personally, in terms of my own work life and approach. Although it’s quite easy to then fill the time you save with more work. You know, I would put that in, there’s that risk.

Paula Redmond (1:01:55)

I was thinking it sounds like it’s opened up doors for you in terms of your own personal kind of healing and discovery and way of, you kind of this interplay between your personal and professional life that has been enriched.

CD (1:02:11)

Indeed, indeed. And I think without that kind of carrying of shame, it means that there’s a lot less shame-based offence. The kind of striving to please, the kind of masking your true self, the kind of constantly seeking that praise but not knowing what to do with it and dismissing it when you get it. The kind of awareness of contempt for others who aren’t able to kind of hyperfixate in the same way as well as contempt for myself, you know, and playing up to some of that, you know, because at least I’m in control of how embarrassing I am, et cetera, et cetera, I think has all really, really helped, definitely.

Paula Redmond (1:02:59)

Really powerful. Thank you, Clark. I wonder if Millie, you have any responses or reflections to what Clark said?

MW (1:03:12)

Yeah, thank you. Thanks for sharing, Clark. It was really interesting. I mean, I think I have loads. As you see, I was nodding a lot. I think there are a number of points where you succinctly described my experience much better than I think I did as well. I think the point you said about in the NHS, that feeling of you’re kind of sharing with somebody and it’s like a great, okay, but just get on with it and don’t let it impact anything, that is exactly what I think I was trying to share in my experiences as well. And also I think I was observing that going first, I think I had some anxiety that people might be thinking, oh no, that’s nothing like my experience, so was nice, really nice for me hearing from Jo and Clark, there was loads of overlap and lots of things that you’d said. I think I kind of really agreed with your point, Clark, about the affordability of a diagnosis and who that’s available to from an affordability perspective, but also from just an understanding, having even that on your radar, you know, because I think when I was at school, and I’ve really noticed that because my one of my best friends is a teacher at my old secondary school and it’s now a specialist in neurodiversity and support and it was not even raised on anyone’s radar when I was there, you know. I think, yeah, that’s really crucial. And also often I’m, you know, reflecting on who is more likely to meet a different type of diagnosis versus ADHD, you know. I also was really pleased to hear that you’re kind of, you know, a leadership and provide consultation to a neurodevelopmental team and you’re part of that leadership team for them. I think that’s great. I was wondering, it’s a question of whether you’re open with your own diagnosis in that role and whether people are aware of that or..?

CD (1:04:58)

I am, yes, both with colleagues, but also patients, I’ll bring it in. It feels like there’s always, you know, a kind of balance in terms of self-disclosure and whether it’s more for you rather than the patient, obviously. But I find that actually self-disclosure around a neurodevelopmental condition is helpful. I think it’s useful as an icebreaker. Sometimes it’s useful to actually provide some kind of a kind of model in terms of kind of what that kind of journey looks like. There’s a normalization kind of aspect as well as a de-stigmatizing aspect of that as well. I think the idea that there’s a task to survive being neurotypical in a neurotypical dominated world is something that’s able to be spoken a bit more if you’re owning your own kind of experience of kind of some of the battles that you’ve had with that. You think, you know, that actually this isn’t, I don’t think inherently a disability, because I, you know, I wouldn’t be in the job I am now, wouldn’t have had the success as a career without ADHD, without what we call ADHD, I’m highly convinced of that. But society itself and elements within, I think, can be disabling and can disadvantage, and I think making that distinction is also useful with self-disclosure to have those conversations. Some people feel like it’s a sentence that they don’t want actually, even if they’re pursuing the diagnosis. I think it helps with that.

MW (1:06:37)

I think the fact you said modeling as well, I’d written that down. I didn’t want to forget any of my reflections for all of your points, but I just think I agreed with what you were saying, like that advocacy and that modeling of it is really important. You know, being able to see somebody in those positions with that diagnosis, you know, a doctor, a medical professional, a head of service, like a lead role, things like that, I think is really important to kind of challenging some of those views. And I think I really connected with what you both said about anxiety. I think again, you summarized it really well, Clark, that shame. I think that was pointed out to me, that ongoing shame from masking or from mistakes being highlighted. But I think I remember thinking when I was working with a young person with ADHD, it’s almost like we have the ability to be anxious about a million things at once. Whereas maybe somebody more neurotypical might just focus on one thing, whereas it’s like you can do it on hyper speed, almost like a hyper fixation or focus on anxiety, and I think that really then feeds into that self-criticism. And I think it connected for me with what you said, Jo, about always being busy. I’m definitely like that too. But I think it’s took me a long time to try and manage ways to learn to switch off, to be able to calm yourself. Because that was just not in my ability. I would just be nonstop busy. And as you said, it’s exhausting. Whether it’s with work or whether it’s with a social thing, but it was almost like a fear that if I stop, then I’m just gonna go into her overthink and over anxious, and so I think, yeah, hearing that from both of yourselves was quite, was validating in that sense. I was also just struck by what we’ve all mentioned about this recent narrative of, oh everybody has ADHD. And I think it can be used as a bit of a stick to kind of beat people with, and I’ve definitely come up against that more recently, you know, with the panorama and, and it’s this idea of like, oh yeah, everyone has that, it’s so popular nowadays and la la la. But then I just think it’s so interesting based on all of our experiences, how actually difficult it is to access and that not being people’s experience, but in the media, it being perpetuated as almost like, everyone gets given a diagnosis, everybody’s put on medication immediately, when actually what we’re highlighting is that if anything it’s often really missed. And I think I often have, I’m going to say discussions, sometimes it can be more arguments or debates, but with with people in this field as you were saying Clark you know in the field, in the profession of clinical psychology in terms of kind of and in teaching, my sister’s a teacher, she often has this discussion now with people. But almost like this idea, I would love for it to get to a place in our world where we don’t need a label, we don’t need a diagnosis, we don’t need to go through an assessment and people just accept that people’s brains work differently. You know, I’d love for that to be the case, but unfortunately it isn’t. And unfortunately our schools and things and work systems are set up where people need to get that. So I think we can’t have it, you know, both ways, a bit like being like, do we even need to diagnose that anymore, everyone’s got it? And it’s like, well, unfortunately, yes, because in order to access support or even understanding or even awareness that is unfortunately the way our systems are.

JT (1:09:57)

And I think I know myself and Paula, we were talking about this the other day, just the way the world is also changing so much in terms of the age of information, obviously now the age of AI, but just that kind of access to information, which I think on the most part is excellent in terms of ADHD awareness, but also we run the risk certainly of being sort of overstimulated and having so much more information that we need to process and deal with every minute of our lives. And that can really also be something really difficult to work with for those of us who have brains that function in this way. There’s just so much overload.

CD (1:10:46)

I think you’re right and some of the patients who I will work with, what they’re looking for actually is for somebody to signpost and direct and to slim down for that journey because it is quite unwieldy if you’re trying to navigate that yourself I think. You know we’re professionals so obviously maybe we’ve got an advantage in terms of you know kind of how we do that, but a lot of other people won’t have that. I think it’s interesting that, you know, I was in a trust-wide meeting with the medical lead for ADHD and her citing her concerns about just how many people are coming through for referral and the questioning of, you know, are we getting this right in terms of a diagnostic concept? Are we, you know, kind of actually at the forefront of where the evidence is with this in terms of assessment, et cetera? And so I do think that there’s a balance there. I think there’s a lot of poor assessment practices out there, particularly in the private sector. And I think that has an impact in terms of the ongoing legitimacy of this as a useful diagnosis, which I think is helpful to hold in mind. But you know, there’s also a kind of legacy that you would expect to be dealt with. I mean, you know, I was born in 1981 and I can’t recall a child in my school having a diagnosis of ADHD. It wasn’t thought about, the school system didn’t really, wasn’t really geared up to kind of work for me. I had to try and make myself work as best as I could and failed and struggled in different respects along the way. As was mental health, not particularly a thing, you know, people having diagnosable mental health conditions in the 80s. So I think there’s the legacy of that in terms of people that have gone through, you know, their childhood and their adulthood and that not been there even thought of as a thing, you know, to catch up on, which is why there’s a lot of adults out there that are seeking diagnosis now. And I think actually even within the kind of current school system, there is a reluctance and I think to highlight these things and to put people forward for. Partly because it’s so difficult as a child to get a diagnosis, even though there is much more awareness of this. So I think inevitably you’re going to see high numbers of referrals. You would expect that, you know. Yeah, I think there’s a balance and I think that’s why you know there is this need for this kind of ongoing science, this science-based approach you know and kind of practice-based as well as evidence-based you know, approaches to continuing to develop where we go in terms of our understanding of this thing.

Paula Redmond (1:13:50)

Thank you all. I’m going to sadly bring this to a close, but it’s been so wonderful to hear your personal stories and your professional insights into this. So thank you so much.

The post Being a healthcare professional with ADHD: sharing experiences and insights appeared first on Dr Paula Redmond, Clinical Psychologist.

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Full transcript below

Paula speaks with Clinical Psychologist Dr Lauren Breese about some of the complexities, controversies and opportunities around ADHD diagnosis, particularly in relation to work.

The conversation includes:

• what ADHD is and how it might impact people in the workplace
• gender differences in ADHD presentation
• thoughts on workplace adaptations
• controversies and misunderstandings about ADHD
• the importance of a rigorous assessment process
• benefits of seeking an ADHD assessment
• navigating conversations about ADHD with empathy and curiosity

About the speaker:

Dr Lauren Breese is a Clinical Psychologist and founder of ‘and Psychology‘ (an assessment and therapy service for neurodivergent adults) and ‘The Neurodiversity Practice‘ (a service supporting ND parents, as well as workplaces and mental health practitioners to embrace neuroinclusivity.

Instagram:

@_andpsychology_

@‌theneurodiversitypractice

Linked In:

www.linkedin.com/in/drlaurenbreese

www.linkedin.com/company/theneurodiversitypractice/

Lauren’s recommended resources:

Podcasts:

• The ADHD Women’s Wellbeing podcast
• The Hidden 20%
• ADHD Chatter
• The Neurodivergent Woman

YouTube:

• How to ADHD – Jessica McCabe

Books:

• How to thrive with Adult ADHD – Dr James Kustow
• We have a free recommended booklist for ND parents to download here: https://www.theneurodiversitypractice.com/book-list
• Download our free neuroinclusion at work checklist to share with employers: https://www.theneurodiversitypractice.com/business

I’d love to connect with you so do come and find me on LinkedIn or at my website and do check out the ACP-UK and everything it has to offer.

Follow and subscribe so you don’t miss an episode!

Transcript

Paula Redmond (00.38)

In this first episode, I spoke with clinical psychologist, Dr Lauren Brees, to explore some of the complexities, controversies and opportunities around diagnosis. Our discussion includes common misconceptions about ADHD diagnosis, gender differences and presentation, how ADHD may impact people at work, navigating conversations about ADHD and more. I began by asking Lauren to introduce herself.

Lauren Breese (01:12)

I’m Dr Lauren Breese, a clinical psychologist specialising in working with neurodivergent people. I’ve worked in neurodevelopmental services in the NHS for over 14 years. And in that time, I had the opportunity to work with neurodivergent people across the life span. So I started working in cams with children and families and then I moved over to working with adults at the national specialist autism and ADHD psychological therapy team. And I’ve also set up two new clinical services as clinical lead for neurodivergent adults, and I’ve taught at universities and conferences all about neurodiversity. Now, though, I predominantly work privately and I founded two companies, the first one is And Psychology, and that’s a service where I assess for autism and ADHD and provide therapy for neurodivergent adults. And also The Neurodiversity Practice, and there we provide more systemic support for the neurodivergent community. That means things like our online community called the Neurodivergent Parent Space and workplace and professional training to support the implementation of a neuroinclusive culture across different settings. 

Paula Redmond (02:35)

Yeah, brilliant. Thank you, Lauren. So we’re talking today specifically about ADHD. And I wonder if we could start with just a question about what is ADHD and thinking specifically about the context of work and I guess a second part to that question about how having ADHD can impact someone’s relationship to work, how might it show up and what kind of impact might it have in someone’s working life. But yeah, maybe let’s start with what is ADHD?

Lauren Breese (03:14)

So yeah, ADHD, it stands for Attention Deficit Hyperactivity Disorder, which unfortunately is quite a misleading name, because what we find is actually people who have ADHD don’t tend to necessarily have an attention deficit. They might have an abundance of attention actually and find it hard to regulate that. So they might find it very easy to attend to some things, but find it very difficult to attend to others. So more broadly, it’s a neurodevelopmental condition that is characterised by difficulties with self-regulation. So thinking about attentional regulation, emotional regulation, and also executive functioning difficulties or differences. So executive functioning is, you know, I always think of it like the little conductor in front of your, in your frontal lobe, in the front of your mind that’s helping you with organising tasks, planning, starting tasks, stopping tasks, kind of time management, things like that. And I suppose for a diagnosis of ADHD, we’re looking in two main areas. We’ve got hyperactivity and impulsivity, as well as difficulties with attention or inattention. And usually people might assume that hyperactivity might look like running around or, you know, an image of a little boy, a child, like running everywhere. It actually can be more subtle than that. So it can be kind of more internalised presentations, like racing thoughts, finding it hard to feel settled or being constantly on the go but that might look like pacing in the workplace for example or doodling. So yeah, we’ve got these two main areas which can be kind of represented by lots and lots of different characteristics and a combination of these. What we’re looking also for if somebody’s diagnosed with ADHD is actually that they are having an impact on that person in the sense that it’s really making it hard for that person in numerous areas of their life with relationships or at work, you know, in kind of multiple situations. That they’ve had those characteristics or differences since childhood, they might present differently or have presented differently in childhood, or people might have learned to suppress them. And we also need to be careful as well that they’re not characterised by other conditions, other mental health difficulties or other physical health difficulties. So yes, that’s kind of broadly what is ADHD.

Paula Redmond (06:07)

Yeah, great. And yeah, that question about when we’re thinking about people in the workplace. What kind of things do you commonly find with the people that you work with when they’re talking about the impact on themselves in work?

Lauren Breese (06:23)

Yeah, absolutely. It can be hugely debilitating. And I always find that it’s kind of two factors. Firstly, the characteristics of ADHD themselves can be very debilitating. So if you struggle to plan ahead or if you struggle to start tasks, tasks at work become quite overwhelming. Then, you know, time management, attending meetings on time, prioritising tasks, having a to-do list that can feel extremely overwhelming and finding it hard to work through it to a deadline. All of these things make being at work or in a traditional working environment very, very difficult. Also kind of schooling. But on the secondary level, I would say that you’ve obviously got these kind of practical things that people do struggle with that then make working hard. But often when I work with people, they have struggled with these things throughout their life. And as a result of that had very negative feedback. So there’s kind of an idea that children with ADHD might hear 10 negative things to every one positive thing in the day. I mean, I think that was potentially, I don’t know if this has been a research study, I think it’s more a professor who said it, but it’s a good guess around kind of people experiencing these negative critical comments around could you not just try harder? Why can’t you do it and that person can do it? You you’re always, you’re always doing that. You’re never able to complete a task. And so then what can happen is then. people can internalise this criticism and it becomes self-criticism. And what I see really commonly is on a practical sense, people being asked questions, for example, at work or being asked to answer something in a meeting. And then the processing speed or executive functioning, it potentially feels like they’re being put on the spot and there’s a well, they’ve had all of those previous experiences of being criticised and not necessarily being able to answer very quickly or had negative feedback on how they have responded. And this just sends them into that flight, fight or freeze mode. They’re in the threat mode. And then their mind goes blank. And it’s kind of a very, very difficult situation to be in because they can’t think straight. They’re very stressed. They do have potential like… or the difficulties that they have with the executive functioning and processing speed. But you’ve also got this extra layer of then criticism which then makes that worse. So, yeah, this is something I commonly find for people that I see in clinical practice, this kind of double warning of your ADHD symptoms and the kind of flight, fight or threat mode that they find themselves in in workplace scenarios. So that’s kind of very tricky. And I think just on a different note, I often see people might have changed jobs quite often. They might have kind of had lots of different experiences of work. People might tend to thrive in a different type of environment that’s maybe less traditional of a workplace.

Paula Redmond (10:06)

Maybe say more about that Lauren if you can. What are your observations around that?

Lauren Breese (10:11)

So, yeah, often we find that maybe a traditional, well, I think for people with ADHD, they can thrive with adaptations to their work environment. And these need to be put into place and to be thought about to kind of make sure a workplace is neuro-inclusive in its culture, but also its practices. So things like, you know, on a practical level, we know that people with ADHD sleep can be poorer and their sleep cycles actually can be different or kind of later onset of sleep. And so actually it really follows then that a nine to five schedule might not work for somebody with, you know, and, you know, other reasons on top of sleep, but that’s just one example. So it might be that outsourcing tasks that are potentially difficult for somebody like having a PA or having somebody to help organise a diary is just a really simple solution to something that somebody finds difficult. And so what I tend to find is I work often with people who have maybe left a traditional workplace and created their own workplace. Maybe they’re an entrepreneur or they created a space where they can thrive, they can be creative and they have the flexibility to outsource the tasks that they might find hard. And that can be very helpful for somebody with ADHD, but obviously it’s not always possible for somebody to kind of go and create their own business. So this is why we’re needing the kind of workplace adaptations to, and actually they tend to suit everybody. It’s kind of making workplaces more inclusive, which is incredibly important.

Paula Redmond (11:58)

Great. And as you’re talking, Lauren, was just thinking about what I’ve been really aware of in my own work, for example, in the NHS, but I hear this in other industries, fields as well, is that with the kind of move to more digital recording and more kind of data driven work practices, that there’s a much greater emphasis on the kind of ticking the boxes and filling in the forms and these kind of practices that help with data collection and much less emphasis on quality of work, you know, thinking particularly about healthcare, that what people get monitored on and assessed on and appraised on is, have you filled in all the right forms and ticked all the right boxes and, you know, is everything up to date on the computer system? Not, you know, how, are you doing in your work? You know, what is the quality of, of care that you’re providing the quality of interactions? And I guess I’m just thinking how, I mean, that’s challenging for everyone. But I think, you know, I’m imagining that if you have ADHD you might really struggle with those more, you know, administrative aspects of the work, how depleting, demoralising that might be in terms of the kind of work environments we now find ourselves in that emphasise that part so much more.

Lauren Breese (13:31)

Absolutely. I think that’s such a good point, And it’s frustrating. It’s, you know, I think you’re right. It’s the prioritisation of the completion of all the forms. Just you’re reminding me of, know, have you asked this question? Have you asked about something that may not be clinically related actually to what you’re working on? And I think, you know, one strength of somebody with ADHD is that they potentially can be quite creative in their thinking and are able to think diversely or outside of the box and may have lots and lots of different ideas. And there isn’t an assessment for that, there isn’t a kind of you’re doing a good job because you’ve actually come up with this idea about how to do things differently. Actually what we’re praised for is doing things exactly the same way and in this way and to tick this box and to be having it completed and yeah it is I imagine very challenging.

Paula Redmond (14:41)

Yeah, and people that I’ve worked with, who’ve been suffering from burnout, and that’s been a kind of a common theme for people either who are starting to kind of think about an ADHD diagnosis or who have one that, you know, the kind of burden of often duplicating work over and over, and never feeling like you can catch up, never feeling like you can do a good enough job because of this emphasis on those kind of tasks. It’s really difficult.

Lauren Breese (15:23)

And keeping things in mind and kind of that working memory and visual working memory which we know people with ADHD struggle with, and I think this also it’s reflected as well in I think the path of later diagnosed people. So what we might find is people struggle with all of those, well they struggle with these things in childhood, but they have either had the environment to help support them or they have learned ways that they can tick the boxes despite it perhaps being quite debilitating. And then as we get older, so, especially for women, if we’re thinking of our reproductive life cycle, our hormones fluctuate across the month, but also across puberty, after pregnancy, perimenopause and menopause. And what that means is at times, at key times we have a reduction in oestrogen, which also reduces dopamine, which is indicated in ADHD and other hormones. So we have this physical change, but also what coincides with that are lifestyle factors that add to the mental load, which, so we’re thinking about the extra burden of potentially childcare or planning for more than just one person, thinking about potentially being carers for the older generation. And this doesn’t just affect women, it also affects men, but we’re also seeing the combination of hormonal changes. And so what can happen is the demand outweighs the capacity. So where we have coped previously, there’s too much now to cope with in terms of the mental load and the checklists and the previous coping strategies haven’t worked necessarily or are no longer working, and we can then lead to this cycle of burnout. So yes, all of the admin tasks at work, but as well as all of these other things on top of the hormonal difficulties is, in my opinion, why we’re kind of seeing these later in life diagnoses, particularly for women. Yeah, when the kind of demand exceeds the capacity.

Paula Redmond (17:55)

And one of the other things that I was thinking about and that I’ve noticed more, I suppose, in my personal life than professional life, is there are people who for whom work is maybe a particular domain where they really thrive and the difficulties actually don’t show up in work that it might be, you know, the one domain where they’re able to really perform and really kind of meet their potential. But everything else is a struggle. And I guess that can be quite challenging when it comes to kind of understanding, thinking about a diagnosis or that being seen or thought about in work when it maybe doesn’t show up there.

Lauren Breese (18:45)

Yes, yeah, I think that that can be a huge challenge and I think, yes, you’re right in that ADHD can show up differently in different environments, so, which is why it’s so important to adapt the environment where possible to support somebody. But if somebody with ADHD finds something incredibly rewarding, for example, potentially quite novel or they’re able to really engage in it, then they, exactly as you said, could thrive. And we see this often as well at school when the structure is right and that it’s very validating, very rewarding, people can achieve. But it’s when those things, so either people can get into then a cycle of then potential hyper-focus and burnout where it’s very enjoyable to have that sense of achievement and that I’m doing well and kind of being able to do it. And then they might do that a lot, and then that’s exhausting. We can’t maintain ourselves at that level. We need time for rest. We need time for soothing. We can’t always be in drive, strive or throat mode. And so it can tend to kind of go into a boom and bust cycle in that sense where some people might end up being exhausted and then at home where they might feel more able to be in that soothe mode then that’s very challenging to maintain that kind of high level that they are achieving elsewhere. And I suppose, yeah, it’s helping somebody to find a balance between those, I suppose, ways of being because all are important, but how is somebody going to be able to thrive in all of the areas that are important to them? Because they might be, they might want to have more of a balance within that at home or at work.

Paula Redmond (21:04)

Yeah. We’ve talked a little bit about women and, and how things might affect women differently. And I wonder if you could say a little bit more about that, about how ADHD might present differently for girls and women and why that might be?

Lauren Breese (21:22)

Yeah, definitely. So we’re not very good at picking up on ADHD in girls and women. Traditionally, it’s been seen or kind of more recognised in boys. It’s interesting, there’s kind of research to show that more boys than girls have ADHD, but actually by the time puberty hits, that equals out a little bit which lends weight also to this idea that there are hormonal implications related to this. Generally, girls and women tend to be more inattentive than hyperactive, or their hyperactivity might present in a more internalised way. So, racing thoughts, more kind of subtle ways of fidgeting, doodling, I think I mentioned that earlier, but less so than kind of running around that you might see in kind of more of a boy presentation.

Paula Redmond (22:29)

And I guess I suppose that is part of why women and girls are under-diagnosed because their presentation doesn’t necessarily fit so easily with the diagnostic criteria.

Lauren Breese (22:47)

I think that’s it. So I think that the kind of research tend to, you know, tends to be skewed in that way and that we don’t, we don’t know necessarily what ADHD might look like in girls and women and that it tends to be based on a more of a boy male presentation. And I think this is why, yeah, we’re less good at picking it up. And in fact, I think what can be more likely to happen for girls and women is that they are misdiagnosed with another mental health difficulty like anxiety, depression, UPD, bipolar disorder. And this happens frequently. So, you know, women that I have heard from who have had a later diagnosis of ADHD, they might go to the GP and mental health difficulties are potentially the first thing that somebody is kind of thinking about, you know, more so than if a male went, this is from my clinical experience yeah, it’s this kind of diagnostic overshadowing that happens frequently for women. So we know that things like PMDD is more common for people with ADHD and kind of menstrual pain, but also like other physical health difficulties, like inflammatory conditions. And, you know, these then tend to overshadow an ADHD diagnosis. So what, you know, is helpful advice, I think, is to keep an open mind at that assessment stage. You know, we’re really, it’s incredibly important to be doing differential diagnosis with ADHD, but it needs to be on the table from the beginning as part of the discussion to be ruled in or out. And I think that it hasn’t been so the case for women.

Paula Redmond (24:39)

Yeah. And I guess there’s also something about masking and social expectations that might play a role in these different presentations. And I guess something about, you know, the internalisation of some of these symptoms that might happen more for women than for men.

Lauren Breese (24:59)

Yeah, I think so. I think it’s what do people expect of, of even play, you know, from an early age of playing for children. And is that running around the playground and being able to engage in sports, for example, or is that kind of sitting quietly and nicely and doing imaginative play. And it’s very gendered from the beginning. I think it’s potentially those narratives around being quiet and being good and being, you know, not shouting out, not being able to express your individual opinion, which I guess without being stereotypical can be internalised as being a good girl. And so you’re kind of suppressing from the beginning that urge to shout out or the kind of traditional hyperactive impulsivity that we might see for somebody with ADHD. You’re learning to suppress that for fear of negative connotations or not being encouraged to be yourself in that sense. So yeah, I find a lot of women tend to have had this experience.

Paula Redmond (26:14)

Yes. And I guess it’s also fair to say that this can be, you know, it’s a very topical conversation, you know, ADHD is around in the news a lot. And there are, I suppose, some controversies in the field around, and even in within clinical psychology around the diagnosis itself, around, you know, the kind of expansiveness of diagnosis and need. And I guess I’m aware of when I, you know, tell people that I’m offering ADHD assessments, it’s really interesting how people respond to that and I tend to get three types of responses, and I wanted to talk to you about those. So the three responses I tend to get are: Is that even a real thing? Like, is this not just an excuse for people being lazy or immature? The second is how come every second person now has ADHD, you know, everyone I know has it. This sort of idea of this sort of, you know, hugely increased prevalence and like how meaningful is this as a diagnosis if everybody’s got it. And the third one is, you know, this you know, Oh yeah I’ve got this friend who, you know, does this fidgeting thing, definitely ADHD. This sort of…

Lauren Breese (27:40)

I hear those too, yeah.

Paula Redmond (27:44)

So maybe if we start with the first one, this kind of question, like, is this a real thing? Does it exist or is it just an excuse? What would you say to that?

Lauren Breese (27:54)

Yes, what would I say? Yeah, it’s a shame because it’s a common, it comes up a lot. And I suppose it’s a shame for the people who experience ADHD, who have ADHD. It can feel very invalidating of somebody’s experience because if you have ADHD and if you know people with ADHD, it can be hugely debilitating. And there is a lot of information about, you know, we want to be neuro-affirmative and we want to see strengths as well as challenges. But in being neuro-affirmative, we can’t deny the challenges. You know, neuro-affirmative doesn’t just mean being relentlessly positive about something. So, I think that this is extremely challenging because it potentially invalidates some of the difficulties and real differences that people experience. I think what I would say as well is there has been hundreds of thousands of research studies on ADHD. And these say that ADHD is a neurodevelopmental condition. And so it’s interesting as to why we are questioning this in a potentially a similar way to some of the conversations we had about autism, know, years and years ago around, you know, very long time ago, autism is related to refrigerator mothers, which we know is not true. But we now seem to have accepted autism as being a neurodevelopmental condition, but ADHD, I feel like we’re still catching up. And, you know, there are neuroimaging studies of structural differences and functional differences in the brains of people with ADHD, particularly in the regions involved in impulse control, attention, executive functioning. And we also know from thousands of research studies is that there’s around a 80% heritability rate, which is about the same as height actually. So if you’ve accepted that, you know, if my mum’s tall, then I might be tall. But actually what we’re seeing is if your child has ADHD, your parents may also quite likely have ADHD. And yes, there are other risk factors involved, but there are even kind of new studies, you know, trying to think about the genetic expression of ADHD. And you know, we’re not there yet, there’s probably likely multiple genes involved, but, you know, I would say that there is a lot of evidence for the validity of ADHD and in the same way that, you know, autism and, you know, we would characterise that as neurodevelopmental conditions, we know lot more about how these present and how we need more research, but yeah, that they are real things. And I think questioning that can be quite invalidating for the people who do experience those real challenges.

Paula Redmond (31:09)

Yeah. And what about this, this the second point that I hear a lot, which is, you know, now every second person you come across suddenly has ADHD, and how does that, how do we make sense of that?

Lauren Breese (31:25)

Yeah, it’s so interesting. I was at a conference this year, an ADHD conference, and I think clinicians are also surprised at how interested people have been becoming in ADHD. So what’s interesting is to kind of separate it out a little bit. So what we know is the prevalence of ADHD is around 3% of adults in the UK. About, we know, probably about two million adults remain undiagnosed. So having clinical experience that’s, that you know I think 3% is potentially on the lower side, it may go up to about 6%. So for children it’s a similar percentage, around four to seven percent something like that. And actually the prevalence rates of these diagnoses haven’t changed, but what has changed is more of the incidence rates. So we are seeing more people being diagnosed. So, you know, yes, people are coming for assessment and diagnosis. And I think that’s related to a greater understanding, a greater awareness and communication about ADHD. It’s interesting it kind of coincided with the COVID pandemic in that I think I read something where it was in that year, ADHD was the second most Googled condition on the NHS website, and I think also like the increase in TikTok videos or like online videos about people’s experiences. And also what we’ve got is people working from home, people having a break from the traditional work setting and either seeing that they can thrive actually, or seeing that they really struggled and kind of wanting to learn more about that. And so I think it’s kind of been a, yeah, a bit of a perfect storm in a good way, I think, because it’s, we’ve got more information, more understanding, and people are seeking assessment. But I personally think that this will level off as we catch up, because we, I think we have been underestimating under diagnosing and assessing and we’re just playing catch up. So, you know, women, people of colour are still under-diagnosed, you know, and so I think there will be a point when this kind of levels off and I don’t think the prevalence rates will change. I think we’re just seeing more people coming forward and recognising. I think another thing also is happening for the older, I say older, I categorise myself in that bracket, but people are kind of coming later on and they may have seen their children struggle at school and they have received an assessment and subsequent diagnosis and then they’re starting to think about their own experiences. So this is very common for the people that I see in adulthood, it’s like, oh right, we didn’t have an understanding of that when I was little, but I really struggled with that, and that’s something that I still struggle with. So we’re getting better at recognising it, but we’re still not there yet. Like, even though there has been a huge demand, we’re still kind of underrepresented, I think, in this area. And particularly research needs to catch up too for women and people of colour, or, you know, and generally.

Paula Redmond (34:59)

Yeah, that’s a really helpful distinction between prevalence and incidence. That really kind of makes it clear. Reports on the news every day about, you know, years long waiting lists for people, and it is, yeah, kind of hard to get your head around those numbers. But yeah, that makes a lot of sense.

Lauren Breese (35:19)

Yeah, yeah, there’s a huge increase in demand. And I think people are surprised in the sense that, you know, we haven’t had that before in services. And so we’re trying, you know, services are trying to catch up and design themselves to be able to meet the demand, but we just haven’t had, or services haven’t necessarily had the funding for that. It has been a bit of a surprise, I think.

Paula Redmond (35:43)

Yeah. And the third kind of response I get is this like, Oh yeah, yeah, oh my gosh, my friend’s always late, or, you know, my husband is terrible at, you know, doing the dishes, he must have ADHD. And I guess, yeah, there’s something interesting in that about, you know, this combination of greater awareness of what that might look like but I suppose questions about the complexity of what a diagnostic process looks like, what, you know, what ADHD in its fullness means. And, I suppose sometimes that question of like, you know, what is a kind of trait versus a diagnosable disorder?

Lauren Breese (36:30)

It’s a great question. I think this is the flip side of sharing information on TikTok. Yeah, yes, it’s really helpful to have an increased understanding or awareness, but I think potentially misinformation can be shared. you know, I’ve seen videos of, I have an ADHD diagnosis and I do this thing, and as a clinician, that wouldn’t be something that I would associate with ADHD. But then that gets shared and people resonate with that and then say, well, I do this thing, does that mean I have ADHD? And actually, it’s very difficult because it kind of dilutes what is quite a rigorous assessment process. So to be diagnosed with ADHD, you will have had to have hopefully have undergone quite a rigorous assessment process, especially compared to other, I mean, it’s not a mental health condition, but you know, other mental health conditions, for example. So, you know, I think there’s that part of it, and I can tell you more about the diagnostic process in a second, but there’s also another part of it as well around, I think people, our evidence base hasn’t caught up yet either. So people who have lived experience of ADHD are describing their experiences also. So, so kind of maybe they, for, a really good example is talking about rejection sensitive dysphoria. We don’t have much research on that. We don’t, that’s not part of the diagnostic criteria at the moment. That’s not to say that it won’t be. But it’s a kind of example of how as clinicians, we’re also trying to catch up with people’s experiences and saying, okay, is rejection-sensitive dysphoria a significant characteristic of ADHD in the sense that it could rule in or out ADHD, or is it something that overlaps with other conditions that is also just part of the experience potentially, but it’s not enough to be included in the criteria, for example? So we’re kind of, I think, at that point where we don’t have a lot of research to back up or we’re still kind of a bit behind in that sense. So, but, in terms of the diagnostic process, it includes multiple parts, you know, a kind of general, a general interview with the client about what they’re struggling with, what they’re finding, potentially easier or what they’re finding hard. A more focused interview around specific characteristics related to the diagnostic manual for ADHD, as well as an interview with somebody that knows them really well. Information from childhood, that might include school reports or an informant, developmental history, even looking at reports from professionals or historical reports, as well as your clinician’s observation. So you’ve got multiple kind of triangulated information which is required. You’re also thinking about impact, which is hugely important. So the impact on somebody’s life. And then another huge part of the assessment process is the differential diagnosis, which is hugely important. So ruling out other mental health or physical health conditions. ADHD can look like different things, anxiety, or potentially trauma, PTSD symptoms, or autism. And so a clinician needs to be really skilled at being able to tell apart these different things and amalgamate all of that information from multiple sources to come to a diagnosis. So it’s quite a rigorous process, and yeah, I think I can see why, you know, people might say, I might have ADHD, I do this thing, which I think may come from more knowledge about it, but actually to have a diagnosis, you have to meet a set of stringent criteria which haven’t actually changed. We haven’t got looser with the criteria, which is another thing when we’re thinking about kind of diagnosis broadening, it’s not changed recently. And so, you know, people do have to have training in assessing as well. So it’s not just something that people can come to, you have to have had training in being an assessor. So, yeah, it’s quite an involved in-depth process.

Paula Redmond (41:22)

And I guess there’s, there’s something about the particular context that we find ourselves in at the moment with these long NHS waiting lists, but also, you know, it’s that the guidelines don’t stipulate a particular profession who is able to do the diagnosis. So, there are lots of options out there to seek private assessment. And I guess we’ve also heard kind of horror stories about people having quite inadequate assessments. But I guess as you say, when you, you know, really are clear about what a rigorous thorough assessment takes, that’s not going to be done in 45 minutes or an hour and a one off appointment. And as you say, I guess that’s something that I suppose a profession like clinical psychology is well placed to offer particularly around the differential diagnosis. So I guess that’s really important for people to be thinking about who might be seeking assessment that, you know, checking out.

Lauren Breese (42:25)

I think that’s it. Yeah, checking out people’s experience. People, you know, because I think people are getting interested in it. You want somebody that has had experience of, you know, working in neurodevelopmental conditions, you know, who are able to differentiate between mental health, physical health, and like you say, clinical psychologists are well placed to do that. And I think what I’ve found as well is the skills of a psychologist around formulation are, I very much value in an assessment process. So obviously you have an assessment, there’s no one tool to assess for ADHD. So you’re using lots and lots of information from different sources and potentially different tools to help inform your clinical judgement. But I think, you know, a clinical psychology assessment doesn’t stop there. It offers also, you know, in my practice offering a formulation around understanding somebody’s journey, experiences so far, what might be keeping them stuck, or, you know, what might have contributed to their current difficulties, which some other assessment processes may not take into account. So I think for me, a diagnostic process is more than just a yes or no answer at the end. It provides a clinical understanding or a psychological understanding alongside an answer, which I think particularly adults who may have, I mean, everybody’s different actually. People may just want an answer and want a yes or no diagnosis, but some people want a more in-depth understanding around, and what else? And recommendations related to that. So I think for me personally, that’s what I value in an assessment process. Something that is very neuroaffirming, that can take into account differences within the assessment process so that they can adapt the assessment to somebody’s needs, but also that kind of formulation approach on top of the diagnosis. I find very helpful and I think people find very helpful. I think it’s interesting as part of the assessment process, kind of thinking it’s not just a tick box exercise. A good assessment, it shouldn’t just be a tick box exercise. It should be more of a narrative, kind of thinking more broadly, you know, tell me about a time in the week that you struggle. Tell me about a time in week where you thrive. And so this I feel like characterises a kind of helpful assessment process in that it’s not just, would you say that you’re constantly on the go and driven by a motor, which is kind of one of the diagnostic criteria, for example, where people kind of say, Oh yes, that’s me. So kind of an assessment should be more of a two-way conversation, and a very curious conversation about where people are struggling and may not struggle. And with that information, you come to the clinical judgement or clinical opinion, which is perhaps where a good assessment lies rather than a kind of tick box exercise of the DSM criteria.

Paula Redmond (45:55)

Yeah. And I guess you’ve, you kind of touched on that, but I wanted to ask what you would say are the benefits of seeking an assessment, I guess, particularly for those people who might not be keen on pursuing medication as an option?

Lauren Breese (46:12)

Yeah, absolutely. And so medication isn’t the only option. And I think it’s, I think that having an assessment and subsequent potential diagnosis, it can really help somebody to understand themselves. So often the people whom I’m working with, they might’ve had a lifetime of feeling different, feeling misunderstood, knowing something is different but not able to put their finger on what that is or understand it and that can result in more self-criticism or more kind of downward negative comparisons. And actually being able to have an assessment and an understanding a diagnosis can help to validate somebody’s experiences, that it’s not their fault, it can very much be de-shaming for somebody and help someone to come to a place of acceptance and subsequently thinking about what they need to thrive. And having the language for that is incredibly important. It’s the, you know, it’s in a similar way that having the language for emotions is important. It helps to, to kind of regulate them and, and, you know, having a language for what somebody is struggling with can help somebody feel understood, validated, as well as find other people as part of a community, which we know is beneficial for people’s mental health. And there are also practical things people can access, like access to work grants or reasonable adjustments in line with the Equalities Act, evidence-based resources, so kind of practical things. But also on the kind of flip side, having undiagnosed ADHD can be quite risky actually. And this isn’t for everybody, but it’s associated with unfortunately poorer outcomes of mental health, of socioeconomic outcomes with undiagnosed ADHD. And this isn’t necessarily to say if you don’t have an assessment diagnosed, that is going to happen, but what we know is that it’s helpful to have understanding where there is some to be had so that subsequent support can be put into place and even if that support just looks like you understanding yourself better and being compassionate to yourself, that is helpful. I think because the risks are that people might be, it’s unlikely that somebody is undiagnosed ADHD and might not be struggling with other things like for example, they might be misdiagnosed with another mental health problem, for example, or diagnosed with a mental health difficulty that may be able to be supported if we also had the knowledge that they had ADHD and they would benefit from some adaptations around the therapy that they access, for example. So, I think, yeah, I think there are benefits to having an assessment that aren’t just medication. And I think on a practical note as well, I guess the NICE guidelines recommend, they say like pills and skills. So it’s not just the medication, there are also, I think like I mentioned earlier, maybe practical skills or tools, sorry, that somebody might be able to learn that can be supportive, but also the secondary aspects that may have come from your lifetime of experiencing difference, for example, potentially self criticism can also be addressed. So yeah, I’m quite passionate about kind of somebody kind of understanding themselves fully. But I think sometimes just on the caveat, as a caveat, it’s not always the right time for somebody. So, you know, you have to weigh up the pros and cons for your own circumstances as to whether it feels right and what assessment would bring, what would happen if the outcome was, yes, you have ADHD, what would happen if the outcome was no, you don’t have ADHD. So there’s a lot of thought that I recommend could happen before coming to the assessment. And it’s not always for everyone, but I do think that there are benefits, but there might be downsides for some people in their circumstances, know? So I guess it’s thinking about that for an individual, what makes sense for them.

Paula Redmond (51:07)

And as well as that, if I wonder Lauren if you have any advice for anyone listening who might be recognising some of these things might be resonating with some of the things that we’ve talked about for themselves, any other thoughts or advice?

Lauren Breese (51:23)

Yes, I think take your time, be compassionate to yourself if you can. Just kind of, I think this coming to this understanding tends to be a long process. It’s not just something overnight that you think, oh guess what? You know, I’ve heard, I don’t know how accurate this is, but you know, on average about five years to come to from the point of wondering to the point of assessment. But anyway, five years or not, it’s a long time. think from my clinical experience, it’s a long time that people have been wondering. And I think being gentle with yourself within that process is very important. I think in that sense, potentially asking the question can be helpful because there’s only so much wondering on your own that you can do. And so sometimes it can help to ask the question so that you know what to do next. And that, you know, because often I find also that kind of wondering phase, people might start to then second guess themselves, oh well, everybody struggles with that. So actually having somebody that you trust to help you grapple with this is useful. I think if you are at the process of wanting an assessment, checking out somebody’s expertise and qualifications and experience is incredibly important. There’s lots of misinformation out there, so finding websites that are trustworthy, that are providing evidence-based information is helpful. Thinking about the process of assessment, do you want a yes or no answer? Do you want more of a psychological formulation-informed assessment where you might seek out a clinical psychologist that can help support with that. Yeah, I suppose potentially talking to other people as well, talking to your family about what the impact of a diagnosis might be for you and what you feel that the benefits might be of that or the downsides.

Paula Redmond (53:33)

Thank you. And I guess another question, and this came in from one of our listeners about how to broach a conversation with someone, either a family member or, you know, a colleague who you might think that ADHD might apply. Any thoughts on how you might go about, or if you might go about having that conversation? If you see someone struggling and that this might make sense of that?

Lauren Breese (54:02)

This is really, it’s a very good question and it’s very tricky. I suppose there’s a lot of nuance that might be needed depending on the circumstances. So when we speak to workplaces, you know, The Neurodiversity Practice where we train workplaces and managers and employees, I suppose based on what we’ve said today, you know, for a colleague who may not know the person well, it might not be appropriate to kind of, because of the nuances that are involved in an ADHD assessment, to kind of, you know, having seen something online and they’re disorganised or something to mention it, that it may not be the right setting or you may not know somebody well enough to be able to approach that conversation. However, what we do know is talking about adjustments generally is helpful for employees and colleagues. So thinking about how we all thrive in the workplace and what’s needed. Perhaps, you know, having a checklist of things that some people might help and then, you know, having that for the whole team, not just singling out one person is, I think, a helpful way to go about even, you know, to kind of thinking about helping people to understand their own needs and what they can ask for. And often for managers as well, it’s helpful for that to come from them and the onus to be on them to be providing or asking about adjustments. So approaching it that way can be helpful. If you’re say like a manager or a colleague that you may need to kind of think about how can we support everybody to thrive in this workplace? Does that make sense? And I suppose for a loved one, I suppose these are very helpful conversations to have. Yes, they are sensitive conversations and should be dealt with accordingly with empathy and understanding and curiosity. But I also think being open about communication is is also helpful and maybe sharing things that that person has learned about ADHD and asking for that other person’s perspective on it and just opening the conversation can be useful. I feel like we’re moving away from ADHD and autism and other neurodevelopmental conditions being a taboo. So I think, you know, this it’s not a deficit, it’s a difference in the way people process information. So approaching it as such can be helpful in a really open and a very curious way that doesn’t feel judgmental or blaming or threatening in that sense. So I think that would depend on the relationship and how they’re able to communicate. But whether that’s sharing something or joining together with somebody in curiosity can be helpful.

Paula Redmond (57:25)

Great, well thank you so much Lauren for joining me today.

Lauren Breese (58:23)

Thank you so much Paula, it’s been a real pleasure.

The post ADHD in Adulthood: complexities, challenges and opportunities – with Dr Lauren Breese appeared first on Dr Paula Redmond, Clinical Psychologist.