Attention Deficit Hyperactivity Disorder affects up to 10% of people. Even a mild case can take its toll on function in daily life, and, among women, who are affected as often as men, it takes a special toll. In women, ADHD is usually not the hyperactive type, and proper diagnosis often goes by the boards. And no matter how the times change, most cultures expect women to not only be organized but to organize others' lives as well. It’s not pretty when you’re a woman with ADHD.
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ADHD is a cognitive disorder characterized by difficulty with regulating behavior and planning things, and it comes in three flavors: predominantly hyperactive/impulsive, predominantly inattentive and combined types. It is the inattentive type that seems to affect girls more, and it is what I’ll stick to, here.
ADHD-PI is different from the other subtypes of ADHD in that it is characterized primarily by inattention, easy distractibility, disorganization, procrastination, forgetfulness, and lethargy - fatigue, but with less or none of the symptoms of hyperactivity or impulsiveness typical of the other ADHD subtypes. In some cases, children who enjoy learning may develop a sense of fear when faced with structured or planned work, especially long or group-based that requires extended focus, even if they thoroughly understand the topic. Children with ADHD-PI may be at greater risk of academic failures and early withdrawal from school. Teachers and parents may make incorrect assumptions about the behaviours and attitudes of a child with undiagnosed ADHD-PI, and may provide them with frequent and erroneous negative feedback (e.g. "you're irresponsible", "you're lazy", "you don't care/show any effort", "you just aren't trying", etc.).
The more intelligent inattentive children may realize on some level that they are somehow different internally from their peers. However, they are also likely to accept and internalize the continuous negative feedback, creating a negative self-image that becomes self-reinforcing. If these children progress into adulthood undiagnosed or untreated, their inattentiveness, ongoing frustrations, and poor self-image frequently create numerous and severe problems maintaining healthy relationships, succeeding in postsecondary schooling, or succeeding in the workplace. These problems can compound frustrations and low self-esteem, and will often lead to the development of secondary pathologies including anxiety disorders, mood disorders, and substance abuse.
I always knew my brother had some kind of attention problem, although he was decades too old for Ritalin or even a diagnosis. He never walked—he ran. Old home movies show a hyperkinetic lad who managed to fill each frame.
My case, as with the majority of affected girls, was a lot less obvious. We all found out something was wrong when I entered first grade, already reading but a complete sit-down striker who did no schoolwork, preferring to daydream. I was scheduled to go into special education when I returned for second grade, but we moved. I hardly did better in the new school system, as the comments on my report cards showed: "Rhubarb can be quite lazy at times," "Desk is a mess," "Daydreams in class," "Can’t seem to pay attention," "Does not turn her homework in," and the hackneyed "not working up to potential."
And I had plenty of potential, according to tests. But I graduated smack in the middle of my class, after 12 years of squeaking through classes by acing the tests. I had other markers of the ADHDer, in retrospect; I was a total slob, and an inconsiderate friend. At work, a classmate asked me why I flitted from task to task without finishing one of them. Another yelled at me for "lacking foresight" as we cranked out plate after plate of fish fry for a full house of Friday night diners. My boyfriend at the time was probably another ADHDer—a hard drinking thrill seeker who admitted to me that his head buzzed with ideas for hours after he laid his head on the pillow. Mine, too.
College was a disaster, the first time around. I flunked two semesters (I didn’t bother going to class) before slinking home. Then I signed up for an emergency medical technician course and was told I couldn’t take the finals because I’d missed too many class sessions. I was never depressed, really, but I felt trapped in a repeating cycle of failure. Great beginnings, petering out in embarrassment.
I did manage to retake the EMT course and spent the next 12 years doing very well in a profession tailor-made for someone who loves novelty. And then I went back to college at age 26. Forcing myself to be a grind, I made the dean’s list, again and again, and it was the first time I ever felt as if I were in control of what happened to me. Mind you, I had no idea that I had ADHD, and would not for many years.
Of course, I switched majors a couple of times, and it took me 9 years to get the sheepskin, and it’s not a degree I use today. Today I am a nurse. Meanwhile my husband suffered from my impatience and my lousy housekeeping and planning skills. How many times did he call me irresponsible? And I was. As steady and linear as he was, he became in many ways my parent, paying the bills on time, vacuuming the floors and watering my poor, poor houseplants.
I never stopped wondering what was wrong with me, that I could not master the many organizational details that other women made look so effortless. And I wondered why I never seemed to have the stamina to, well, get shit done. Nor could I figure out just why I let my many friends slip away.
When my son was born, everyone in my family seemed to breathe a collective sigh of relief as they saw that I was a "good mother." I can only imagine what they were expecting. My time as a stay-at-home mom was a very constructive time, and transformative in the ways it brought me together with enduring friends.
The penny dropped
But I have never been able to outrun my fundamental disorganization. Disorganization has eroded at my sense of myself as a good mother who can provide her child with much-needed structure. Even getting out of the house can be difficult; when my son was only four, he asked, "Mama? Why do you always run back to the house for the car keys, or your glasses?"
Nor I have ever been able to outrun my tendency to let myself get scattered. Nursing is another profession tailor-made in some ways for the ADHDer; it is multifaceted and portable, which is nice for a person who chafes under the yoke of the routine. But, there are details. Those important details! It was details missed that got me fired from my first nursing job, in a nursing home, where I was good with patients and cool in those rare emergencies, but awful with the myriad clerical tasks, forgetting many, and getting the rest done late. Nor was I good at delegating tasks. "You can’t focus," the HR lady told me as she handed me my pink slip. "You seem to lack the tunnel vision to get done the million little things that must get done every shift."
This firing came at a time when my son was being diagnosed with ADHD, (combined type), and between that and the post mortem I did on my work performance, the penny finally dropped: I myself had ADHD.
Pulling focus out of one's ass
My approach since then has been twofold: managing my executive function problems with timers, tickler files, planners, and developing routines, and seeking to improve my brain with exercise and nutrition. Meanwhile, I’ve found a terrific nursing job with a world-class institution in a behavioral unit, (where, ironically, many of my patients have ADHD). So far, my new approach has been working, and my preceptor has said that I am organized enough to have progressed unusually rapidly to a full patient load. But I’m yearning to try stimulant medication, to see if the "effortless" organization might happen, because I have been working so hard to stay organized that it exhausts me, and I am scared.
Scared because behavioral shaping can only go so far. Tweaking neurotransmitters, though--there's the rub. A helpful colleague wrote me:
If you have ADHD, your dopamine levels will speed up on meds. This is usually the greatest effect of meds because the fog lifts. Also, if you have noticed that you are more focused working EMS and ED its cuz you are functioning with more adrenaline in your system (which speeds up dopamine levels). The quicker the dopamine, the more the focus... This is why you do well in emergencies. [nursing home work] is a killer for most ADDers. You are trying to pull focus and motivation out of your ass. It's not that you can’t get focused. It's that you are not stimulated.
The happy days ahead?
So I am poised for the moment, trying to make sense of my life and plan at least a partial recovery, perhaps with stimulant medication. I say partial, because, as psychologist Sari Solden, an ADHDer herself, is wont to say that there is never a fix, and we eventually have to learn to embrace our disorganization and find a way forward. ADHD men often have a highly organized assistant or wife to help them, but an ADHD women is a bit like the proverbial barber in search of a shave.
I will be around for a few hours to engage you in discussion. All commenters are welcome, and most especially if you are a woman wrestling with the special stigma of being disorganized. If you have managed to become Martha Stewart and your local PTO loves you, please tell me your secret! ;-)