Attention deficit hyperactivity disorder (ADHD) affects around 2% of UK adults, and is commonly recognised as a specific learning difference (SpLD) due to the impact of inattentive and hyperactive symptoms on performance at school, university and work. It is often not diagnosed until adulthood – sufferers are often first misdiagnosed with depression and anxiety disorders during their teenage years, induced by the struggle of compensating for an unrecognised neurodevelopmental disorder.
I myself was finally diagnosed with ADHD at the age of 20, in the summer between my second and third year at medical school. Through raising awareness, the perceived stereotype of hyperactive little boys is beginning to change – adults, and especially women, can have ADHD too.
Less commonly known is that emotional dysregulation can also be a sign of the disorder. Emotions in ADHD can often be described in three ways: fast-building, intense, and short-lived. Put simply, we feel emotions a lot more strongly than our neurotypical peers. The working memory impairment present in ADHD can allow a fleeting emotion to become totally overwhelming. We can’t focus on anything else, not even information that might regulate the feeling.
ADHD often presents with comorbidities. These may be other SpLDs like dyslexia and autism, or psychiatric diagnoses – depression and anxiety are particularly common. All the struggles of compensating for a brain that doesn’t cooperate with you can make people with ADHD feel a bit rubbish about themselves, so coupled with emotional dysregulation, a majority of those with ADHD will have experienced low mood at some point.
I’m not ashamed to admit that I have struggled with bouts of clinical depression and anxiety for the past decade. For years, I struggled to keep on top of my mood, and the circumstances of lockdown have made this year at medical school particularly challenging for me. However, I’m now finally on the perfect combination of medication, and I feel great.
Medical students need support that empowers us to stay on placement
I have become even more aware of the stigma associated with long-term mental health conditions. I’m frequently asked if I’m ‘better’ now. I don’t believe that recovery has an end-point, and am all too aware how easy it is to slip back into old patterns, and not recognise that downward spiral until you’re in too deep.
I often see confusion when I explain that actually, I don’t plan on stopping any of my meds now I feel better – it’s thanks to them that I do. ADHD, and its travelling fellows, are deficiencies of chemicals in your brain… so if you can’t make your own, store-bought is fine!
Since starting a blog about life as a medical student with ADHD, I’ve been stunned by how many peers have confessed that they were too anxious to share their diagnoses publicly, due to the familiar stigma of being anything less than perfect. Perfectionism is still rife in medical schools, but so is being different – medical schools are not factories. No two doctors are going to be the same, other than that we all have ‘imperfections’.
When it comes to being open about our struggles, the medical profession may ‘talk the talk’, but I’m yet to see us ‘walk the walk’. Being aware of mental health is great, but employers and educators need to ensure that support is more robust than vague notions of ‘reaching out’.
In the same way that not everyone will experience mental illness, not everyone with mental illness will experience it in the same way – one size does not fit all. Medical students need options besides leaves of absence (usually in the hope that time will heal all). We need support that empowers us to stay on placement, if that’s what is best for our wellbeing, instead of barriers like compulsory blocks far away from our appointments.
My neurodevelopmental disorder is lifelong. It’s not going to disappear, but medical careers might if the system, and the support it offers us, resists change.