For Stacey Duguid, focusing on simple tasks and making plans was difficult but she had no idea why. The she was told she had ADHD — and, as she discovers, she's one of a growing number of women now being diagnosed in midlife
I do not present as the classic ADHD (attention deficit hyperactivity disorder) stereotype. I don't fidget or tap my fingers. At school I was a sensitive child who masked shyness with comedy but was never disruptive. My daydreaming, forgetfulness and emotional sensitivity were "character traits", my dogged devotion to art viewed as "passion".
"But wait!" I hear friends say. "She has a successful career, close friendships, looks people in the eye and is a right laugh at a party. She can't be ADHD!" Oh, but I am.
You see, whereas boys with childhood ADHD tend to be hyperactive, which often lands them in trouble, girls are more likely to present as inattentive ADHD, which all too often goes unnoticed. Unnoticed until many years later, when after a lifetime of masking symptoms as well as implementing complex coping strategies, a diagnosis happens pitifully late on in life, rather like the autism diagnosis that the TV presenter Melanie Sykes recently had at 51. And this is what happened to me.
In April this year I decided to leave full-time work to go freelance. In the days that followed, instead of finding the headspace to breathe, I properly unravelled. With no access to a work diary (which colleagues added meetings to, not me) or Microsoft Teams bleeping away in the background, all semblance of daily structure was gone. I began to miss sessions continually with my therapist — odd, considering they had been scheduled on the same day at the same time for the past three years. I felt something was "off" but put it down to stress and a lifelong inability to keep a paper diary — my God, all those expensive, half-filled Smythson diaries; what a waste. As for attempting to use a digital diary, it felt like The Krypton Factor. After a third missed appointment — I was in central London when I was supposed to be at therapy, while at the same time my neighbour called to say she'd accepted my Ocado delivery — I was so confused that my therapist dropped the bombshell that changed the course of my future: "Perhaps you might consider making an appointment to see a psychiatrist?" Maybe I am mad? I certainly felt it.
I had started seeing my therapist in 2018 when the strains of a high-pressure job, a marriage in turmoil and the all-consuming demands of parenting young children began to overwhelm me to such a point that I had to take beta blockers just to be able to walk into the office. Three years of hard work with my therapist later, I had good reason to trust her "hunch" and so I contacted the Portobello Clinic in London to make an appointment to see the consultant psychiatrist Dr Mo Zoha. It cost £570, and it's from a position of privilege that I was able to afford to go private; waiting times on the NHS can be months, if not years. On May 19, the day after my 47th birthday, I had a Zoom call with him. The hour that followed felt as though he'd reached inside my mind.
"Do you often find it difficult to organise tasks and activities?" Yes. "Do you often find yourself talking too much in social situations?" Yes. "Do you have difficulty waiting your turn in situations when turn-taking is required?" Yes. "Do you have difficulty completing administrative tasks?" Yes. "Are you easily distracted by noise and events?" Yes. "In which areas have you had problems with the following symptoms: not achieving promotions, underperforming at work, did not complete education, tire quickly of relationships, financial problems, difficulty maintaining social contacts, not being attentive (ie, forget to send a card/phone etc), unable to finish a book or watch a film all the way through?"
It was like playing bingo except the full house was my mind. "You are high-ranking ADHD," Zoha said. I left the virtual meeting and cried.
I cried from the sweet relief at knowing the permanent overcrowded motorway that resides inside my head, where cars pile up and there's no hard shoulder in sight, now has a name. Although I feel a huge sense of relief and don't wish to dwell too much on the past, I felt so much grief for my younger self, a young woman who had implemented many complex coping mechanisms such as staying late at the office to avoid noise and distraction and who would often drink too much to overcome a minor comment made by a boss that had derailed her to the point of feeling she didn't deserve to be alive. Not to mention all the friendships lost because of my inability to make a plan, to confirm a date to meet.
Holly Bell, mother of three boys, Bake Off alumna and founder of Mrs Bell's Brownies, was diagnosed at 41 and went through a similar period of what she says felt like mourning. "I was sent a review copy of Rebecca Schiller's book Earthed earlier in the year and with every page I read the realisation became clearer. By the time I had finished her brilliant book [about Schiller's move to a smallholding and subsequent ADHD diagnosis] a diagnosis felt more like a formality. I had spent the first half of my life knowing I was a bit different to other people. I was sure I wouldn't spend the second half of my life wondering what might have been if I'd chased a diagnosis."
Talking to Holly was like having a chat with myself in the mirror. I asked Zoha why so many women slip through the net for so many diagnoses that are usually spotted during childhood, from ADHD to autism. "Midlife and menopause can lead to changes in mood but it is also a time of reflection," he said. "Having reached a significant life milestone that can lead to a sense of disappointment at not having reached certain life goals. I have several female patients in their sixties seeking assessment."
Jay Émme, 42, an ADHD-diagnosed classical cellist and trained life coach, works one on one with women with ADHD. "It can be hugely affected by hormones and menopause further upsets that balance and can worsen ADHD symptoms and make you feel like you're literally losing your mind," she says.
The digital creator Natalie Lee (@stylemesunday) was 41 when she was diagnosed with ADHD. "My brain felt like a big ball of cotton wool and it can be like wading through mud to extract information." When I asked what prompted her to seek diagnosis, hearing her reply made me cry so much I had to step away from my desk and go for a walk. "After I separated from my partner of 24 years, my life went into turmoil. I hadn't realised how much our dynamic had masked my symptoms. We took on roles because he was good at doing stuff and organising, but after separation I'd lost my crutch."
Natalie takes 40mg of Elvanse a day, the same medication Zoha prescribed for me. "I now know I'm not stupid or lazy," she says, her relief palpable. "Taking medication has been like lifting a very heavy lid off my head. It explains so much. The clarity and the understanding I now have of myself cannot be underestimated."
Sadly the medication didn't have the same effect on me. The first morning I swallowed 30mg, I felt less "hyper focused" — what I was expecting — and more "cocaine-high". By 9am I fancied a cigarette, and I've never smoked. I had to stop myself from opening a beer, then rattled off a series of unsolicited aggressive texts to friends while walking around the house in circles. My morning "working from home" was more like being in a nightclub at 3am in the 1990s. Headaches and dizziness followed by jumpy paranoia; there was simply no way I could endure this every day. Even though my doctor told me the side effects would wear off after two weeks, I couldn't cope feeling so off my head. So I gave up. Living with a constant feeling of defeat has been a lifelong side effect of my ADHD, and yet here I was, newly diagnosed, raring to go, feeling more defeated than ever.
After being diagnosed I read Gabor Maté's Scattered Minds. It was chapter five, entitled Forgetting to Remember the Future, that struck a chord. For years I have been unable to fathom the future. I don't have a pension. I remember a man in a suit coming to my place of work when I was 30. I found listening to him talk about something so far off so discombobulating that I left the room. The same theory applies to my past impulsive shopping addiction — I have ended up in thousands of pounds' worth of debt, having not considered the affordability of the outfit I was about to buy or how I planned to pay it off. Summer would roll around and I would have invariably forgotten to book a holiday. When the children were young, I found joining baby groups very difficult for a multitude of reasons associated with ADHD, but mainly because I would forget I had booked the class in the first place. When my two children started school, the endless WhatsApps about playdates felt so overwhelming I'd answer a few then drop off with no arrangement made. On the odd occasion I did manage to schedule one, I would double book, cancelling at the last minute, thereby ensuring I'd never be asked again.
An unplanned life lived "winging it" can be thrilling, but in all honesty it's mostly exhausting. Holly Bell decided not to pursue her Oxford application because her boyfriend at the time suggested she train to be a midwife. She agreed to marry another boyfriend nine days after meeting him and was pregnant another nine days later, on purpose. She left London, her flat and job to live with him and be unemployed. My impulsivity, decisions made on a whim, has also been a huge cause of stress over the years. I took an overnight coach from Edinburgh to London aged 17 to live with a boy I met in Mallorca on a family holiday. A few years later, having dropped out of art college, I moved back to London to pursue a career in fashion. I had no clue what I would do and knew no one in the industry. I also had no money so ended up sharing a bed with an old woman who lived in South Woodford.
The writer Grace Timothy, who is launching the podcast Is It My ADHD? early next year, was diagnosed at 37. She describes her days as "boom and bust", a sentiment to which I relate. "Some days I can't believe how much I can juggle, then at other times it all falls apart," she says. The podcast is new and exciting territory. "I'm very aware that there's a huge gender gap in the diagnosis of ADHD but also a racial gap in terms of research, diagnosis and treatment," she explains.
Kate Everall, who runs LesBeMums, a same-sex family blog, was in her early thirties when she first thought she might have ADHD. "I was diagnosed with OCD in my early to late teens, which has similar characteristics. However, during lockdown one I began to explore my neurodiversity and found a community of others going through the same thing," she says. Kate is not as yet officially diagnosed, and the NHS simply cannot handle the demand. An appointment with a GP in London may end with a referral to a psychiatrist. The specialist service at the Maudsley Hospital in south London "undertakes over 25 assessments each month, with a follow-up caseload of between 350 and 400 patients".
So is medication really necessary? According to Zoha, the drugs prescribed for ADHD "primarily aid transmission of the neurochemicals dopamine and noradrenaline, which are the main messengers in the part of the brain involved in complex planning activities". I tried four different types only to return to Elvanse a month ago, white-knuckling it until the side effects subsided. I now arrange my working week around the greatest cognitive demands, and at 7am on those days I take 30mg of Elvanse, which is slow release, and I'm at my desk and ready to go at 9am. Just don't pick up the phone to me until 11am. My manner may be a little intense.
Neurotypical types may be forgiven for thinking ADHD sounds all gloom with no upside. Not so. As Penny Jarrett, a mental health coach and writer who was diagnosed at 30, says: "I am full of ideas, almost nonstop. Having ADHD feels like your brain is a browser with way too many tabs open and all are so interesting that none can be closed down." I don't doubt my neurodiversity has caused many problems in my life, but it has also provided me with an unbeatable work ethic.
And now I'm taking medication, I even plan in my — wait for it — Google diary, which is all colour-coded so I never miss a thing. I no longer feel the urge to shop online for clothes, I tend not to scour dating apps in search of endless dopamine-hit compliments from strangers, nor do I scroll Instagram until 1am. When the traffic light inside my head changes from red to green at the right moment, I drive at 100mph. I work hard. I play hard. I'm unbelievably driven. Until I crash the car. But at least I now know how to find my way to the garage.
Written by: Stacey Duguid
© The Times of London