What ADHD looks like from the inside

You only know the brain you have.

A diagnosis built on what people cannot do

ADHD stands for attention deficit hyperactivity disorder. The name itself starts from the idea that something has gone wrong.

Most of the diagnostic criteria describe what a person cannot do, or finds hard. It measures productivity, how much difficulty the behaviour causes other people, and the strain it puts on relationships.

So the whole picture is drawn from the outside looking in. It captures how much trouble a person is having and how much trouble that causes other people, but not what it is actually like to be them.

What the criteria does not ask

Very little of the assessment asks how it actually feels to live in an ADHD brain and body.

That outside-looking-in view is one of the biggest reasons ADHD gets missed. From the outside it can look like daydreaming, or fidgeting, or being a little distracted.

From the inside, it is much harder work than that.

The story that fills the gap

You cannot compare your brain with anyone else's. You can see that other people manage things more easily than you do, but you have no way of knowing why.

So the story that fills the gap is usually an unkind one. You are not trying hard enough. You are simply worse at organising yourself than everyone else.

That story can run unchallenged for decades.

Why it gets missed so often

The criteria grew out of research on boys, and there is only one set for everyone, with no differentiation by gender.

So anyone whose ADHD does not present in that way is measured against a picture that was never drawn from them. That is part of why so many women and girls reach adulthood without a diagnosis, and why people of any gender may recognise themselves in this conversation.

How Victoria came to her own diagnosis

She was working in a child and adolescent mental health service with no idea she had ADHD. She knew she found it hard to focus, that everything got done at the last minute, that she could never find her keys.

Then a colleague who had her own diagnosis asked her, quite matter of factly, when she had got hers.

Looking back, the signs were all there. Perfectionism. Sensitivity to criticism. Working extremely hard without getting the same results as everyone else. Being completely derailed by an open plan office. None of it looked like the version of ADHD most people picture.

Am I making it up?

She went away and read about it, and recognised herself immediately. What followed was a longer question about whether to seek an assessment at all, and whether she was imagining the whole thing. That doubt is very common.

What settled it was a teenager she was working with, who told her it was all right for her because she did not have ADHD.

She could already see how much difference the right understanding made for the young people she supported, at school, at home and across the systems around them. An assessment could only help. And if the answer came back no, at least she would know.

What an ADHD brain brings to the therapy room

Being neurodivergent is not a label she puts on and takes off. It shapes how she sees the world and how she experiences it, so it comes into the room with her.

A brain that is endlessly curious about stories and makes far more connections than she asked for is not always convenient, especially when the task in front of her is a simple one.

But systemic family therapy is about exactly that. How the different parts of a life connect and intersect, and how to hold the complexity of people and their stories.

Working as a translator between neurotypes

Much of her work is with neurodivergent young people and their families. It is not unusual for a parent to sit through their child's assessment and realise the description fits them too, which opens a conversation of its own about what runs in families.

In rooms where there are different neurotypes, she often feels like a translator.

She also spends a fair amount of time explaining to neurodivergent people why neurotypical people behave so strangely.

Why nobody thinks to ask about peas

She hates peas. They have layers. The texture is odd. They are a bit wet. From a sensory point of view, there is a great deal going on.

When this comes up with children, their parents are often baffled. Peas are just peas.

But unless it bothers you, you would never think to ask. Why would you ask a child about peas, or whether the big light is too bright, or whether they can still feel the seams in their socks halfway through the day, when most people put their socks on and forget about them?

A child cannot answer a question nobody asks. And they cannot flag a difference they have no way of measuring.

What a neuroaffirmative approach actually means

Neuroaffirmative is a fairly new word. It means being positive about and accepting of all neurotypes, and it is slowly making its way into how we think as a society.

Children want to connect with their parents, and parents want to connect with their children. Where their neurotypes differ, there is often a miss.

Take a child who says they are too hot and does not want their coat. The parent points out that it is snowing, so they cannot possibly be too hot. Conversations like that happen all the time, and the message they carry is that the child's way of experiencing the world is not correct.

Accepting someone's experience does not mean pretending you feel the same. It means not denying theirs. There is no correct way to be a human.

The adjustments that help everyone

Most of what helps neurodivergent people helps everybody else too.

• Clear expectations
• Clear boundaries
• Knowing exactly what someone means
• Having things in writing, not only said out loud

A neuroaffirmative approach starts from yes, this is how you experience the world. Then it asks what the two of you can do about it. The aim is a shared understanding, not one person moving entirely over to the other's way of being.

Disabled by systems, not by brains

ADHD is defined as a disability, and Victoria is clear that she has a disability and that she is disabled.

What she would change is the assumption that this reflects badly on her. There is nothing inherently wrong with her, and nothing wrong with the way she is wired. She is disabled by the way things are set up.

She is perfectly able to do things. What is not set up is a world where every neurotype can reach them equally. That is not a me problem, it is an us problem.

The way she puts it, there is friction between a neurodivergent brain and the way systems are built, and it is the neurodivergent person who ends up with the friction burns.

Changing that framing would lift a great deal of the stigma, shame and worry that people carry when they first think about an assessment.

Talk to us

If you are making sense of your own ADHD later in life, or trying to understand one another better as a family, you are not doing it on your own.

Our clinicians work with children, adults and families every day, and we would be glad to talk it through with you.

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