This conversation explores the personal journeys of 3 NHS clinicians 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

Other links:

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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 Millie Wicher, Dr Joanna Thirsk, an intensive care consultant, and Dr Clark Davison, another clinical psychologist. We'll hear from Millie first as she explains how she came to be assessed for ADHD.

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.

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?

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.

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

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.

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

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.

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.

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...

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?

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.

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

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.

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?

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.

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?

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?

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.

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?

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.

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.

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.

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.

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.

Yeah, absolutely.

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?

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.

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

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…

Co-occurring stuff.

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.

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?

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.

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.

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.

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?

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.

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.

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…

That's true. Yeah, yeah.

…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...

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.

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.

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.

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.

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

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.

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

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.

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.

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.

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

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..?

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.

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.

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.

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.

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.