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A Medical Student’s Journey to ADHD diagnosis

“No matter how much you want to force yourself to pay attention, boredom allows curiosity to find the key and open the dungeon door, allowing attention to escape and find some interesting place to visit.”

- Edward M. Hallowell, M.D.


Attention deficient hyperactivity disorder (ADHD) is a medical condition that can cause inattention, impulsivity and hyperactivity in individuals (1). Whilst being written about since the 18th century, the condition was only formally recognised in the 1960’s by the American Psychiatry Association (APA)(2). It wasn’t until the 1980’s that eventually the terms ADD and ADHD were used (3).



“If you’ve met one person with ADHD, you’ve met one person with ADHD”

- Unknown


ADHD, like many other learning difficulties, affects everyone differently and everyone has their own unique relationship with it. So, whilst I can’t speak for the entire ADHD community, I can provide an insight into my own journey and compare it to published medical research. This will hopefully raise awareness of university students with ADHD and maybe even help somebody with their own learning difficulties. Like many others, my story starts in primary school.


Growing up, I was fidgety and distractible. I was not personally aware of this, but multiple teachers mentioned it to my parents. I tended to lose interest early on during lessons the moment I had a grasp of the content. This is a typical presentation of attention deficient hyperactivity disorder. In the DSM-5*, it’s stated that common symptoms of ADHD include “difficulty sustaining attention”, “easily distracted” and “squirms in seat”, all of which I was a culprit of.


[*The “Diagnostic and Statistical Manual of Mental Disorders” or DSM-5 is a medical publication used by clinicians to classify and diagnose mental health conditions, including ADHD.]


I also had (and still have) atrociously bad handwriting. One could make the joke that this was an early indicator of a future doctor but what I remember the most was that I got my pen licence a year later than the other kids. Everybody else in Year 3 got to use their fancy Berol handwriting pens while I was stuck scrawling with a pencil like a toddler. If you couldn’t tell, I am still slightly salty about this. It was only recently that I discovered there is a strong link between poor handwriting and children with ADHD due to its effect on both motor and cognitive pathways (4). Knowing this back then would’ve really helped my self-esteem.


Moving on to secondary school, I started to notice these things myself. I lost both my school bag and P.E. kit in the first week of Year 7 as well as going to the wrong lesson which earned a tongue lashing from both parents and teachers alike. I had a hard time paying attention in lessons; it struggled to listen for more than a few minutes. This meant that by the time the teachers got onto explaining the lesson plan, I was already staring at the ceiling wondering how there was a muddy footprint up there. During the easter before GCSEs, I really struggled with sticking to revision. My poor mother ended up forcing me to sit down with her and read CGP guides aloud to me. But this wasn’t the best method either as I randomly just got up after a few minutes and walked away countless times. I didn’t even realise I was out the room until my mum asked me what the hell I was doing and/or threw a pencil at my head. We both found my behaviour and inability to sit still extremely bizarre. It was only years later while doing my own research on ADHD that I finally got some closure. In fact, I audibly laughed when I read that “leav[ing] seat in situations when remaining seated is expected” is a strong symptom of hyperactivity/impulsivity (5).


It was around this time I seriously suspected I had ADHD. But I did not follow up for a diagnosis for many reasons. Cultural and social stigma played a large part. My perception of ADHD back then was very askew, and I associated it with low intelligence and troublemakers. I did not want that kind of label. Moreover, I kept procrastinating and putting it off and ironically, procrastination is a very common symptom of ADHD. I was stuck in this cycle of worrying about my ADHD but doing nothing about it at the same time. Reading peoples’ experiences online wasn’t the greatest help either. Between “rude GPs” and “long waiting lists”, I decided I didn’t even want to try.


Up until this point, I had done relatively well academically despite my ADHD. But it ended up costing me in the long run as I was undiagnosed for all my childhood and teenage years. I did not understand why I was the way I was nor was I given the tools to navigate the hardships of ADHD. This came into fruition during sixth form and my undergraduate degree. The workload for A levels and university was much higher than anything I had previously experienced. The symptoms of ADHD that I had previously hidden or joked about were having a serious and detrimental impact on my education and mental wellbeing. My previous method of intensely revising for a few nights before were not working. I really struggled with staying on top of work and revision. Eventually, alongside other external factors, it led to me flopping my A levels and getting a middle 2:1 despite the amount of “work” and effort I put in. But even after all this, I still refused to get a diagnosis and was willing to ‘just get by” academically because of both the stigma and the lack of motivation to get an appointment. In fact, getting into medical school almost proved to myself that I’d be okay. Boy was I wrong.


Medical school is a wonderful opportunity and it’s something I’ve been working towards for years. But its reputation as a very intense course is well deserved. Whilst not conceptually difficult as one might assume, the sheer volume of content can be overwhelming. To succeed in a course like medicine, you need to be disciplined and well organised. With a learning difficulty like ADHD, you’re inclined to be anything but that. I had the usual problems, e.g., leaving assignments till the last minute, revising for exams just a week before (if that) etc. But medicine posed a new set of problems for me which centred around patient care. Doing patient interviews, I tended to zone out seconds in after asking a question and I would have to ask the (model) patient to repeat themselves which was very embarrassing. To further add to my shame, during the feedback, I was told that I kept swivelling in my chair, fidgeting and was generally very distracting for the patient.


This was the wakeup call I needed. Me toughing it out was not only going to harm my education but also interfere with my future patient care and career as a doctor. I finally bit the bullet and got myself assessed. It was an interesting and eye-opening experience. It helped me to understand a part of myself that was previously a mystery to me, and it gave me closure that I did not know I needed.



ADHD is a gift and a curse. Whether you suspect you have ADHD, already been diagnosed, or just interested in the subject, I urge you to do your own research into it. To remove stigma, you must first educate yourself on the matter.



“By telling my own story, I hope to help remove the stigma. It never should be something to hide.”


- Richard Dreyfuss




Author:


Prithvi Bahu


Newcastle Medical School


NMRA Welfare Officer





Bibliography


1. Attention-Deficit / Hyperactivity Disorder (ADHD) in Children | Johns Hopkins Medicine. Available from: https://www.hopkinsmedicine.org/health/conditions-and-diseases/adhdadd

2. Crichton A. An inquiry into the nature and origin of mental derangement: On attention and its diseases. J Atten Disord. 2008 Nov 20

3. KENDELL RE. Diagnostic and Statistical Manual of Mental Disorders, 3rd ed., revised (DSM-III-R) . Am J Psychiatry. 1988 Oct;145(10):1301–2.

4. Langmaid RA, Papadopoulos N, Johnson BP, Phillips JG, Rinehart NJ. Handwriting in Children With ADHD. J Atten Disord. 2014 May 22

5. ADHD DSM-5® Criteria | Diagnostic Criteria for ADHD


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