I was diagnosed with ADHD, combined type, at the fabulous age of 40. I sought out a diagnosis “late” in life because I was 99.9 per cent sure I had it. I figured a definitive answer would do one of two things: either explain my entire personality or force me to stop using ADHD as an excuse for it.
The diagnosis itself wasn’t particularly surprising. Many of my mates reckoned they could have made it years ago. In fact, many did. What fascinated me wasn’t the diagnosis, it was the assessment.
Fundamentally, ADHD assessments rely heavily on observable childhood behaviour. But my childhood behaviour wasn’t just shaped by neurology. It was shaped by fear, gender, class, culture and, more importantly, my parents’ fists.
There was no way on God’s green Earth that I, Poppy Jay, could afford to be disruptive. I would have come home to a cane, a slap or whatever object happened to be nearest. Usually a trainer, expertly lobbed at my face. The assessment assumes your symptoms were visible. Mine never had the luxury of being visible.
I hadn’t realised quite how many questions I’d have to answer. By the second appointment, after hearing variations of the same questions over and over, the assessment began to feel like a multiple-choice exam. I had a gut feeling there were “right” answers and “wrong” answers. It wasn’t that I wanted to game the system. I just became acutely aware that the assessment seemed to be looking for a very particular kind of childhood.
The clinicians asked their questions and I answered as honestly as I could.
“Did teachers say you weren’t paying attention?” No. If I came home with a bad report card, I’d get beats.
“Were you easily distracted?” Duh. But when you’re eight years old translating letters for your parents, remaining distracted isn’t really an option. You learn to style it out.
“Did you forget homework or books?” No – I was doing it after everyone else had gone to bed because it was the only time my ADHD-addled brain could hear itself think.
“Do you interrupt people?” Finally, one I could answer honestly. Yes. Turns out it wasn’t just my personality after all.
As part of the assessment, I was asked to find someone who’d known me at around 12 years old to complete a questionnaire about my childhood. I couldn’t ask my mum. She doesn’t speak English, and ADHD to an Asian parent is just surviving a Tuesday. Instead, I asked my younger sister, who probably understands me better than anyone. It was another reminder that even the assessment process assumes a certain kind of family.
What surprised me most was that although the assessment did ask what was happening at home and inside my own head, it seemed far more interested in what everybody else thought of me. Did teachers notice? Did my parents complain? Did other children find me disruptive? Did I talk too much? (That one was easy.)
One of the clinicians was a black man, and I’d been bantering with him. When I joked about getting beats if I came home with a bad school report, he laughed. I remember thinking: thank God, someone who gets it. I explained that I couldn’t afford to be disruptive, that in my house mistakes had consequences, and that my sisters and I learned very young to hide anything that looked like failure.
Then he carried on asking different versions of the same question anyway. Not because he didn’t believe me, but because he was following protocol. However well he understood the cultural context, the assessment still had to be completed in exactly the same way.
Fern Brady writes brilliantly about masking her autism in her memoir Strong Female Character. It made me wonder whether girls from working-class, strict immigrant families spend their childhood masking ADHD in much the same way. If you’re taught from childhood that being loud, forgetful and/or disobedient comes with a backhand, you don’t stop having ADHD. You just become very good at hiding it.
By the second appointment – you need two before you could be diagnosed – I’d cottoned on. If I didn’t say the things the assessment was looking for, perhaps I wouldn’t get the diagnosis.
So, in my head, I started answering like Dan (not his real name). Dan was the only white kid in a class made up almost entirely of British Bangladeshi children, with a couple of Somali classmates. Looking back, he became the benchmark in my mind for what ADHD was supposed to look like: loud, restless and forever in trouble. I fantasised about what it would be like to get into trouble like him and not be afraid to go home.
That’s probably unfair to Dan. Plenty of other kids were naughty. But his behaviour looked remarkably like the childhood the assessment kept asking me about. I, meanwhile, was the teacher’s pet. The nerd. The eldest daughter. I didn’t outgrow my ADHD. I trained it. I reined her in.
The questions about my adult life were far easier to answer. Do I struggle to start tasks? Absolutely. Do I procrastinate? Constantly. I’ll happily spend hours doing tier-11 work to avoid the tier-one task staring me right in the face. Do I interrupt people? We’ve covered this extensively. Perhaps that’s because, at 40, I finally have the luxury of letting my ADHD be visible. I live alone. I have independence and autonomy. I no longer have parents, teachers or an entire community watching how well I behave. The symptoms I spent my childhood learning to suppress are now free to roam around my adult life causing havoc.
I’m not suggesting we throw out ADHD assessments or rewrite the diagnostic criteria overnight. But this experience has convinced me that we need to widen the lens through which we understand ADHD.
We already know it often presents differently in girls than it does in boys. Perhaps we also need to ask whether it presents differently in children whose first priority wasn’t expressing themselves, but was staying safe, pleasing their parents and growing up far too soon.
Maybe that’s why so many women, particularly those of us from strict working-class or immigrant families, arrive at an ADHD diagnosis decades later. Not because our symptoms weren’t there. Not because we didn’t struggle. But because we learned, from a very young age, that those struggles had to remain invisible. I didn’t outgrow my ADHD. I just became exceptionally good at hiding it. Until I couldn’t.
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