I have a scattered and chaotic mind. Lately, I’ve been taking drugs designed for people with attention deficit hyperactivity disorder (ADHD) and it has been going well. The first time I felt the effects of the dinky, pale blue cylindrical pill containing the stimulant compound methylphenidate, I knew this could be life-changing for me. I could see efficiency with work, money, time-keeping and the dreaded life admin improving. It quietened my jabbering monkey mind and made me less emotionally porous. If someone was curt or dismissive, instead of their perceived malevolence penetrating me to the core, I just thought, ah well. This pill, brand name Concerta, gave me hope. Until it ran out.
I’d acquired the pills via a friend who has them prescribed by a private doctor for her child. She gave me a few as an act of kindness and I couldn’t ask again. This little exchange was, of course, illegal. The drug had been prescribed for her kid. And the compound in Concerta, methylphenidate, is a class B drug.
Concerta effectively tipped my brain out of its overthinking default mode network, or DMN (DeMoN, as I call it), with its simultaneous and multiple tiers of thoughts, ideas, concerns, feelings and distractions and its endless shower of ants in my pants, into the more productive and focused task positive network, known as the TPN. What it made me feel, mostly, was that I wanted to have this medication prescribed to me legally by someone properly qualified. For that, I would need an ADHD diagnosis, which is difficult to come by.
This month, a Nuffield Trust report on rapidly growing waiting lists for autism and ADHD assessments showed the NHS cannot possibly keep up. “The extraordinary, unpredicted and unprecedented rise in demand… has completely overtaken the NHS’s capacity. It is frankly impossible to imagine how the system can grow fast enough to fulfil this demand,” said the think tank’s chief executive, Thea Stein.
If I have to wait for eternity to be assessed, how will I get my hands on “the meds”? A girlfriend splits with me a spare box of Dexedrine, another stimulant used to treat ADHD that also increases the concentration of the neurotransmitters dopamine and noradrenaline in the brain. The packet was a windfall of sorts. It had been rejected by her son’s school because the packaging was damaged. It’s a bit milder than Concerta and the effects don’t last as long. The result is more or less the same, though. I get stuff done. My mind is clear; I stop thinking so much.
I watch the blisters empty day by day and feel tempted to explore the dark web for more, but cannot face working out how to do it. I have heard about a dodgy pharmacist who sells prescription drugs under the counter. The prices, I am told, are not very different from what you would pay for a private prescription for ADHD medication. “Dexys” are cheaper than Concerta. I could probably get them for less than 50 quid.
I’m 54, and for a year now I have been wondering if I have ADHD. First, I completed the NHS-approved adult ADHD self-report scale. Questions include “How often do you misplace or have difficulty finding things at home or at work?” and “How often are you distracted by activity or noise around you?” Then there was the emotion regulation questionnaire, a lesser known metric for a lesser known symptom of ADHD. Sample question: I keep my emotions to myself. Strongly disagree. I moved on to less credible self-assessment questionnaires online. Adults with ADHD are highly self-critical… Misplacing stuff… Sometimes you overshare… Always late… Craving crunchy things… Listening to the same song over and over again. So many ticks. All my answers came out “highly consistent” with ADHD. Sometimes I did a quiz multiple times in different moods.
But surely everyone can answer yes to a few of these questions. As my teenage niece says, “Oh, Katie, literally everyone has ADHD,” before going on to tell me about someone at her school who sells their meds in the playground. (I did not ask her to hook me up. Can’t promise I didn’t think about it.)
Many in my quite large family roll their eyes whenever I discuss ADHD. My father is a retired paediatric surgeon, a much loved man who saved seriously sick children’s lives in an increasingly stressed NHS for more than 50 years. It is not hard to imagine why he might find some people hand-flapping about poor concentration a bit of an irritation. He has always been sceptical about what he sees as the growing pathologising of personality. I overheard him talking to one of my brothers over dinner a few weeks ago about the near permanent news about oversubscribed autism and ADHD waiting lists. “ADHD is for people who feel they don’t quite fit in and need a label to make them feel better,” he said. Ouch, but possibly fair.
The letters ADHD have hovered about me for a few years now. It’s just that I ignored them until I tried the meds. In 2019 I had dinner at the Royal College of Physicians with Dad and his old friend, the rather eminent-sounding Professor Ricky Richardson, with whom he had set up children’s health services in Oman in the Eighties. ADHD and I came up and Dad poo-pooed it. I’m not going to mention this again, I thought. But then Richardson piped up, “I could have told you that when I met her as a teenager.” I was surprised anyone was even talking about it back then, but Richardson is a general paediatrician with a special interest in ADHD, autism and Asperger’s. To me, at least, this felt somewhat validating.
He has not been the only professional to suggest I have ADHD, albeit in an off-duty sort of way, like a hairdresser might say, “You’d look fantastic with a few lowlights.” The first was Dr Thilo Beck, whom I interviewed in 2017 on assignment at a rehab facility in Zurich. We talked journalist to expert about the unique nature of his super-rich patients’ addictions, then he asked about me and I was delighted to describe a few top-line issues. Perhaps I would get some handy hints.
As we talked, my notepad ran out and I vocally despaired at the parlous way I wrote chaotically all around the page, like a spider on acid, and often ran on writing over the covers. “You do the job in your way,” he said, his psychotherapy poker face never cracking. As I wrapped up the interview and closed my scrawled-on notebook, he said, “You have ADHD,” and suggested I get it diagnosed formally.
When I returned home, I said to my boyfriend, “When I was doing this story, the psychiatrist said I should test for ADHD and I wondered if that might explain some things.” I am not sure he even responded, despite the fact that almost everything we fight about is due to my poor executive function and excessive hours spent with the DeMoN when I would be better served in the TPN.
He has budged a tiny bit. We have gone from, “You don’t have ADHD. You just don’t try hard enough,” to a cautious ambivalence: “Hmm, you’re not going to take those mad medications, are you?”
Still, my more urgent quest to uncover my brain’s pathology did not really crank up until a friend started telling me over and over that she thought I had the ADHD she had been diagnosed with. Any time I said anything or did anything, or if certain issues came up, she’d say, “Well, that’ll be the ADHD.” It began to feel like an assault. She said it in front of other friends once or twice. “Please stop saying that,” I’d say. It felt like she had crossed a line. Wildly, inappropriately so.
A few days ago, as I mulled the wisdom of publicly discussing this subject at all, my Uncle Nigel said, “What is ADHD?” He listened quietly to my telling of it and then shrugged and went, “Isn’t that just people?”
Sometimes I do wonder what is worse, the stigma of being diagnosed with ADHD — a colleague texted me recently to insist they never wanted to work with someone with ADHD again (upon hearing this, I decide I am someone who only thinks they have it) — or the stigma of just thinking you are someone with it?
Last year, ADHD was the second most viewed health condition on the NHS website after Covid. In 2022, it came in fifth. In October 2023, ADHD UK, after a number of freedom of information requests, found that waiting lists for assessment varied from 12 weeks to more than 550 weeks. That is well over ten years.
After the Concerta epiphany, I arranged a telephone appointment with my GP. I told her my story, and she said, “Yes, it does sound very likely you have ADHD.”
“The waiting list for assessment is very long, I know that,” I said.
“No, it is not long,” she said. My hopes lifted briefly. “I am sorry to tell you that the waiting list is closed.”
Closed? I was stunned. ADHD UK estimates 2.6 million people in the UK have the condition, the majority of whom remain undiagnosed. There are no clear figures for formal diagnoses. The charity says some 70 per cent of people with a formal diagnosis opt to take medication. Yet NHS England data indicates only 240,000 people had a prescription in 2023.
My GP went on to say, “I have so many patients who have a bit of trouble focusing and insist I refer them for ADHD assessment. People are clamouring for autism, ADHD and gender reassignment diagnoses as answers to their existential crises and the NHS is overwhelmed.”
So what next for me? I cannot take my quiz to the chemist. A private assessment costs in the region of £1,000. Drugs from a private pharmacy then cost about £200 a month, rather than a tenner. I do not have that kind of spare cash. Being crap with money is very ADHD. I resolve to do what I have always done: get by.
Looking back, I realise I have used good, bad and indifferent methods to try to corral my mind. Let’s gloss over the disastrous impulsive choices that trashed my late teens and early twenties. Since, there has been smoking (definitely helps with focus; downside, it’s smoking), caffeine (OK, but it can only do so much), targeted supplements (hard to judge) and cold water immersion (absolutely lifts mood and focus, when I can face it). Sleep and exercise are crucial. Until I got my time-consuming dogs, I was always engaged in some physical antic such as an ultra-marathon or mad sea swim.
These, however, were never enough to curtail the procrastination — which can be epic — to which I have lost desperate weeks.
My attempts at self-medication, meanwhile, have differed wildly in efficacy from nearly killing me to helping me write a couple of modestly successful books. Before setting about writing each book I spent two illicit weekends, one in a village hall in England, the other in Scotland, trying the South American hallucinogenic drug ayahuasca, which is often touted as doing a year’s worth of therapy in one session. It is hard staring down the contents of your mind while your brain does a quick rewiring job under the influence of psychedelics. It is dreadful, but by weathering a night of strategic misery curled into a foetal position with only a sheepskin I took out of the dog’s bed between me and the floor, I went on to enjoy some lovely months of a far quieter and less critical mind. One small trial has shown benefits with microdosing psychedelics for ADHD (which should be a bit easier than the macrodosing), but psychedelics are illegal too. Class A, in fact.
Back to the drawing board.
With the knowledge I have now, I realise that the tender memoir I wrote in 2019 about my lovely first dog should be reframed as Lost Dog, a Classic Tale of ADHD Behaviour. The substance abuse, drinking, chaotic spending, procrastination, impulsiveness, the ordinary madness, hyperfocus, the risk-taking, the wild emotional drama — it’s all in there.
I have gone round and round in circles with psychotherapists all my life who have never mentioned it. At first, seeing shrinks was helpful, but after I had talked incessantly about Mum and Dad’s miserable divorce in the mid-Seventies,I kept waiting for something to shift. Life still felt like trying to operate a confusing electrical item for which I had no manual. No one diagnosed ADHD; no one explained how my brain worked. Instead, I learnt that from a clear 80-minute lecture, Rise of the Planet of the Neurodivergents, by Dr Alberto Pertusa on YouTube. His ADHD specialist London Psychiatry Clinic has tripled in size since the pandemic.
It is now six years since Beck muttered his gnomic suggestion and a year since Richardson brought it up and still I can only suspect that I have ADHD. I do not know. I just know that I have spent my whole life thinking I need to sort myself out and get on top of my shopping-trolley brain with the wobbly wheel that veers all over the place except where I want it to go. In some ways, discovering that I have ADHD would be a relief. I don’t ever want to use it as an excuse. “Hi, sorry my copy is late but I have ADHD.” “Hi, sorry I defaulted on the mortgage. I have ADHD.”
But I would love to be able to say to myself, and believe it for once, “Kate, it’s OK. It’s not your fault.”