Now It All ADDs Up

Embracing neurodiversity at "almost 40"

Image courtesy Upper Valley Behavioral Health

Two days ago, I perched tensely on the edge of an overstuffed leather armchair that should've been comfortable, holding a clipboard and struggling to mark thick, black Xs on a badly mimeographed diagnostic test. It was awkward. The spaces for answers were, of course, blank; they should’ve been white, like the copy paper. Instead, they were badly discolored in a gradient ranging from light grey to black. And for every question, I somehow needed to check the very last box - invariably the darkest.

Using my bad arm, I gouged exaggerated marks into the paper with a ballpoint pen. It didn't take me long, but it hurt. Wincing, I handed the clipboard back to Dr. M.

“Um. I hope you can see it,” I said, rubbing my right shoulder.

Dr. M pursed her fuchsia lips and I watched as her dark eyes moved down my list of answers. “It is just as I expected,” she pronounced in the sonorous, slightly stilted cadence of a fluent but non-native English speaker. Not making eye contact with me, she reached for her desk phone and jabbed the “Reception" button.

“Have they taken your vitals?” she barked as it rang.

“Uh, no,” I said.

"You opted out?” she asked. “Or nobody even tried?”

“Nobody mentioned it,” I answered, feeling as if I had done something wrong.

“Yes, Julia?” Dr. M asked sharply. “I need you to explain to me why no one has taken my patient's vitals. It affects the medication that I will prescribe for her!”

There came a few seconds of silence, and then her beautiful accent buckled.

“This is nothing short of outrageous! This practice must be corrected at once!” She slammed the receiver down and busied herself with a stack of forms, exhaling a staccato burst of frustration.

I squirmed. This was exactly how I had hoped not to feel today.

As my eyes rose to the deep russet and black African prints framed behind Dr. M, my mind began to wander.

I had wanted to feel as confident and in-control as possible for today. As usual, my weapon of choice was fashion! I’d planned my outfit for this doctor's appointment the day before. I chose a dark gray crochet-neck halter top and palazzo pants made of tangerine-colored gauze, and paired them with gold snake earrings and strappy black platforms. I’d arrived feeling great. But now, my outfit’s power seemed to have failed me.

Earlier this morning, I’d succeeded in my plan to make time to wash my hair and use my best sculpting cream on the non-natural curls that had inexplicably showed up as a 35th birthday present. I'd imagined tweezing my eyebrows, doing full-face makeup, and removing my chipped nail polish, but I hadn't had time, somehow.

Actually, that was becoming a pattern.

This year, I’d realized that I regularly failed to find time to physically carry out the tasks that were constantly on my mind. It was incredibly frustrating - and not just for me. Over and over again, I'd neglect something for days on end, Dave would finally do it himself, and I'd protest, “I was just about to take care of that!" Each time, I truly felt that I had been just about to spring into action, but simply hadn't gotten the chance to.

Something about this pattern was starting to strike me as weird. And I'm sure poor Dave - not to mention my first husband - felt the same, but more strongly.

But it wasn't just that. Recently I’d recognized that the mundane multi-step chores I'd always struggled with seemed to be handled capably by others. Why is that? I’d wondered. Surely I was just as smart as anyone else. And just this summer, I'd suddenly noticed I was always, always either jiggling my leg or my foot, unable to stop, even when I felt totally relaxed. Trying to hold still produced a driving discomfort akin to physical pain.

I remembered an odd phase in my tween years: whenever I sat at a table, I couldn't seem to stop my right hand from silently executing the melody of whatever song was stuck in my head. I spent years obsessively plonking out inaudible piano music on dining tables, school desks, and car consoles. I have no idea how I ever stopped.

But the last straw was something else. The previous week, when I'd talked to my mother during a week at Universal Studios with my niece, I barged into her vent session about how Zoe was having fun, but got cranky quickly when the noisy, overstimulating theme park got busy.

“I’d get her some noise-canceling headphones,” I'd told my mother, who had absolutely not asked for my advice. “She may have some neuroatypicality or sensory issues.” Mom asked Zoe whether she thought that would help, and she'd said yes right away. Nonetheless, I thought it might be an adjustment. To make the new sensation of something over her head less distracting, I suggested Mom glue a fun, sparkly headband to the top part - Zoe’s a girl after my own heart, eager to at least try any new fashion accessory.

I thought about how much, I would, in fact, enjoy being given a sparkly, glammed-out set of noise-canceling headphones. As I turned over that idea, that coincidence, I heard my own words echoing in my head: Maybe Zoe has some neuroatypicality? It sure sounded like maybe I do.

That was when I'd called to make an appointment. And that was what I was trying to figure out on Monday, there in Dr. M’s office.

She shuffled her papers one more time and tapped the stack on the desk. “I will now give you your several diagnoses,” she pronounced regally.

Suddenly I had a terrible feeling of being in the principal's office, waiting for a punishment to be handed down. That was a scenario I'd never experienced , as a compulsive people-pleaser. Still, I automatically sat up straighter, clutching the blue water bottle I was never without.

“I do see evidence of minor anxiety and some depression. But your scores on the attention-deficit portions are off the charts. Literally,” she enunciated. “I do not have a high enough scale to show you where your score is.”

All of my thoughts crashed together and turned into nothing.

“I see,” I said inadequately.

“You have masked your attention disorder expertly through the years by being highly intelligent and motivated,” she explained. “You are very skilled at masking. But this is a severe impediment. I cannot imagine how you have coped with this for 40 years without medication.”

Gahhh - there was that number again! Earlier, she had greeted me with the rather unorthodox salutation, “Welcome! Why, you do not look 40 at all!” She'd sounded relieved, somehow, to note this.

“Aha! That's good! Because I'm not - I'm 38!" I'd responded with a friendly laugh.

Dr. M had smiled, smugly turning her glamorous mahogany cheekbones to their most angular angles and announcing, "Believe it or not, I have just turned 60, so I know.” She’d preened at me, not needing to say, “You can't believe it, can you?"

That was implied.

Uhhhh. I had made some polite noises of surprise. And it was true: I'd pegged her much younger. But privately, I thought, what the hell? “Why, you do not look 40 at all?" What kind of a thing was that to say?

Really! Had she been waiting here, terrified of my arrival, living in dread of being visited by a woman who looked 40? Did she have recurring nightmares about the prospect? Perhaps a psychiatrist of her own was engaged to help her cope?

Well, maybe so, I'd realized abruptly. If I were as beautiful as she is, I'd probably be frightened of the general aging public, too. But now, even once corrected, she was busting out the F word again!

It wasn't just me: this was objectively weird, right?

I knew it was. To my shock, though, as she gave me my final diagnosis, the part of my brain that took exception to my rounded-up age surrendered to the part that had always known something was wrong, and so felt pitifully grateful for this validation.

I felt my shoulders sag with relief.

When I was a little girl - back in the Dark Ages, apparently - girls were rarely screened for ADD or ADHD. They certainly were not checked for it if they were highly intelligent and their mothers weren't driven to tears over their hyperactivity. I was, and my mom wasn't - so that was that.

Even in the age of Ritalin ubiquity, these were considered conditions that mostly affected boys. And when ADD and ADHD were diagnosed, they certainly were not recognized as forms of neurodiversity that could provide valuable perspectives. Almost no one understood that both high intelligence and learning differences can occur in the same person - a situation known today as dual exceptionality.

There's still a real disparity between ADD/ADHD as it is both observed and diagnosed in male and female patients. (I don't yet have a good understanding of how it's recognized and treated in patients with non-binary gender identities.) When most of us think of these conditions, we think of a little boy, racing around a restaurant or tearing through his home like a tornado, shedding toys and garments, spilling things, and generally terrorizing his immediate surroundings. Or perhaps we think of a child lost entirely to whatever's going on around him, seeing only his video game or book, absentmindedly dressed for school in a polo shirt and pajama bottoms. But that's not how ADD and ADHD always present, and in girls and women, they look even more different.

For one thing, boys tend to turn their frustrations outward. They're much more likely to be what was once called “mouthy,” and to suffer from full-blown oppositional defiant disorder as a comorbidity. Girls with these conditions turn their negative emotions inward, simmering and working toward a rolling boil that will eventually spill over, while they're still busy trying hard to maintain pleasant, placid exteriors.

Learning this was like being smacked in the face. I’ve practically copyrighted the phrase, “No one needs to know about my frustrations but me!” It wasn't until this year that my brother confronted me with the longstanding feeling that I seemed “fake" for presenting positivity to the world at large while privately struggling.

Hearing that, I'd been speechless. I was just a positive person, surely? I’ve never known any other way to be. But now I was learning that at least some of my sunny inner narrative had been a coping mechanism - and a maladaptive one, at that.

I ran down the evidence:

My family and close friends had not known I was an alcoholic until I announced that I was sober.

I had been raped repeatedly in an important relationship, but only mentioned it to anyone once we broke up.

My marriage had disintegrated to the point that I had already left my husband before even my adored, totally nonjudgmental mother knew what had been going on.

And those were just off the top of my head.

Now, as I sat in Dr. M’s cool office, I learned that swallowing every difficulty instead of expressing myself or even asking for help - even as I enjoyed helping others! - was textbook attention-deficit. Oh, I remember thinking stupidly.

I nodded, hugging my water bottle to my chest, listening as she recited my life to me. Dr. M flawlessly enumerated all the other ways I'd been affected by this set of symptoms - episodes and patterns I'd never told her about, that she accurately inferred based solely on my diagnosis.

I thought of that old Roberta Flack song, “Killing Me Softly.” I'd never understood it before.

As I listened to her rich voice explaining why I reacted to difficulty or unpleasantness as I did, my blood pressure began to creep up. My head suddenly reeled. I couldn't figure out why: I'd come here with the express objective of learning whether or not I might have ADD or ADHD. And now my suspicion was being confirmed. Successful appointment, right? But learning just how wide a net executive-function disorder cast over myself and my life in general felt … uncomfortable. Overwhelming. Unmooring, even.

I began to rub my temples. Dr. M interrupted herself:

“ … with neuroatypicality - Okay. I can see that this is a lot for you. We will stop here for today. Now. Is your pharmacy still the Rite-Aid in Yucca Valley? I am sending over three prescriptions …” We made plans for me to come back in three weeks; I nodded and said “thank you" at more or less the correct times.

I was clutching my water bottle like it was the handle to an escape hatch as I walked back out into the blistering heat. I felt hassled, harassed, accused. The thought, "You use your water bottle as your fidget toy” dropped down from the sky and hit me on the head. I unlocked my car and instinctively lit a cigarette - I'm supposed to be quitting - and realized smoking served the same purpose. Staying hydrated is fine, even healthy, but smoking is … well, not great. I resolved to buy some real fidgets toys to redirect this impulse.

Yes: redirect it. Paper over it. Quick, hurry!

Because that's how this stuff works, right? Fill the prescriptions. Buy the tools. Do the reading. And then pick myself up so I can, at all costs, keep moving.

As I drove home, little thoughts continued to descend on me, slotting neatly into place:

This is why you can't sleep unless both legs of your pajama pants are even.

This is why you hate the squeaky feel of denim on your skin.

This is why the sight of people eating seafood makes you feel faint.

This is why you get headaches from the lights in a Walmart.

A random bunch of idiosyncrasies, I'd thought. After all, what else is a personality? But what this collection of traits indicated was more than that: it showed that I was neurodivergent.

Neuroatypical. You're neuroatypical, Sally.

My heartbeat quickened.

Now, treat this fast and don't struggle, Sally, I repeated. Don't let anyone guess that this is hard for you. Pick yourself up and move on! Or, if you must struggle, then, for heaven's sake, don't let anyone know about it.

I thought that mindset had allowed me to sail forth toward adventure. Instead, it had run my life aground.

It was a dismal realization.

The next day, I had indeed picked up the prescriptions, found some purpose-created fidget items, and done some reading. I still felt overwhelmed. I still wondered which parts of my life, my personality, my character - which parts of me - were nothing but maladaptive coping strategies.

Dave had sensed that I needed a wide berth to process the news, and that I would talk when I was ready. But he was concerned. “How are you feeling today?” he asked.

I decided to be candid. “Right now, not great,” I told him. “But I know it will get better.”

And that's true. It's not many words, but it conveys quite thoroughly where I am right now.

What I'm sure of, for now, is that that's the version of me I should be trying to find: the one who's honest, but optimistic. Dealing with this condition will likely be the project of a lifetime, but slowly and surely, I'll find relief, even when the truth isn't entirely pretty.

Come to think of it, that's a pretty good approach to makeup in one’s 40s, too.