“ADHD symptoms should not lead to an automatic diagnosis”, concluded the Times in a recent article.
Neurodivergence continues to intrigue and baffle the scientific and social media communities, offering glimpses of our own complexity, potential and diversity.
Social media risks turning nuanced discussions about ADHD diagnosis into a false binary: that ADHD is either overdiagnosed or under-recognised.
A diagnosis of ADHD may open doors to support, but it can also shape what we expect of ourselves.
I never searched for a label when I was practicing medicine. I never felt like I needed one. That’s not to say that I was especially easy to work with or infallible, but within the walls of the Intensive Care Unit, I found a place that suited.
Looking further back, to my childhood, I recognise traits that nowadays might prompt an educational assessment. Pigeonholing a complicated, infuriating, high-achieving child into a sterile checklist of characteristics.
Would a diagnosis have helped me?
Perhaps.
Depends on what we mean by ‘help’.
Educational understanding and recognition might have made learning less difficult for me, my classmates and my teachers.
But I wonder how I would have used the label?
The diagnosis of ADHD might have helped me understand my difficulties, but it might also have given me a reason to stop battling with them; decide that certain things were beyond me before I had discovered whether they were.
That is a not meant as an accusation against anyone who receives ADHD as a diagnosis. None of us can know how our younger self would have responded.
Everyone has weaknesses. Mine included an inability to concentrate on other’s agenda, rather than focus on my own.
I was both top of the class and a massive pain in the arse, competitive and driven, ignorant and rude, incurious of what others thought.
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Medical school brought further struggles; poor grades, failed assessments but eventual qualification.
All those facts matter.
My success does not prove my ADHD was irrelevant, nor that a diagnosis would have solved my problems.
Perhaps more support would have helped me direct my effort more effectively.
Perhaps I would have allowed the label to narrow my ambitions.
Perhaps monkeys might have flown out of my butt?
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What concerns me is the moment when an explanation becomes an expectation: “This is why I find it difficult” quietly turning into “This is something I cannot do.”
After flirting with the military, motorsports, medicine, nephrology and anaesthetics, I finally found my calling in critical care. Many of my friends and colleagues in intensive care exhibited the same obsessions, contradictions and wild social proclivities that I did.
The peculiar demands of intensive care snugly fitting our varied skill sets.
Urgency focused us.
Complexity engaged us.
Critical care patients demand a deep absorption and sustained attention across a multi-disciplinary team.
In the right circumstances, characteristics that troubled me elsewhere became professional assets, a ‘superpower’ if you like.
That’s not the whole story.
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The useful traits did not exist separately from the difficult ones.
Absorption is helpful until you need to disengage.
Intensity can serve one task while making other demands harder to manage.
Being resilient and driven does not mean that every part of life runs smoothly.
I didn’t ever feel ‘burnt out’ but night shifts and exams became prioritised above football in the park with my boys.
Medicine also supplied structure: defined roles, routines, responsibilities and a clear reason to act.
I cannot neatly separate what came from me and what came from the environment in which I worked.
Perhaps I had found work that suited my mind?
Perhaps medicine’s structure helped contain my tangential tendencies?
Probably both.
I had the cognitive reserve to manage all of these things and meanwhile cycling became a quiet place to rest my brain.
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Containment and structure became much more problematic after my injury.
I discovered that while I could still become deeply absorbed in something, I no longer had the capacity to sustain the effort and recover from it.
I wanted to continue but couldn’t. Cognitive fatigue made that painfully clear.
My longstanding tendencies towards hyperfocus interacted with my limited cognitive stamina. Becoming absorbed carrying me beyond the point at which I could sustain my sanity and control my impulses.
I now need help understanding that interaction. I need structure that helps me recognise fatigue, disengage and rest before I have gone too far.
Here, my earlier belief in battling through becomes less dependable. Persistence helped me build a career. Applied indiscriminately now, it can leave me exhausted and less capable.
I have had to learn that respecting a limit does not mean surrendering to it. Equally, I do not want to assume that every difficult task lies beyond me.
The challenge is distinguishing something I can work through from something that requires a different approach.
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An ADHD diagnosis may help explain part of my history. It cannot, by itself, explain everything that happened after my injury. Nor should every current difficulty automatically be attributed to the injury. I need room for overlapping explanations and for uncertainty.
This is where a label can help. It can give language to experience, guide assessment and make support accessible, replacing a moral judgement, lazy, careless, difficult, with a more useful understanding.
But a label can also become so persuasive that other explanations receive too little attention. Once everything fits the diagnosis, we may stop examining circumstantial alternatives.
I am equally cautious about the suggestion that people with milder difficulties simply need a “holistic solution”. Looking at sleep, workload, relationships, routines and environment makes sense. But “holistic” needs to mean something concrete. Otherwise, it becomes a pleasant word for leaving someone to manage alone.
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True rehabilitation needs diagnoses and practical support to work together. A diagnosis should inform decisions rather than dictate a person’s future. Support should address the difficulties someone actually experiences, including those that remain hidden behind apparent success.
I am not trying to justify my entire childhood retrospectively, romanticise my medical career or explain my injured brain with a single label.
I want to understand why some tendencies helped me in one setting and hindered me in another. I want to preserve the determination that served me, without mistaking exhaustion for a failure of character.
The useful question is not only, “Does this person have ADHD?”
It is also, “What are they struggling with, what helps them function, and what would make a meaningful difference?”
I have been the problematic child, the struggling student, the capable clinician and the person unable to find his arse with both hands.
Any explanation worth having needs to leave room for all four.
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I don’t feel like a fully fledged member of the ADHD club; more like an honorary member, invited to share stories and ideas with people whose lives have been more seriously affected than mine.
I recognise parts of myself in those conversations, even when other experiences feel some distance from my own. Listening gives me a chance to reconsider what I once dismissed, what I managed without understanding, and what I now need help with.
Those conversations have value beyond the people who carry the diagnosis. Those of us who recognise some of these traits, with a label or without one, can learn from listening.
Shared experiences do not mean identical needs. They give each of us something to reflect on: what matters in our own life, what deserves attention, and what might help.
Help us to feel like we belong.
