I knew early in life that something was wrong with me. I absolutely could not sit still. I could hyper-focus on things that interested me, and I found it nearly impossible to pay any attention to topics I found boring.
Attention deficit hyperactivity disorder was first added to the DSM in 1968 (it was just called ADD then), but I grew up in a hyper-conservative ultra-evangelical Christian family, so I had no chance of being diagnosed and treated for ADHD. When I acted out due to my condition, the parental units simply prayed for me. The prayers did absolutely nothing to address my easily distracted reality or my need to finish other people’s sentences for them.
Having ADHD means that any rabbit hole I come across MUST be explored immediately. That makes it extremely hard to maintain the type of deep focus that is required to, say, write a novel. Or get any kind of advanced degree. I have somehow managed to do both, but I definitely wasted a lot of time along the way.
The impulsivity that comes along with ADHD means I often start something and then lose interest. Years pass. Suddenly the thing I lost interest in becomes a top priority once again. I was 51 when I finally got diagnosed after asking the VA to assess me for ASD, ADHD, and OCD. Those three were my best guesses after going through a master’s program in psychology.
The paragraphs below are my diagnostic results, and they are both personally important and deeply personal. In sharing them, I hope others who have been in similar circumstances and are seeking answers will be motivated to ask for help, as I did.
INTEGRATED ASSESSMENT SUMMARY:
Pen is a 51-year-old cisgender, heterosexual white male who presented with attentional difficulties, social concerns, somatic problems, and an established diagnosis of depression and posttraumatic stress disorder. This assessment was recommended by his treatment team for diagnostic clarification and effective treatment planning. Pen's goal in engaging in this assessment was to better understand how to connect more with others. This assessment considered possible diagnoses of autism, obsessive-compulsive personality disorder, and/or attention deficit hyperactivity disorder.
Pen's history and assessment protocol indicated a problematic level of inattention, impulsivity, and hyperactive symptoms across his lifespan beginning at age 3. His symptoms have caused clinically significant dysfunction in grade school and graduate school, in connecting with others, in his home life, and in his work life. These symptoms also likely contribute to some interpersonal communication patterns identified by others (for example, his partners saying he is "too blunt" is likely a reflection of impulsive speech). This symptom cluster may also contribute to challenges related to completing multiple incomplete degrees. However, Pen's heightened intelligence, work ethic, and carefully developed organizational system to which he admittedly may spend too much time attending, likely mitigate some symptoms and allow him to make good grades and track important information during most of his school and work endeavors.
Pen meets full diagnostic criteria for Attention-Deficit Hyperactive Disorder, impulsive/hyperactive type, with symptom severity at a moderate level.
Pen had a nontraditional upbringing; he was raised by devout evangelical missionaries, and his family moved between Canada, Bangladesh, the United States, and Haiti. It was a morally rigid household which he viewed as unsupportive, inauthentic, and untrustworthy, which likely contributed to feeling disconnected from others as a child. Nonetheless, he was able to form some healthy and genuine relationships with others throughout his life. While Veteran's assessment measures suggest a high probability of Autism, many of the symptoms endorsed on these measures were either not present throughout all stages of his life or are likely to be better explained by PTSD or ADHD. For example, the Veteran's strong avoidance of groups of people or desire for order/control are likely related to his traumatic experiences. While the Veteran endorsed feeling disconnected from others and partners have reported interpersonally challenging behaviors, he has demonstrated the ability and capacity to connect with others and have meaningful relationships in childhood and adulthood. He demonstrated insight, ability to be empathetic, enjoyment in valued interactions with others, and ability to be cognitively flexible despite his strong preference for being alone, focusing on specific interests, and having a highly structured and rule-oriented environment. Furthermore, Veteran does not report or demonstrate pervasive and sustained impairments in communication or stereotyped or repetitive motor movements or vocal patterns. Considering these factors, Veteran does not meet the diagnostic criteria for ASD.
Veteran has insight into his strong personal preferences for an organized home environment and has examples of how his organizational systems can take excessive time to maintain and he can become frustrated with others when they do not comply with the system. However, this is not debilitating and he is able to demonstrate flexibility and move past things that are not in order following initial reaction of frustration. Further, much of his current rigid organizational patterns and "rules" were developed as an adult during or after the military as a response to inattention or trauma reactions. Considering this, Veteran does not meet diagnostic criteria for OCPD as related symptoms appear better explained by other diagnoses.
Overall, this assessment profile indicated symptoms consistent with PTSD and ADHD that manifest in both emotional and physical symptoms. Depression symptom severity is to be expected considering Veteran's lifetime of adjusting behavior to neurotypical expectations and having to function in invalidating and stressful/traumatic environments, all of which can be lonely and exhausting. The years of unresolved trauma and chronic pain most likely compound his executive functioning capability and interpersonal challenges.
While some of his assessment responses suggested that low mood and energy may negatively impact his ability to engage in care, his intelligence, established values, openness, work-ethic, and insight suggest he will engage in treatment effectively and have a favorable prognosis and likely beneficial therapeutic outcome.
314.01 (F90.1) Attention Deficit Hyperactivity Disorder, Predominantly
hyperactive/impulsive presentation, Moderate
309.81 (F43.10) Posttraumatic Stress Disorder, Chronic
If you read all the way to the end, I thank you.
The point of sharing this diagnostic outcome is simple: it sucks to know something is wrong with your brain and be dismissed every time you try to get others to pay attention to that fact. It only took me a half-century of trying before I got someone to meaningly listen.
If you know of someone similar to me, someone who needs help and isn’t getting it, direct them here. I will do my best to put that individual in touch with the right parties. Life is short and often brutal. If I can mitigate someone’s suffering, I will.
I am grateful to everyone who struggled before I came along in order to build a society and culture based on science and evidence. If they had not existed and struggled, my life would be a living hell. Instead, despite many challenges along the way, I have a data-driven, evidence-based safe space in which to exist for now.
I am able to share that with you, the reader, and for that I am always thankful.
And here is another creepy AI image. I blame ADHD for making me post it:
Evolving Together is a reader-supported publication. To receive new posts and support my work, consider becoming a free or paid subscriber.
Thank you for sharing this Pen. I have known many people through my life that have undiagnosed ADHD. Back when I was in school (a really long time ago) the kids were just labeled hyper, inattentive, or troublemakers. It’s known now with proper treatment, or even just understanding how the brain is processing, people with ADHD are some our most brilliant, creative and productive. If you haven’t read Thom Hartman’s book about ADHD, “A Hunter in a Farmers World” it’s a good one. Thom has ADHD and had researched it extensively.
Pen, this piece was an uncommonly brave act. Thank you for the insight it provided as I get to know you.
In my teaching days I read hundreds of these. It became easy to spot the good psychologists from the weaker. You had the good experience to have one who translated your life experiences and commentary wisely.
The mystery is whether it would have affected you or your teachers and those who interacted with you 30 years ago as profoundly. Now you bring a lifetime’s experience to it and have had literally dozens of “Aha” moments. My personal experience was that such a report didn’t necessarily affect the child as much as it provided parents a cudgel with which to legally beat the school and demand differentiated education (that’s how it works in Canada - a Psych-Ed report is a legal obligation to a school.
Even at that, even with a more suitably tailored education, what was really transformational was that one teacher who relentlessly believed in you and poured his/her soul into helping you. Some kids found that person. Some didn’t.
I continue to admire your persistence, your ability to scramble under, over, or around deep obstacles. It feels to me like a life well-lived. I hesitate to even write that because I had things considerably easier growing up, and it feels judgmental to say that.
One last point, based on an earlier post. You talked about the quest to live in a technocratic utopia. I am interested in your more fully developed thoughts on that because I am suspicious of both words.