ADHD and ACEs: A Complicated Relationship

What do you think of when you hear ADHD?

If the so-called ADHD awareness merchandise all over the internet is anything to go by, the answer is probably a goofy child jumping around and shouting about squirrels.

Image Source: Amazon

(No, seriously, what is the obsession with squirrels?!)

However, as ADHD becomes more accepted and more widely-known as a disorder rather than a perceived “excuse” for bad behaviour, the world is learning more about its nuances and complexities. That is to say it’s not only the parts of the disorder that inconvenience the outside world that are being seen, but the parts that affect the actual person with ADHD – I know, what a wild concept!

One of the complexities of ADHD that is becoming more evident is that it appears to present differently in people who were assigned female at birth. Rather than the cliché rowdiness and silliness, girls are more likely to be withdrawn daydreamers with perpetually messy rooms and a tendency to cry. This is only just becoming widely known, which is contributing to an uptick in adult diagnoses of ADHD and autism.

However, my biological sex is far from the only reason I wasn’t diagnosed with moderate to severe ADHD until age 26. There was a darker factor behind the scenes causing my ADHD to manifest in such a way that it was never picked up on, a factor that is still very much overlooked in this context and many others: trauma.

You see, for as far back as I can remember, I have struggled with what I now know to be symptoms of ADHD, and it didn’t go unnoticed by those around me. Even my late grandpa, though he adored me and I him, once looked at my grandmother as I stared aimlessly at something simple I had done a thousand times before having completely forgotten how to do it and made him repeat the instructions because “I am listening, Opa, and I hear you talking but the words don’t go in”, and solemnly said in the chronically politically incorrect style of the time “Maria, I swear to God this wain is a few sandwiches short of a picnic.”

It was noticed by my peers at school too, as I got older the children around me would notice that I was “weird,” for example that I would “space out” when overwhelmed. They would laugh when I was told off for staring at a page of paper for 45 minutes because I got stuck on a question instead of asking the teacher or skipping the question, and the teachers would roll their eyes when I swore that I was just looking at it for a few minutes.

Eventually the possibility of ADHD was mentioned. I was 15, and explained to the deputy head teacher (after my German teacher had lost his temper with me and sent me to his office following another genuinely forgotten homework assignment) that I really did struggle with my memory, and that I wasn’t sure if the German teacher had told me about the assignment and the “words hadn’t gone in”, or I’d just forgotten in the meantime. He demanded to see my planner and the absence of any homework assignment for that day confirmed that it was the former. I became emotional as I explained that I did listen to my teachers, and no it wasn’t a hearing issue, but unless I knew they were talking and tried hard to focus on the words it just sounded like the vaguely-English sounding gibberish from The Sims.

“I don’t want you to take this the wrong way,” he said, looking concerned rather than angry, “but have you ever been tested for anything like ADHD? We have some other pupils with that. It can cause auditory processing issues.”

I told him I hadn’t, that I’d talked to doctors about my struggles but ADHD itself had never come up, and thanked him for the suggestion. I went to my GP two days later, and asked to be assessed for ADHD, thinking I had finally found a reason and might get some help. Those hopes were quickly squashed when the GP scoffed and shook his head. “It’s a trend right now, this ADHD. Your teacher is probably one of the types who would have everyone diagnosed with something just to have an excuse for the school not having control of the kids!”

After I insisted that the teacher was only responding to the issues I had told him about, the GP explained that I couldn’t have ADHD. ADHD kids were attention seeking, where I was a wallflower. ADHD kids couldn’t sit still, I was eerily still and silent a lot of the time. ADHD kids interrupted conversations and spoke out of turn, I barely spoke in turn. He did, however, agree to refer me to a psychologist.

Around a year later, after several meetings comprising of multiple conversations and cognitive, attention and memory tests, the psychologist presented her findings. “You’re just inattentive unless you’re hyperfocused, unable to multitask, easily stressed and anxious. You also appear to have issues with executive dysfunction and auditory processing.”

She then went through the motions of offering me counselling and group therapy to deal with these issues, but completely ignored the fact that she essentially just read out an ADHD checklist. I knew why – one of the questionnaires she had given me asked about those signs the GP had mentioned. Do you find yourself skipping queues? Do you often interrupt conversations? Do you tend to get up out of your seat when you’re not supposed to? I had answered honestly: no. And once again, that had been enough for them to discount ADHD.

This time, I assumed they were right. Despite my symptoms only causing more stress, anxiety and feelings of hopelessness and self-loathing as I got older, started work, became a parent, and went to university, I wondered if maybe life was this difficult for everyone and I was just weak, or maybe I was simply too stupid, too lazy, or too crazy to navigate everyday life.

My mental health plummeted and by my final year of university I found myself having regular appointments with a psychiatrist. Due to the COVID-19 pandemic, I am still at the time of writing yet to meet him in person, but I get the impression from his voice and demeanour that he is an old man with little patience but a lot of compassion.

One day, I told him about my aforementioned issues, and how I had believed them to be symptoms of ADHD, and he immediately agreed to carry out a diagnostic test. I stopped him and explained that it had been ruled out due to not getting up, barging in, interrupting, skipping queues, et cetera, and without skipping a beat he pointed out what no one, including myself, had considered before.

“Well, no. You were too scared to do any of that.”

Suddenly, everything made sense. It was true – between the violent, abusive household I was brought up in and the bullying I faced at school, I had been an incredibly nervous child and teenager, scared to draw attention to myself in any way. It would later turn out that I had inattentive type ADHD, meaning hyperactivity was a very minor factor for me, but when it did manifest it had done so differently; being unable to concentrate, stumbling over words, impulsive behaviour and irritability or impatience. This was likely due to an acute awareness of the fact that if I had expressed those traits openly, it would have ended very badly.

Image Source: The Canberra Times

My mind was constantly racing, but I wasn’t – out of self-preservation. I wasn’t the stereotypical squirrel-chasing jumping bean, not only because ADHD does not always present itself stereotypically, but because I was simply too scared to be.

From there, it was a relatively quick and painless path to being diagnosed with ADHD and starting treatment. We quickly found a medication that was right for me, and I can’t believe how easy things could have been this whole time. Conversations and social interactions are infinitely easier, I can do the dishes without the danger of staring at them for three hours wondering what to do about the burned pot then realising I’m late to pick my daughter up from school, I can invite people over without worrying about the mess of the house because tidying up is manageable, and grocery shopping is no longer the most overwhelming, anxiety-inducing experience imaginable.

However, as well as relief, I do feel a certain level of resentment. I spent 26 years of my life in a state of stress, fighting constantly just to navigate parts of everyday life that come as naturally as breathing to many others, wondering what was wrong with me and why everything was so hard, because no one made a connection that took someone who’d never met me two conversations to make.

I, and many others, believed for over two decades that I was just stupid or lazy, when in reality I was a neurodivergent person too traumatised and terrified through the violence and abuse I faced in childhood to exhibit the symptoms that inconvenience others, and in the eyes of too many, those are the only symptoms that matter. In fact, at the time of writing, those symptoms, that are very much the tip of the iceberg and more likely to affect those assigned male at birth, were still the first result of a Google search, as displayed on the NHS website.

Image Source: Google

Going forward, I believe that there needs to be a big shift in how we think about ADHD and trauma, especially when they present together. A huge first step towards this point would be recognising the true nature of ADHD. Tiktok user @connordewolfe suggests, I assume with his tongue firmly in his cheek, renaming it “Dave” – Dopamine and Attention Variability and Executive-Dysfunction, due to the fact that people with ADHD do not in fact have a “deficit” of attention at all, we simply struggle with focusing our attention on what we’re supposed to.

While the full version of Dave might be a little too long and jargon-y for many to understand, I do wonder if renaming the disorder might help people to understand its true colours, which would be a great first step towards not writing off anyone who is not presenting stereotypically.

From there, serious movement could be made towards recognising and taking into account the impact of abuse and trauma on neurodivergent children. ACE (adverse childhood experience) awareness has been a cause close to my heart since I learned about it from respected child psychologist and researcher Dr. Suzanne Zeedyk, but it was only when I finally got a diagnosis and the help I needed all those years that I realised quite how much my own life had been affected, not only by my own ACEs but the lack of awareness even among those who really should be the most clued-up and vigilant.

Not only was the abuse I faced in my home life never noticed – and on one occasion even openly dismissed as me lying and being “ridiculous” by a guidance teacher I thought I could confide in – by the school staff who consistently called home about my “nervousness,” “listlessness”, “never being dressed neatly,” “borderline obsessive attachments to teachers” and “refusing to speak up” without ever questioning why, thus making things worse in a vicious cycle that lasted until I left home at 14, but no one ever considered how that could affect how ADHD symptoms present themselves, leaving me battling both “Dave” and my family alone with no support purely because I wasn’t badly behaved enough to fit into the overused and misunderstood clichés.

I said earlier that I feel a level of resentment because of that, and while that’s true, I feel something else: determination. Determination to make sure that other children are not caught in a similar cycle. So I leave you with this: if one person reads or hears my story and recognises neurodivergence, trauma or both in themselves or a child under their charge, and that leads to someone getting the help and support they need, then every second will have been worth it.