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How Are You? *Cue Internal Panic*

Mental health, but make it neurodiverse.

I received my ADHD diagnosis a few years ago. This was life-changing and yet nothing changed. All the same challenges were still present; the world still expected me to mask and present as neurotypical. Even after countless deep dives of ADHD research, I still feel the effects of having lived most of my life without any understanding of what neurodiversity was.


Shame


Lazy. Messy. Flaky. Too much. These insidious and familiar comments penetrate and stick with you. I recall when I was in Year 9, a very close friend mentioned to me in passing "You're so smart but at the same time you're so dumb". At the time, I found this freeing because I thought "Wait, I can be both?" I had spent so much time attempting to reconcile this internal dichotomy that hearing this, although quite hurtful, gave me some permission to exist as I am. At school, I was constantly being sent out and in detention for missing homework, speaking out of turn, loss of necessary stationary, tardiness, and challenging the status quo. Quite frankly, it's a miracle that I managed to get myself to university to study Pure Mathematics.


Growing up as a young girl, I certainly felt the crushing weight of societal expectations placed on my gender; I felt more judgement cast upon me for exhibiting ADHD traits. For boys, they would more often be referred to be assessed, whereas, for young girls like me, it was viewed as a moral failing and with judgement that we should just do better. Inundated with well-meaning adults advising me to "just try harder" or remarking on how much "potential" I had if I "just applied myself" lead to an internalisation of such shame. These internalised ableist beliefs still haunt me on a daily basis. Why can't I just be on time? Why can't I stop interrupting people? Why don't I remember that person's name? What's wrong with me?


ADHD equally prevalent in boys and girls, yet 50% fewer girls referred

Stephen Hinshaw, professor of psychology at University of California at Berkeley, says ADHD is an "equal-opportunity condition." Yet 50% fewer girls are referred for ADHD evaluations and treatment than boys. Studies show that ADHD in girls is often overlooked for many reasons:
  • A greater tendency to internalise symptoms rather than externalise them

  • Higher likelihood of masking symptoms better by developing coping strategies

  • Missed diagnosis due to co-occurring conditions such as anxiety and depression so ADHD symptoms may be mistakenly attributed to these instead

  • A lack of awareness among healthcare professionals regarding the specific symptom profile of ADHD in women and girls

Relationships, RSD and regulation


Having ADHD presents a flurry of challenges that make for a perfect storm when it comes to relationships, especially romantic or close proximity relationships. Rejection Sensitive Dysphoria (RSD) is when you experience severe emotional pain because of a real or perceived rejection. This condition is linked to ADHD and experts suspect it happens due to differences in brain structure.

Emotional regulation is the ability to manage emotions. A common symptom of ADHD is emotional dysregulation which is characterised by:

  • Overly intense emotions

  • Impulsive behaviour e.g. Interrupting

  • Lack of emotional awareness

  • Trouble making decisions

  • Inability to manage behaviour

  • Avoidance of difficult emotions

The result of emotional dysregulation, for me, presents as saying the wrong thing, not thinking before I speak, interrupting and feeling overwhelmingly emotionally flooded. Most importantly, challenges with working memory (that are further compounded in times of heightened emotional experience) make it difficult to simultaneously hold my own thoughts whilst also listen to another person speak.

So, how are you?


Seems like such an innocent and unassuming question...right? From an early age, this question would never fail to stump me. People with ADHD often struggle with interpreting social cues, as well as participating in the social niceties of the performative dance known as social etiquette. The experience of this varies but my personal experience has been that, sometimes I can tell that something is wrong, however, I often have no idea what is wrong. Deciphering the subtext behind peoples words and actions when they lack clear, honest and direct verbal communication presents a continuous challenge for people with neurodivergent brains.


How are you? The journey


Beginning: I assumed that people asking me ’How are you?”, actually wanted to know how I was and so I would tell them everything. Whether they were essentially a stranger or a lifelong friend, I would just answer as honestly and authentically as I could.


Middle: I started realising that, for some people, I was oversharing; they were just asking to be polite or worse they didn’t truly care about how I was, but, they were asking because “it’s just what you do”. My response was to overcompensate by masking and answering in the socially appropriate way. I would often find myself replying “Yeah, I’m good” even if I wasn’t really good at all. This made me resentful and exhausted, the lack of authenticity I maintained for the sake of social norms, made me feel uncomfortable in my own skin.


End (kinda): Although I still battle the fear of social disapproval and insecure thoughts, I now find myself somewhere in between my previous approaches. When people ask, sometimes I can’t avoid thoughts like “Do you really wanna know...like really?”, however, I still choose to answer honestly without violating my boundaries by sharing more than is warranted. I made a commitment to myself that whenever anyone asks me “How are you?” I will stop and actually ask myself “how am I actually doing right now? Truly?” Depending on my relationship with the person asking and my mood, I will vary the level of detail, but, I will never give a disingenuous answer. This is (and I think may always be) a work in progress, but I have to say, I am much happier here.


Helpful tips:

  • Community: Be a part of something bigger than yourself. For some that is religious community, for others there is a cause that really speaks to them. Gather with fellow humans who share this passion and you will be surprised what you can achieve.

  • Body double: Work alongside someone in the same room (although can be virtual too) who is also working on their own independent task. Creates just the right amount of accountability to keep you on task but not so much that you feel suffocated.

  • Talking therapy: Also known as psychodynamic therapy, this can be useful as some people with ADHD find it easier to express themselves through verbal processing than through writing, although articulation can still be a challenge for some too.

  • Journalling: Recommended for everyone but especially for those who have a harder time speaking or therapy is inaccessible. The individual process of journaling can allow for the cognitive dissonance (space between yourself and your thoughts) that is a component of the role a therapist provides, so you can reflect on your own thoughts yourself. This need not be restrictive or regimented. You can practise journaling daily or on more of a case by case basis (e.g. when you feel the need to unjumble your mental state). Journaling can be done by following prompts and asking yourself certain questions in a more structured way, or can simply be a brain dump stream of consciousness for 5-10mins. It’s important to find what works for you.

  • DBT not CBT: CBT can often be unsuccessful for the neurodivergent. DBT takes the best parts of CBT and adds a focus on key aspects such as emotional regulation and interpersonal skills.

  • Maintain social connections: This does require effort but the links between a fulfilling social life and health are robust. Reach out to that friend you’ve been meaning to text back, call a family member, ask someone to have a coffee for platonic friendship.

  • Take a breath: Count to 10 or walk away if you need to.


Key takeaways:

  • Practising greater empathy goes a long way in battling shame

  • Increased awareness of how ADHD presents in girls and women will mean less fall through the cracks and actually get the help they need and deserve

  • Greater understanding of the reality that people with ADHD are more sensitive and feel emotion more intensely so should be met with compassion rather than judgement

  • Ask people “How are you?” more often, however, make sure you actually mean it and actually want to know

  • When asked “How are you?” use this as a cue to check in with yourself and really assess “How am I actually doing? Truly?”

  • There are tools and skills out there that can help! Just don’t give up on yourself

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