When Dani Donovan sits down in a new clinician’s office, she hopes they see her as a whole person, not just a 30-minute time slot. Donovan has attention deficit hyperactivity disorder, or ADHD. She’s had the hallmarks of the attention disorder her entire life but didn’t get an official diagnosis until long after she entered adulthood.
Estimates put the prevalence of ADHD at around 8.4 percent of US adults aged 18-44 years. Studies suggest that only around 10-15 percent of adults with ADHD receive a formal diagnosis. As with Donovan, some don’t get a definitive diagnosis until later in life even if they’ve been living symptoms for years.
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The Understanding Gap
Donovan said that many clinicians understand childhood ADHD but seem unsure about how to approach the condition in someone who has long since graduated middle school. They don’t always grasp that adult ADHD translates to adult problems, touching every aspect of life, from relationships to work to home responsibilities.
“Clinicians who dismiss common ADHD struggles as depression or anxiety do a disservice because these things often sit on top of untreated ADHD,” Donovan told Psychiatrist.com. “’The things I’m anxious and depressed about are because the ADHD isn’t getting dealt with. I often rely on coping mechanisms and brute force just to function.”
“Why can’t you just—“
I don’t have a procrastination problem. I have a “getting started” problem. The first step is always the hardest.
Getting enough willpower to initiate action is difficult. Constant shaming wrecks my self-esteem, and teaches me to always blame myself. #ADHD pic.twitter.com/Ruzi0VtOp4
— Dani Donovan 🐉🔜 DragonCon (@danidonovan) March 19, 2019
Some clinicians suggest one-size-fits-all solutions without grasping a patient’s individual challenges. Donovan said they need to dig deeper, and evaluate how ADHD impacts a patient’s emotions and self-esteem.
“When those ‘umbrella’ solutions are given to us as the answer, it can actually be damaging,” Donovan noted. “Well-meaning advice like ‘make a plan’ implies previous failure.” Instead, Donovan suggested that clinicians first ask, “What have you tried?” so patients feel heard rather than judged.
Empathy and Compassion
Donovan also said she wished more clinicians recognized that a multifaceted approach to care works best. For example, treatments like medication, talk therapy, and coaching may be out of reach logistically and financially for some patients. However, most can find an online ADHD community to provide connection and support.
Donovan said that adjusting clinical approaches for ADHD requires empathy. At one appointment, Dani shared her anguish over appetite loss from ADHD medication. The clinician brushed it off, saying those symptoms were desirable for a lot of people and were probably just temporary anyway. “That interaction still hurts,” Donovan admitted. “This person could not understand how distressing these things were for me.”
My deep-seated anxiety of annoying others is at the core of my low self-esteem. I can read into anything and everything. A one-word e-mail from my boss? He must be pissed at me. People whispering just out of earshot? They must be talking about me. The list goes on and on. #ADHD pic.twitter.com/Y8okeI21xN
— Dani Donovan 🐉🔜 DragonCon (@danidonovan) March 5, 2019
What would have helped in this instance, Donovan said, is asking how the side effects impacted her daily life. “That would have shown they were listening and they cared.”
Another time, Donovan waited weeks for a refill when a psychiatrist sent her prescription to the wrong pharmacy. Each follow-up call and trip to the various pharmacies all over town depleted her mental stamina, she recalled. Perhaps the average person would have been able to resolve the situation quickly, she said. But Donovan, and many other people with ADHD, simply don’t have the skills to efficiently manage this sort of communication breakdown. Worse, when she finally reached the psychiatrist after several months of back and forth, they scolded her for rationing medication instead of taking responsibility for their role in the miscommunication.
“It made me feel so bad, like I am a difficult person, when I really just wanted my refills sent to the right location,” Donovan explained.
That particular psychiatrist appeared to lack compassion for what it’s like to have ADHD, Donovan mused. Conversely, another practitioner she worked with admitted when she didn’t know something. She’d promise to do some research and come up with a good answer. “Something like that can really make a difference,” Donovan said. “Clinicians who learn from patients provide better care while building trust.”
Overcoming Shame
Donovan stressed that little things matter when working with adult ADHD patients. She said she appreciated when clinicians confirm that a situation sounds challenging or when they seem sympathetic to the daily realities of ADHD.
“ADHD patients respond really well to positive reinforcement,” Donovan added. So when she pushes herself to do something hard like scheduling an appointment, she hopes the clinician will recognize and praise her effort.
Shame is perhaps the most common recurring theme for Donovan when discussing what it’s like to have ADHD as an adult. In her experience, clinicians frequently overlook the deep guilt and self-blame patients feel over what appears like “lazy” behavior they can’t control. Donovan said she believed compassion is the number one thing a provider can bring to the table to improve treatment experiences for patients.
“Practitioners willing to learn and humanize adult ADHD will get better outcomes,” she said. “”Helping people get to self-acceptance should be the goal.”
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Donovan is an advocate and online influencer for adults with ADHD. She is author of The Anti-Planner: How to Get Sh*t Done When You Don’t Feel Like It, a guide designed to help people with ADHD conquer procrastination.
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Check it out: https://t.co/ltHo6hHuro pic.twitter.com/j8JalbrdLK
— Dani Donovan 🐉🔜 DragonCon (@danidonovan) November 9, 2021
