Think Attention Deficit Hyperactivity Disorder (ADHD), and the image of a hyperactive boy might come to mind. It’s a misconception that has caused some people to struggle for decades before they learnt the truth, and found their tribe.
SINGAPORE: Growing up, Cheyenne Seah always felt she had to work twice, even three times as hard as the people around her to get things done.
“I felt like I was the stupid one,” she said.
Seah, now 39, would forget even the simplest of things. Organisation and administrative tasks stressed her out to no end. She could never motivate herself to get her homework done until the last minute – and would end up copying from friends.
At the age of 10, she realised that her brain “worked” when she drank coffee, so she picked up the habit to “give herself a hit”. By the time she was in her early 20s, she was downing eight cups to get through the day.
After the caffeine overload, she would drink alcohol – 500ml or so – in the evenings to sleep. When she won a scholarship and began pursuing a PhD in biology and research, however, the demands became too much to bear.
I felt like I was the stupid one.
Despite putting in 16-hour days in the lab, she never felt she was able to catch up. The anxiety of turning in quality work on tight deadlines began to gnaw away at her. Soon, there were days she couldn’t even get out of bed. She knew she was failing, but could not do anything to motivate herself.
“I didn’t shower for days. I just wanted to die,” she said. “It was like seeing a car crash in front of you in slow motion and you cannot help yourself.”
At the urging of those around her, she saw a doctor and was treated for anxiety and depression for almost a year. She was 30 by the time an eagle-eyed visiting doctor dug a little deeper and looked at her childhood habits.
“Cheyenne,” he told her. “I think you might have attention deficit hyperactivity disorder (ADHD).”
THE UNLIKELY CANDIDATES
As an adult woman by then, she was an unlikely candidate.
There are no local studies on the prevalence of ADHD in Singapore, but international data suggests that about 5 per cent of children have ADHD, according to Dr Bhanu Gupta of the Institute of Mental Health (IMH).
Traditionally, ADHD has been known as a childhood disorder associated with, in Bhanu’s words, “young boys bouncing around and creating a lot of trouble in the classroom”.
Despite the association with hyperactivity, there are elements that may be harder to pick up, said the consultant at IMH’s department of mood and anxiety. For example, some people with ADHD are simply inattentive. “They can be easily distracted, have difficulty in focusing or sustaining attention on tasks, and can be quite disorganised,” he said. There are also those who are impulsive and may act or speak without thinking.
A review published in the Lancet Psychiatry journal noted that ADHD is more common in boys than girls, with a ratio of 2 to 3:1 reported in community prevalence studies. “This may represent the fact that ADHD in girls and women is not recognised very well,” said Bhanu.
Some of the female patients are quietly sitting in the corner daydreaming, and they’re never surfaced.
This is because male patients tend to be more hyperactive, according to psychiatrist Lim Boon Leng.
“The behaviour is obvious – they’re running around shouting and disrupting classes,” said Dr Lim, who is in private practice at Gleneagles Medical Centre. “But some of the female patients are quietly sitting in the corner daydreaming, and they’re never surfaced.”
About 30 per cent of children with ADHD will grow into adulthood with difficulties, and continue to have symptoms that need treatment, he said. While adults with ADHD may be able to suppress their restlessness, they may continue to have difficulty sustaining their focus and be distracted and careless.
From 2018 to 2020, IMH saw an average of 67 new cases of adult ADHD a year. But this represents only the tip of the iceberg, Bhanu said. “A lot of people with ADHD don’t seek (medical) attention.”
One reason is that they may not know they have it. Patients may also develop skills to live with their condition and only come forward when they are no longer able to cope.
WHAT IS ADHD AND HOW IS IT DIAGNOSED?
Characterised by hyperactivity, inattention and impulsive behaviour, ADHD is one of the most common neurodevelopmental disorders in children. It is, however, a lifelong condition: About 30 per cent of children would have their symptoms continue into adulthood.
Not everyone with ADHD will have the same symptoms, but common ones include being easily distracted, having difficulty concentrating, fidgeting or feeling restless.
While ADHD cannot be cured, its symptoms can be treated.
Medical professionals use diagnostic tools like the Diagnostic and Statistical Manual (DSM-5) to diagnose ADHD. There are nine criteria for hyperactivity, and nine for inattention. Children would usually have to meet six out of the nine, while adults have to fulfil five.
Only a trained medical professional can diagnose ADHD.
Misconceptions do not help. For example, the notion that people can “grow out” of ADHD, or it afflicts only those who are struggling academically.
Misconceptions had very real consequences for Jnanee Krishnasamy, 30, another “unlikely candidate”.
In primary school, her mother had structured and organised her schedule, making sure she completed her homework. Thanks to this, she excelled, doing well enough to get into the Integrated Programme at one of the top secondary schools in Singapore.
“That was when my mum decided I was old enough to manage my own schoolwork, and that’s when everything came crashing down,” she said. Jnanee would attempt to do school assignments but get distracted by video games within a few minutes. She rarely handed in assignments, and would be extremely late if she did.
She tried her best to get her life organised, getting a diary and making to-do lists. But within days, she would lose or forget about them.
When her grades started slipping, no one thought much about it, she recalled. “People thought it was a combination of laziness, because we had no O-Levels, or that I didn’t have the natural aptitude to begin with.”
Curious about psychology, she remembers coming across ADHD in a book and was startled to realise that the description matched what she was feeling. She told her mother about it and asked to see a doctor.
“As soon as the doctor heard the name of my school, he was like, ‘No, you can’t have ADHD. You’re from a good school, you’re probably just stressed’,” she said. Over the next few years, she saw another two doctors, both of whom told her she was “probably just stressed” by the upcoming A-Level exams.
“If two or three of them have said that, then who am I to question them?”
Now a veterinarian, Jnanee was only diagnosed two years ago due to “a difficult situation” that she declined to elaborate on.
Psychiatrist Lim acknowledged that there has been a general lack of awareness about the condition. “Traditionally, ADHD is understood and emphasised to be a childhood illness,” he said. It can, in fact, persist throughout one’s life.
“If you were disorganised, not completing what you’re supposed to do, the advice would be to try harder,” added Bhanu. “A lot of the time, people just end up blaming themselves, even though they recognise that they seem to be struggling much more doing day-to-day tasks compared to their peers.”
JOBS AND RELATIONSHIPS TAKE A HIT
The repercussions of a late diagnosis can be huge. The demands of going through life with undiagnosed ADHD can be so overwhelming that patients can end up developing other conditions.
“We do see people who come with depressive or anxiety symptoms. But when you talk to them more in detail, it turns out that’s the external manifestation, and they struggled all their life with ADHD-type symptoms,” said IMH’s Bhanu.
By then, the condition could have damaged careers and relationships.
Take Angie Chang, 28, who remembers never being able to focus in school and failing subjects right from the beginning. She took six years to complete secondary school and four years to get a polytechnic diploma.
“Some people said I would never make it in life,” she said. Her parents thought she was a slow learner, and it never occurred to them that she had ADHD.
After graduating with a nursing diploma in 2016, Chang reckoned she tried out more than 20 different jobs, from nursing roles to part-time positions like waiting tables. She estimates that 95 per cent of the time, she did not manage to pass probation. Twice, she was fired after only three days.
“They said I was slow. Couldn’t focus,” she said.
She often found it difficult to explain her employment history to prospective employers. “I always said I’d rather work (at the company I was interviewing at), or maybe that (the previous) place wasn’t my ideal, or I wanted a change,” she said. “But it was just to cover the weakness.”
Moonlake Lee, 53, meanwhile, is happily married to her husband of 29 years. But it was only at the end of 2019, when she was diagnosed with ADHD, that she realised her condition had caused tension in her marriage.
“Sometimes, it’s the small things you do that get on people’s nerves,” she said. She remembers always being late, interrupting her husband during serious conversations and being very disorganised.
Time blindness, which in Lee’s case meant she could be anywhere from 20 minutes to an hour late for appointments, can have a negative impact on work, family and social relationships, she said. This is compounded by the struggles people with ADHD tend to face with executive functioning skills like planning and organisation.
SEEING CLEARLY WITH A DIAGNOSIS
Lee’s daughter was diagnosed with ADHD in 2018, and it was then that she realised she also had the condition.
The benefits of a diagnosis were immediate – first and foremost, in her marriage.
“There’s a lot more compassion,” she said. “In the past, my husband would see all the little things that bugged him about me as character flaws. But now he knows it’s just my ADHD ‘wiring’.”
On a deeper level, a diagnosis can also aid self-acceptance.
For this reason, doctors say getting formally diagnosed can be life-changing.
There’s a lot more compassion. In the past, my husband would see all the little things that bugged him about me as character flaws. But now he knows it’s just my ADHD ‘wiring’.
“They never realise that the problem was not them – they have always been blaming themselves,” said Lim. “So they heave a sigh of relief and say: ‘It’s not me, it’s just a condition’.”
“It’s really akin to short-sightedness,” he added. “Imagine a person who has been seeing with blurred vision suddenly wearing glasses – it can really be life changing.”
After diagnosis, treatment can make a remarkable difference.
Medication can help those with ADHD sustain their concentration and perform better at work, said Lim.
There are also other forms of treatment. Life coaches can help with strategies on time management and overcoming some of the symptoms of ADHD, said Lim. Individuals can also see a psychologist or counsellor to address any other emotional difficulties arising from their condition, such as anxiety or depression.
Imagine a person who has been seeing with blurred vision suddenly wearing glasses – it can really be life changing.
There are also individuals who think they have ADHD but actually do not, said Lim. Some may have read misleading articles while others feel they have certain symptoms. There are also people who may erroneously attribute their difficulties or failures to ADHD when that may not be the case, he said.
“We often get people who come to us, and are worried that if they come for the diagnosis, we will prescribe medication,” added Bhanu.
“But it’s always a consultation. We give people a choice – you’d discuss what you think is the best possible treatment, and a lot of people choose not to take medication or go for therapy. We respect that choice.”
Following her diagnosis, Seah’s life has taken a different turn.
She decided not to pursue her PhD or a science career, telling herself to start on a clean slate.
She took a part-time diploma in learning disabilities management to understand how she could manage herself better and use her strengths and weaknesses. She read books and listened to podcasts to find out more about ADHD.
These equipped her with practical ways to deal with her “bad short-term memory”. She now sets recurring reminders on her phone to pay her credit card bill, for instance, and has a smart watch that beeps every hour to remind her to go for meetings.
While she still enjoys a cup of coffee in the morning, it’s nowhere near the amount she used to drink to get through the day.
“(The diagnosis) gave me the peace to know that I’m all about the new stuff – so it’s okay to achieve a certain level, hand it over well and then go on my next adventure,” she said.
She has done this with panache. In recent years, she has tried her hand at business and industry development, human resource strategy and psychology. She now does business advisory and career coaching, and is studying cybersecurity and blockchain.
She also coaches girls with ADHD, teaching them life skills and some executive functions like managing priorities, handling people, and dealing with emotional trauma. “I want to buy these girls an opportunity for a better life than the one I had,” she said.
These days, she works out of the bedroom of her simply decorated flat. With the air-conditioner running and soft music playing on her laptop, it is a conducive spot. Small squeeze toys and gummy bears are within close reach as outlets for stress and to “help her brain work”.
So is her medication – she is prescribed two different drugs, one for days she needs to focus and “be an adult”, and another to help with her disrupted sleep patterns.
Chang, too, decided to play to her strengths after being diagnosed in 2020. A colleague had urged her to get herself checked – and it was, in her words, an “aha” moment, especially when she did online searches on the condition.
“I saw there were so many famous people with ADHD, and I was like: ‘Wow, I’m not alone’,” she said.
She realised she shared some of their traits – in particular, creativity and the ability to hyper-focus on things for long periods of time – and this gave her the courage to turn her back on corporate life altogether.
She chose not to take medication to deal with her condition. Instead, her therapy involves pouring herself into a passion project: Her own business, ThriftStoreIAm, where she gives second-hand items a new lease of life.
“As I focus on packing and doing things like design, I’ll be very tired at the end of the day, and that helps to calm me down,” she said. She is also sleeping better at night after picking up relaxation techniques, such as breathing exercises, online.
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SHATTERING THE STEREOTYPE
Today, there is much more awareness about ADHD than a few years ago, said both doctors, and there is less stigma in coming forward for help. Younger doctors are gaining an understanding of the condition and becoming more aware of the misconceptions surrounding ADHD, said Lim.
Spurred on by the lack of local resources for people with ADHD when she was trying to help her daughter, Lee started an online portal called Unlocking ADHD in April.
She hopes to raise awareness about the condition and help people access support groups and coaching programmes. “We wanted to have a comprehensive portal on everything (about) ADHD that people need to know, to live a better life,” she said.
Through word-of-mouth and the recruitment of volunteers, she has also managed to meet more people with ADHD and build a support network.
This sense of community was particularly helpful for Jnanee. “It gives me a sense of comfort to know that you’re not alone,” she said.
The group often shares jokes or memes about ADHD, and she has also learnt coping strategies like setting multiple reminders for meetings and carrying a clipboard with all her tasks for the day.
The aim is for Unlocking ADHD to share real stories: Of living with the condition, the struggles, treatment options and, ultimately, the triumph of transformed lives. To Lee, this is the most powerful way to reach people.
Jnanee concurs. She “found her tribe” only after meeting Lee and reading about adults with ADHD in a 2020 news article. She now wants others to do the same.
“I also want to shatter the stereotype that ADHD is only found in hyperactive little boys,” she declared.