Membership BADDges: Identifying ADHD in Girls with Co-morbid Anxiety

It’s rough being an intelligent girl with ADHD. If such a girl is halfway successful, multiple doctors’ 15-minute default assumptions that she merely has anxiety/depression will too often have been the reason she spent most of her twenties ineffectually medicated with SSRIs – and labeled treatment resistant – instead of receiving the medications that will eventually change her life.

Such a girl has probably railed against the gatekeepers that barred her from having a shot at becoming truly successful – not just halfway – for so many irreplaceable years. She probably has become lost in an RSD spiral at least once after scoring off the charts on her ADHD self-assessment and being shot down anyway because she “did okay in high school.”

Such a girl may even have spent the first year after her formal ADHD diagnosis doubting it. She never forgot the doctor who said her difficulties were due to a lack of skills, not a neurological condition. She may have heard the bully-in-her-brain aping that doctor – telling her that she chose a job she “wasn’t good at” – for quite some time before she learned to trust her lifetime of ADHD experience over an ignorant GP.

If she has learned to trust in diagnostic criteria over doubt, she may become incandescent with rage when she sees other smart girls in Facebook groups and on WordPress being treated the way she once was treated. She may start to write an angry blog post after thinking back on what it was like to be told that she “didn’t need ADHD medications to solve her problems” – she just needed to choose a job within her “realistic personal capabilities.” She may instead realize that diagnostic criteria and angry rants wouldn’t necessarily have helped her in her own diagnosis journey. They wouldn’t necessarily have penetrated the fog of self-flagellation at the time.

She might then wonder what would have helped her feel more confident that she really did have a neurological condition back in her undiagnosed twenties. One thing that would have helped would have been to know that the “ADHD” versus “anxiety/depression” dichotomy is a false one. If a smart girl has ADHD, she most likely has anxiety and/or depression, too. It would have further helped her to have learned how to recognize her ADHD lurking behind her anxiety. It would have helped her to recognize her shibboleths: little traits of hers that stem from the diagnostic criteria for ADHD and aren’t as easily confused with other diagnoses as a non-specific criterion like feeling overwhelmed.  It would have helped to have some way to laugh about just how ADHD she was, not internalize the issues.

The following are some of those shibboleths that one such girl, known as Lavender, shared with another smart girl still in the process of being diagnosed. (She has added a few since that original exchange!) They have no formal diagnostic validity as an ADHD screener, but they probably have a fairly high specificity (though maybe not sensitivity!) To use the guide, assign the female subject +1 points for each item as described below. There is no clear-cut diagnostic threshold for ADHD. As in Improv, everything is made up and the points don’t matter. However, if the girl happens to self-identify with a few of these traits, she is more than welcome to an unofficial Membership BADDge, at least in this girl’s book.

Field Guide to Identifying ADHD in Girls with Co-Existing Anxiety and Other Psychiatric Diagnoses

• (+1) She is unaware of – and unable to modulate – the volume of her voice. People tell her she is yelling one minute and whispering the next. Assign an additional point if she is often thought to be angry or intense when she is really happy or excited: her volume increases in proportion to how ebullient she is at any given moment.
• (+1) She has characteristic sensory sensations – often sticky or slimy – that she just cannot stand. She may be fine swimming in the ocean, but she can’t take the tepid film of water over a freshwater lake. She may also be miserable in winter because she must choose between dry scratchy skin or the horror of using lotion.
• (+1) She can’t accurately perceive time. She will say something took place “a week or so ago” – and truly believe it did – when it has been a month or more. Assign an extra point if she can’t recall the details of even her most meaningful autobiographical memories without tangible aids such as photographs or journal entries.
• (+1) She tries to tell a story with multiple distinct female characters, but she only manages to use the ambiguous pronoun “she” to identify them, utterly losing her audience. Assign an additional point if she vacillates in her story telling between giving too much detail one day – overwhelming her audience – and so little detail that her audience can’t even tell whether the story is about her or someone else the next day.
• (+1) She has invested real money or unhealthy amounts of time in at least three endeavors (or more!) that should be full-scale, multi-month projects or social commitments in less than half that amount of calendar time. Assign an additional point if she has completed none of these projects to date. Assign another point if she has legitimately forgotten to eat one or more meals because she was in a trance-like fixation (hyperfocus) during one or more of those projects. Assign yet another pee(r)-less point if she got so lost in hyperfocus she nearly forgot other bodily needs that are typically much more urgent.
• (+1) She has driven on an expired car registration for 3+ months, but not because she didn’t have the money. She only managed to remember that she needed to take care of her registration after normal DMV business hours. By the next morning, these best-laid plans were erased from her brain. Assign an additional oh-yes-she-did point if she has also lost her credit card, driver’s license, birth certificate, wedding ring or some other “how could she possibly lose that” item critical to daily living at least once this year. Assign an additional Easter-Egg point if she can deliberately hide money in her “safe places,” knowing her ability to lose it there will prevent her from impulsively spending it.
• (+1) She has flipped at least one pen clip across the room during a business meeting at work. Assign an additional point if she managed to hit her boss in the process. Assign an additional see-me-in-my-office-later point if the pen that hit her boss somehow managed to be her boss’s own pen that that she had accidentally filched from him during the meeting.
• (+1) She has had to be yanked back from walking into traffic. Assign an additional point if she didn’t notice. Assign an additional but-don’t-think-saving-her-exempts-you-from-listening-to-her-story point if she continued to talk the entire time this was happening without hitch.
• (+1) She has hyperfocused through a fire alarm, tornado siren or other warning of impending natural disaster. Add an additional this-is-not-a-drill point if she also hyperfocused through the actual fire/tornado or other natural disaster hitting nearby. Add an I-bow-before-my-queen point if she also hyperfocused through the tornado coming down on top of the house. (The author of this guide has the first two points, but not the last one, so far!)
• (+1) She has wasted more of the coffee/tea in the package than she has drunk by setting it down for “a minute” to “wait for it to cool down.” Add an additional point if there are more than two half-full glasses of any drink within three feet of her right now because she forgot she had already grabbed a cup/opened a can/obtained the liquid before. Add an additional bonus point if she has had to carry around multiple water bottles in her purse because she forgot she already put one in. (Add a dysautonomia-diva point if she happens to have a chronic illness wherein carrying a water bottle is critical for disorder management, yet the only way she can follow doctor’s orders is to buy five separate water bottles and leave one in each place she frequents.)
• (+1) She has at least four reminder alarms set on her phone each day. Add additional points if she a) has that many alarms just for waking up and b) at least one of those alarms is labelled with curse words and an injunction to “get your forgetful/lazy/procrastinating @$$ going, girl.”
• (+1) Any password strong enough to keep a thief out keeps her out, too. She must request three-step verification and set up a new password each time she logs on to her online banking account. Assign an additional point if she has legitimately forgotten her own ATM pin. Assign an ADDulting-is-hard point if she has managed to forget her ATM pin at the same time she has also lost her debit card and/or driver’s license, and she, thus, has no way to convince the teller that she is the person she claims to be while she attempts to retrieve it.
• (+1) She must carry around an ideas notebook to have any hope of remembering her inspired flashes (or basic project instructions.) Assign an additional point if the notes in her notebook are unable to be interpreted by anyone except her. Assign an additional point if her handwriting is so bad her notes are also unable to be interpreted by her. Assign an on-IRS-list-somewhere-I’m-sure additional point if she has a job wherein precisely documenting her work for others to review (for audits, lab notebooks for study replication, billable hours submission, etc.) is in the job description, yet she still can’t manage to keep records that can be verified by anyone else. Assign a but-at-least-she-noticed-the-text-that-time-so-don’t-press-your-luck point if anyone has ever had to send her scanned pages from her old notebooks three years later – while the auditor was in the room – going “what the heck does this mean?” Assign a to-hell-with-anyone-who-says-women-with-ADHD-aren’t-smart point if she was then able to a) re-derive the entire results of the old project on the fly (after she couldn’t read the notebook either) and b) the auditor gave full marks for record keeping as a result.
• (+1) She has more time management apps on her phone than there are hours in the work day. Assign an additional point if, despite all those apps, she still relies on some form of a paper planner/bullet journal anyway. Assign an additional bonus point if, among all those apps, she refuses to download Slack, even though it is the office standard. Assign a Silicon-Valley-doesn’t-understand-the-ADHD-they-idolize point if she detoured from this assessment for a minimum of ten minutes while she read a dozen articles to figure out what Slack is – and why it’s so horrible for folks with ADHD. Assign another Slacker – um, ADHD – point if she uses Slack regularly, but she still detoured from the assessment to read about how awful it is, anyway!
• (+1) She intellectually understands that post offices exist (and that people send things like birthday cards and thank you notes at them, roughly 1-2 weeks before/after major events), but she can only manage e-cards. Assign an additional maternal-guilt-trip point if she can’t even manage e-cards. Assign an additional no-really-maternal-guilt-is-the gift-that-just-keeps-on-giving point if she has planned to set up automatic e-cards multiple times, but she still can’t remember to be on time with her automation intentions.

If this assessment is being completed in a clinical setting, additionally include the indicator below:

(+1) Her psychiatrist has dropped her as a patient for repeatedly running more than the allowed 15 minutes late to appointments. Assign an additional why-are-we-even-doubting-she-has-ADHD point if she arrives late even though she regularly leaves with “enough time” to get to appointments and/or her stories about why she was late could put sitcom writers out of business.

Assign an I-guess-this-turned-into-an-angry-rant-after-all point if multiple doctors have observed this behavior at appointments, yet none of them ever stopped to ponder whether her willingness to face the embarrassment of being multiple hours late to an appointment, yet keep begging for something to help her get control of the chaos, just might be a sign she has a certain diagnosis with four letters…

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Need a recap of anything I’m talking about in any post? Check out the Glossary of Terms.