Why I’ll still be taking pills even if I get pregnant: a follow-up

A few months ago, I shared a post in which I revealed I’m planning to continue taking my ADHD medications even if and when I someday get pregnant. I explained that I literally wouldn’t be able to afford to stop taking my daily dose of CNS stimulants; sans pills, I can barely function, which means I would be unable to work (or even drive to work, for that matter). In short, I would have to risk exposing my unborn child to all manner of adverse health outcomes in utero.

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As it turns out, however, such exposure may be far less likely than originally thought. As reported in a Nov. 29 ADDitude article, “The risks associated with taking an ADHD stimulant medication during pregnancy are real, but quite small,” according to an extensive population-based study published last month in the journal Obstetrics & Gynecology

In the study, the authors examined a cohort of pregnant women “and their liveborn neonates” enrolled in Medicaid from 2000 to 2010. They compared women who took Adderall or Ritalin alone in the first half of pregnancy to unexposed women, and women who continued to take the medication past 20 weeks’ gestation to women who discontinued.

The takeaway? 

Psychostimulant use during pregnancy was associated with a small increased relative risk of preeclampsia and preterm birth. The absolute increases in risks are small and, thus, women with significant ADHD should not be counseled to suspend their ADHD treatment based on these findings.

This is an indisputably significant development in the field of ADHD research. Until now, studies of methylphenidate (Ritalin) use during pregnancy were based on cases “not representative of the general adult ADHD population having methylphenidate as monotherapy during pregnancy,” according to a 2014 systematic review published in the British Journal of Clinical Pharmacology. That is because “all the articles reported combinations of methylphenidate with either known teratogenic drugs or drugs of abuse.”

But this new revelation is equally noteworthy for what it represents. In the past, discussions of whether women should discontinue their ADHD medication during pregnancy were cloaked in foreboding language, declaring it should only be done “if the potential benefits to the mother outweigh the potential risks to the fetus.” To me, it seems inevitable any woman faced with such tacit guilt-tripping would opt to go off her daily pill regimen — to, in short, prioritize the safety of her unborn child over her own well-being.

Also, this new knowledge has given me a newfound sense of legitimacy. While I’m an ardent feminist, I can’t deny that in Western society, motherhood is held up as the quintessential state of womanhood. So when years ago I found out having ADHD may mean I could not become a mother — at least, not if I wanted to continue to receive treatment for it — I felt like an essential part of myself was forcibly eroded. It was as though I was no longer a real, full-fledged woman because I probably wouldn’t be able to have a baby. And it wouldn’t be for a legitimate reason, like income or infertility; it would, like so many other things, be dictated by my need to take medication, to engage in preemptive damage control of my disability. In essence, it would have meant a disability I had from birth would prevent me from giving birth, myself. And when that dawned on me, one thought repeatedly ran through my mind: “It’s not fair.” 

I don’t know if I’ll ever end up having a baby. As I said in my earlier post, because of the strong likelihood my offspring would have ADHD as well, I would only want to bring a child of mine into this world if I knew it were a world more tolerant of ADHD than the one in which I grew up. Plus, I couldn’t handle single parenthood, and I don’t know what the future holds for me vis-à-vis finding a life partner. 

But with the publication of this study, for the first time in my life, I know if circumstances do align for me, I’ll be able to do what I’ve always wanted — become a mother — without stigma and without the overwhelming fear of putting my baby at risk in the process. 

That’s an invaluable gift. 

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The lie we need to stop telling women about ADHD

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Girls are less likely than boys to be diagnosed with attention-deficit hyperactivity disorder. The general consensus is this is because for boys this tends to manifest in hyperactivity, which is much more noticeable to parents and teachers than inattentiveness, the type of symptom most common in girls. Luckily, as awareness spreads (albeit sometimes at a seemingly glacial pace), more and more women are eventually finding out the distress they’ve dealt with for their whole lives has a neurological explanation, and it’s called ADHD.

The long-delayed moment of diagnosis is often held up as a new beginning for the diagnosed. But while being diagnosed may very well be the most significant event in an ADHDer’s life, it’s not the be-all, end-all everybody makes it out to be. No, ADHD diagnosis is a new beginning — just not of pure, wholesale relief forever after. Instead, it’s the beginning of a life of newfound clarity about enduring struggles, for enduring they indeed are: Even if she starts an ADHD treatment regimen, pharmacological or otherwise, post-diagnosis, the ADHD woman faces an uphill battle that will continue for the rest of her life.

Nobody ever seems to talk about the extreme fallibility of ADHD medications, at least those currently on the market. In truth, ADHD is often treatment-refractory or treatment-resistant, meaning an ADHD medication may only have potency in a given person for a limited period of time, if at all. Now, there are two primary classes of CNS stimulant medications: amphetamine, aka Adderall, and methylphenidate, aka Ritalin. Most people respond better to one type of stimulant than the other. But many people, for whatever reason, don’t get symptom relief from either.

Moreover, you can have the most positive response possible to a given medication, but still not experience complete ADHD symptom relief, even temporarily. Unfortunately, the neurotypical expect us ADHDers to perform at their neurotypical levels if we’ve been “lucky enough” to be diagnosed and treated. Promised patience tends to run dry.

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This is particularly unfortunate for women, who earn the censure of society for displaying ADHD symptoms that tend to be revered in men. For instance, a man who doesn’t follow directions is deemed an “out-of-the-box thinker,” while a woman gets a reputation for recklessness. And a man who speaks out of turn is viewed as assertive; a woman, lacking self-control.

On top of that, women are tacitly expected to assume and maintain responsibility not only for themselves but also their entire household, both in its upkeep and of its members. Many women discover their ADHD at some point during or after their child’s diagnostic process. The upshot is these women being responsible for a higher than average degree of care for children with ADHD when they, in fact, need to expend extra effort just to take care of themselves. 

Just to put it into perspective, for you, I’ve been aware of and received treatment for my ADHD since early childhood, yet even I have to strive every single day just to avoid falling behind. Getting ahead, excelling almost always feels like a pipe dream — this, despite the fact that I’m on the highest possible dosage of all of my medications; not to mention, I live with my parents, rent-free! 

All of this is to say, it’s time to infuse a little honesty into the adulthood-diagnosis narrative, especially for women. We need to stop leading these ADHDers to believe everything is going to be OK because frankly, it’s highly unlikely that will turn out to be 100 percent true. Again, this is in large part because of the tacit mandate to fulfill traditional gender roles. As Kathleen Nadeau, one of the foremost experts on women and ADHD, explains,

Society has a certain set of expectations we place on women and ADHD often makes them harder to accomplish. … They are supposed to be the organizer, planner, and primary parent at home. Women are expected to remember birthdays and anniversaries and do laundry and keep track of events. That is all hard for someone with ADHD.

Honesty, it seems to me, is what’s called for here — honesty and compassion. And in that vein, there’s also a great need to reconfigure the typical response to a newly diagnosed ADHD woman, which right now is something to the effect of, “Congratulations! You have ADHD. Good luck!”

In this day and age, that kind of MO is unrealistic, and as such, utterly unhelpful.

7 tried-and-true tricks for traveling with ADHD

ADHD profoundly affects many aspects of our day-to-day lives. Travel is no different. But luckily, after years and years, I’ve learned how to minimize the fallout of ADHD-induced, travel-related trials and tribulations. And with the holiday travel season drawing ever closer, I thought I’d share seven of my foolproof methods.

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1. Invest in a large suitcase.

Pro tip: As long as a suitcase weighs less than 50 pounds, you may check it like any other bag. So instead of trying to be someone you’re not and attempting to squeeze two weeks’ worth of luggage into one medium-sized suitcase, go big or stay home! And if you really want to ‘go the extra mile’ with your ADHD-proof luggage, choose a suitcase that’s indestructible, like this stylish pink one

2. Pack everything you’ll need — AND everything you MIGHT need.

We ADHDers have a reputation for being underprepared — a reputation that isn’t ENTIRELY unwarranted. That said, if you’re anything like me, you tend to overcompensate by overpacking — and then later, trying to thwart everyone’s judgment that you’re a pack rat, ending up underpacking. All things considered, I think it’s better to be overprepared than underprepared. Don’t you?

3. Do a packing dry run.

 As early as possible before the start of your vacation, gather all of the items you’ve decided on after reading tip #2 and try packing them in the suitcase purchased after reading tip #1. Granted, some things, like your toothbrush or your medications, can’t be packed until day-of. However, you can TEMPORARILY pack them, and you should; you need to verify that your luggage hasn’t exceeded that 50-pound weight limit. To do that, you first need to weigh yourself. Then, pick up your full suitcase and step on the bathroom scale again. Finally, subtract your weight from the weight of you and your luggage. After that, you can adjust your packing list accordingly. 

4. Spring for TSA Pre✓

As the Transportation Security Administration website boasts, with a five-year, $85 membership, “you can fly through security and don’t need to remove your shoes, laptops, liquids, belts and light jackets.” I know, I know: Not everyone can afford this. But if you CAN pay for this option, then by all means, for the love of all that is good and holy, DO.

5. Set up a mobile boarding pass in addition to printing one out.

It would surprise me very much if I were the only person with ADHD ever to misplace a printable boarding pass while en route to a flight gate. Those damn little pieces of paper are just WAITING for us to lose them! Phones, on the other hand, are much harder to lose track of, if for no other reason than that you can track them using GPS. Avail yourself of these technological innovations — you’ll be glad you did.

6. Pack your medications in your carry-on — NEVER a checked bag.

Inevitably, luggage sometimes gets lost; and it can be days before its owner reunites with it. If you make the mistake of packing your ADHD medications in the said checked bag, you could face multiple days sans pharmacological symptom control. Granted, my ADHD is particularly severe; nevertheless, I think I speak for all other ADHDers when I say having to go neurologically ‘au naturale’ for even a single day can be pretty much the worst thing imaginable. 

7. Treat yourself and pay for some Wi-Fi time — BEFORE the day of your flight.

When I was preparing to fly to Washington, D.C. to visit my boyfriend last month, I surprised myself by getting everything together ahead of time — or so I thought. On the day before my flight, I received an email trying to entice me into paying $16 for a day’s worth of in-flight Wi-Fi. I smugly chaffed at forking over so much money for web access when I had already downloaded four e-books on my iPad that could be read without an internet connection. Unfortunately, it wasn’t until I was on the plane and in the air that I remembered something: It’s impossible for me to concentrate on reading while flying due to the cacophonous sounds coming from every direction on the airplane. Suddenly, I was stuck in the sky for three-plus hours sans any entertainment. And as it turned out, Delta Airlines doubles its prices to for a full day of Wi-Fi once the day of the flight has arrived. In the end, I just bit the bullet and shelling out $6 for an hour online.

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That’s really the salient point: Something WILL go wrong, no matter how many fail-safes you’ve devised. The key is to expect it. And above all, you have to have a sense of humor about problems while peregrinating. Otherwise, your ADHD may keep you from enjoying yourself.

…Bon voyage!

7 things about ADHD I wish I had always known (ADHD Awareness Month post #6)

This is the sixth and final post in my series on ADHD Awareness Month. But rest assured, although the series is wrapping up, I’ll still be publishing writings on ADHD-related issues; just not necessarily so many per month. — DRD


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Having lived with ADHD for as long as I can remember — and even longer — I’ve learned a few valuable lessons about my disability the hard way; I’ve done my share of learning by doing. I can’t help but feel that my life would have been a lot easier if I had known said lessons from day one. I hope that someone out there reads this and they — or their child — can benefit from my experience. Read on!

1. People will tell you to go easy on yourself, but still, expect you to be ‘on.’

I’ve found that even if you tell your manager, for example, that you have ADHD, and he claims to understand that this makes you function differently, his understanding nevertheless flies out the window when you have a deadline to make but quite clearly aren’t going to be able to. 

2. ADHD has nothing to do with your personality or morality.

I spent a horrifying number of years of my life feeling guilty — often, despite not having done anything wrong. And even when I did err, I was convinced that whatever act of misbehaving I had committed was evidence that my character left something wanting. Moreover, I was sure that with the right resolve, I could ameliorate this situation and become a better (read: less ADHD) person. I don’t think I’ll ever stop regretting this now that I’ve realized how wrong I was back then. I’ll never get back the time I wasted feeling guilty for nonexistent or out-of-my-control incidences of ADHD-ness. Don’t make my mistake.

3. You shouldn’t necessarily believe teachers who say, “Oh, I’m so ADD too!”

I was diagnosed relatively young, back in pre-k; meaning that I knew I had ADHD — and all of my teachers knew it too — for all 12 years of my lower education. And I swear, every single year a new teacher would tell me upon learning of my ADHD diagnosis, “OH, that’s totally fine, I’m really ADD too.” Unfortunately, that usually turned out to mean, “I don’t understand ADHD at all, but I think I’ll bond with you by saying I have it and referring to it in the pejorative.” Over the years, I heard many teachers say a lot of stupid, cruel things without seeming even to give it a second thought, but that is not ADHD. There’s a difference between wanting to think before you act and not being able to, and just deciding that you’re so wise, you never need to think twice. In the end, only one of my teachers ever turned out to have ADHD, my AP World History teacher during my senior year of college. How did I know he had it, and that he was the only one of my teachers who did? One day I was sitting in his classroom at the end of lunch when he walked in, looked around his desk, and announced that he just realized he had lost a pair of Bruce Springsteen tickets. I’m totally serious. But you know what? He was also one of the best teachers I ever had. 

4. Medications may “last” 12 hours, but that doesn’t mean you will.

Here’s a fun (by which I mean, not fun at all) fact: Even if the prescribing information for an ADHD medication says it lasts up to 12 hours, that doesn’t mean you’ll be able to use all 12 of those hours effectively. You see, even when medicated, people with ADHD have to expend more energy to complete tasks that seem to take our neurotypical counterparts no time at all. Do that for a full workday, and the remaining man-made focus you have left in your nervous system via medication is reduced to the equivalent of potential energy,  never getting used. (This is a lesson I’ve started learning literally in the last few weeks.)

5. Stimulant medication isn’t the be-all, end-all. 

From ages 5 through 22, I was on some form of the stimulant medication methylphenidate (aka Ritalin). For over 5 years now, I’ve been taking both an immediate-release dosage and extended-release dosage of dexmethylphenidate (aka Focalin). I first went on Focalin because when I was a senior in college, I discovered, to my horror, that my medication did not seem to be working anymore. Like, at all. That’s when I went on Focalin. But just two years later, I again ceased to feel medicated enough on a day-to-day basis. It was then that my PCP put me on bupropion (aka Forfivo), which belongs to a class of antidepressants known as Norepinephrine and dopamine reuptake inhibitors. Later, I also started taking guanfacine (aka Intuniv), a non-stimulant ADHD medication initially formulated to treat hypertension. As it turned out, for me, at least, these Forfivo and Intuniv were the magic bullets of ADHD treatment regimens. 

6. Coffee is your friend.

During my ‘bad concentration’ time of the month, and especially toward the end of it, my verbal acuity temporarily goes out the window. Somehow, this always seemed to happen *right* when I had a big paper due imminently (like, in two days, or even sooner). One day, in desperation, I did some Hail-Mary googling, seeking confirmation that yes, in fact, coffee does help ADHD people concentrate. According to a post published recently on ADDitude, it “arouses the central nervous system by stimulating the release of dopamine and other neurotransmitters, and by blocking the absorption of adenosine, which induces sleep.” I’ve found that a Starbucks frappuccino with a shot of espresso enables me to write even when my medications are at their least potent. Pardon the pun, but I really do think you should give it a ‘shot!’

7. ADHD is nothing to be ashamed of. People should be ashamed to think it is.

…Self-explanatory!

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5 reasons to diagnose an ADHD girl when she’s young (ADHD Awareness Month post #6)

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I was diagnosed with attention-deficit hyperactivity disorder, better known as ADHD when I was 5. For 1994 — and even 2017 — this was unusual: Girls typically are diagnosed later in life than boys; tending to exhibit symptoms of inattentiveness, rather than hyperactivity, they fly under the radar of parents, teachers, and other adults in their lives. I, however, was one of those rare littlest females whose symptoms included inattentiveness and hyperactivity. Although this meant my ADHD was severe enough to send up a red flag, it also signified I would get the help I needed at a much younger age than many little girls do even today. And I can tell you from personal experience that the younger a child with severe ADHD is diagnosed, the better. But that’s not all. According to the Centers for Disease Control and Prevention (CDC), “About 2 million of the more than 6 million children with ADHD were diagnosed as young children aged 2–5 years,” however, “Children with more severe ADHD are more likely to be diagnosed early.” But I believe that girls with even milder forms of ADHD should be diagnosed earlier as well. Here’s why:

1. It may take a while to identify the right treatment regimen for her.

This is a passage from the CDC’s National Center on Birth Defects and Developmental Disabilities website:

For children 6 years of age and older, the American Academy of Pediatrics … recommends both behavior therapy and medication as good options, preferably both together. For young children (under 6 years of age) with ADHD, behavior therapy is recommended as the first line of treatment, before medication is tried. Good treatment plans will include close monitoring of whether and how much the treatment helps the child’s behavior, and making changes as needed along the way.

As you can see, there is a lot of wiggle room — whether or not you want it — in the creation of treatment regimens for little ones with ADHD. And it is much better to start this process early in a girl’s education. Ideally, in fact, it would be finalized (for the time being) even before first grade, so that, come the first day of school, she’ll be able to start her academic career on a level playing field. 

2. She needs time to figure out her limitations and how to work around them. 

Just because a girl finds a medication that works for her or has success in therapy doesn’t mean she’s limitation-free. As I’ve said in the past, ADHD medications aren’t 100 percent effective, and CNS stimulant medications last 12 hours at most. Even with modern medicine, the onus is on the ADHD girl to know what she’s capable of — or isn’t, as the case may be — and engage with life accordingly.

3. The earlier she is diagnosed, the earlier she qualifies for accommodations

This can include accommodations via an Individual Education Program (IEP), as well as informal academic accommodations requested by parents or even arranged with a teacher at the request of the girl herself (see below). For all their shortcomings vis-à-vis their response to my ADHD, most of my K-12 teachers were reasonable enough to agree to informal accommodations if I made an effort to propose them, and the few who didn’t, well, they eventually consented once my mom intervened (thanks, Mom)! But my experience was the exception, not the rule. The fact is, people are a lot more likely to be decent human beings and accommodate kids with ADHD if there’s a legal impetus for them to do so. 

4. She should have plenty of time to learn to self-advocate.

According to the CDC, an article published in the Journal of Attention Disorders found that “girls who had a number of symptoms when they were young were as likely as boys to continue to have those symptoms after they became teenagers.” Thus, ADHD can be a chronic (long-lasting) issue for all children, regardless of gender. This means an ADHD girl needs to know just what’s wrong with her (her neurology, not her character) so she can develop coping mechanisms and learn to adapt her life to her brain, such as by arranging informal accommodations with a teacher (see above).

5. She deserves, right from the start, to know she is not a bad person.

As I said, a problem with your neurology doesn’t indicate a problem with your character. In fact, if you find out that you have a mental disorder, in this case, ADHD, you’re also finding out that you haven’t actually been to blame for all the “bad” things you do or ways you behave. But this revelation only comes with the proper diagnosis. The reason this is particularly pivotal for girls, even more so than boys, is that in this world of misogyny and sexism, people whose gender is coded ‘female’ have enough to grapple with just by said gender. There is no need to compound those challenges with untreated neurological impairments; in fact, that must be avoided at all costs. 

Why I’m thankful that I have ADHD as a millennial (ADHD Awareness Month post #5)

For an ADHD blogger, you may have noticed my feelings about ADHD aren’t exactly of the warm-and-fuzzy variety. It’s true: I’m far from attention-deficit hyperactivity disorder’s biggest fan. It’s not that I believe this kink of the human nervous system is anything to be ashamed of; in fact, I’ve spent a great deal of my life attempting to convince people it’s not. It has just had too deleterious an effect on my life for me to join the ADHD-is-an-evolutionary-adaptation camp. If I had to be born with ADHD, though, I’m glad my birth year of 1989 classifies me as a member of Generation Y, aka the millennials. 

Technology 

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(Photo credit: Adobe Stock)

I honestly don’t know what I’d do without the internet and my various electronic devices. And I’m willing to hazard a guess that I’m far from the only ADHDer who feels this way. I first knew modern technology would be my ADHD-related salvation in middle school when my math teacher started posting homework assignments online — not just textbook page numbers but scanned copies of our worksheets we could print out if we didn’t make it home with the sheets distributed in class. There was something so liberating about being thwarted by my ADHD, as I inevitably was from time to time, but then being able to reverse the damage right from home, with no one else but my mom the wiser. Of course, not even 2002 Drew could have conceived how integrated the internet would end up being in my education, from googling for research on weekends in high school to emailing professors term papers late at night in college.

As I got older and technology more advanced, I found additional workarounds for my pesky ADHD problem in the form of various hi-tech devices. When I was 22, for example, I bought tickets to a concert in my hometown, but when the day of the show arrived, I realized I had left the printable tickets in my college apartment, a two-hour drive away. Suddenly, I remembered having received a confirmation email I could pull up on my iPhone, which I did, and was granted admission to the concert as a result.

Over the years, the combination of my iPhone and my MacBook Pro has been my saving grace; in a future post, I’ll explain exactly how. But trust me, we ADHD millennials have benefited immeasurably from the ‘i’ revolution.

Treatment

My gratitude for being born with my particular disability in my specific generation is also due in part to the fact that there are a variety of pharmacological treatment options available today. By my count, based on the most recent information on WebMD (last updated in April 2016), there are five short-acting CNS stimulant medications, 14 intermediate and long-acting stimulants, six nonstimulants, and seven antidepressants used in the treatment of attention-deficit hyperactivity disorder. That’s 32 in all. Now, granted, many of these medications are chemically the same drug, just prepared in different strengths and dosages. And I’ll be the first one to tell you it is essential for Big Pharma to prioritize developing entirely new medications for those whose ADHD is unresponsive to any drugs currently available.

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Nevertheless, this is a leaps-and-bounds improvement over the breadth of options (or rather, the lack thereof) on the market not very long ago. Between 1936, when the first ADHD medication, Benzedrine, was approved, and 1982, only six medications were developed and released on the market. And after that, there were no new ADHD drugs for another 14 years, when Adderall first hit the market in 1996. In other words, for almost half a century, a new ADHD medication only became available once every seven years or so. Subsequently, Concerta, an extended-release preparation of methylphenidate I took from ages 13 to 22, was released in 2000; Focalin, the stimulant I’m on now, hit the market in 2001; and the FDA didn’t approve the non-stimulant medication I take, Intuniv, until the year 2009. Imagine if I had been born just a decade earlier: I wouldn’t have had Concerta to get me through all of high school and college, Focalin to get me through my ’20s, or Intuniv to get me through grad school. And I definitely wouldn’t be able to write this post now!

Tolerance

But perhaps the no. 1 reason I’m glad I was born when I was is that in the 1990s, ADHD awareness spread like wildfire. It was unprecedented. There were conferences and self-help guides, not to mention the first issue of ADDitude! And things are only getting better. Gone are the days when jokes about parents putting their kids “on Ritalin when they just…won’t…behave!” were fodder for popular primetime comedies (*cough*”FRIENDS”*cough*). With every passing year, ADHD is shedding the stigma that surrounded it in the past and getting closer and closer to its rightful place in the public consciousness as just another fact of life. And if this is a trend, you know what the very best part about being a millennial with ADHD is? It means the next generation may live in a world that would never conceive of ADHD any other way.

What is it with ADHD people and time, anyway? (ADHD Awareness Month post #4)

You know that song “Time is on my side”? I’d bet you a million bucks whoever wrote it didn’t have ADHD. After all, people with attention-deficit hyperactivity disorder are often — OK, fine, usually — late. Recently, however, I’ve learned that there’s a neurological explanation for why I’ve had to send so many messages to my friends over the years containing some version of this text:15 mins lateApparently, we function on a different timetable. In other words, ADHD people experience time differently

In an article in ADDitude, ADHD specialist Ari Tuckman notes, “Because everyone — not just those with ADHD — feels the present more strongly, it’s difficult to do challenging things now that won’t have an immediate positive impact,” but even so, for people with ADHD, “It’s difficult … to plan for the future because they don’t see the future as clearly as their peers.”

Still, I don’t believe we ADHDers are entirely at fault here.

To feminist philosopher Alison Kafer, the concept of ‘being on time’ isn’t innate; instead, it’s something society has created. What if we ceased to place such a high value on punctuality, she muses — what if we stopped penalizing people for being late, and viewed such punishment as ableist?

Naturally, as someone with chronic ADHD, this intrigued me a lot. But my boyfriend, who is neurotypical, just could not wrap his mind around the idea that our social mores exist outside us, meaning that they could be changed to be more inclusive of people with disabilities (PWD). Now, he is a scientist; abstract thinking has never exactly been my boyfriend’s forte. And yet, in this case, I think it’s just impossible for neurotypical people, much as they may love us, to understand how far removed their world is from ours — or, for that matter, that their world isn’t the only world.

Punctuality can be a struggle for all PWD: a need for “extra time,” according to Kafer,

might result from a slower gait, a dependency on attendants (who might themselves be running late), malfunctioning equipment (from wheelchairs to hearing aids), a bus driver who refuses to stop for a disabled passenger, or an ableist encounter with a stranger that throws one off schedule.

ADHD people practically invented the concept of needing extra time. If you have ADHD, from the day of your diagnosis, you know that you and time will always be at odds. Think about it: The longest-acting CNS stimulant medication lasts 12 hours; but many people, from attorneys to high-school students, work far more hours a day than that — often well into the night. And even so-called regular people, who only work in a professional sense eight hours a day, are born with the ability to concentrate and be at least slightly productive the moment they get out of bed in the morning and only resting their brains after they get back in at night.

That’s not how it is for us ADHD people, though. The simple fact is that it’s impossible to have an average life if you have less than the average amount of time. And not having enough time, well, that’s ADHD 101.

When I was younger, I used to apologize anytime I was even the slightest bit tardy to an appointment or late on an assignment. Now, I’m trying something new. As I near my 28th birthday, I remind myself that life is short; the time in which we actively live, even more so; and for people like me, with only 12 hours of each day at our disposal, time is the most fleeting — and the most precious — thing of all.

I guess what I’m trying to say is that I would feel guilty at my lateness, but I just can’t seem to find the time.