I was always drowning. I couldn't breathe for so many years. I had to do the work alone; I had to fail and fight and lose to get to where I am, and I am so angry... It was a waste of my energy.
- Alison Foletta
Alison Foletta, 31, is an ACM journalist at the Wimmera Mail-Times in southwest Victoria.
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She asks: "What sort of person could I have been if I never had to fight so hard to breathe?"
I first met Alison during one of ACM's editorial training sessions for early-career journalists. She came across as intelligent, quick-witted and confident. It was not until later in the workshop I learnt Alison was fighting a silent battle; one I knew all too well.
For the last few years, Alison has suspected she has ADHD. All the signs were there.
"I always had a serious problem in university with mental paralysis, which is a huge sign of ADHD," she said. "I wanted to do something, I mostly knew how and yet I simply couldn't."
"I have failed more classes than I've passed at this stage, despite being a fairly intelligent person who is able to grasp concepts quickly."
Alison lists other symptoms of ADHD, such as overstimulation in supermarkets, sensitivity to criticism, difficulty regulating her emotions and hyper-focusing on tasks.
"Looking back, I was always deemed a brat as a child - temper tantrums, spoiled - but now I realise, it was all signs of ADHD," she said.
"I've held onto the label of a brat for so long, I can't look at my behaviour objectively. I just see a bad person, a failure or lazy."
Alison was diagnosed with anxiety when she was 21 but felt like the diagnosis wasn't complete.
The tools she gained from therapy weren't working and other people who had more severe anxiety seemed to manage everything better than she could.
A few years ago, she stumbled across some videos on social media about ADHD and mental health. She said watching these videos "perfectly summarised" her behaviour.
"I thought I was just a crappy adult who was lazy and a failure," Alison said. "But to think I had something like ADHD means I was just playing without a full deck."
What is ADHD?
Attention Deficit Hyperactivity Disorder (ADHD) is a complex neurodevelopmental disorder which affects the brain's executive functions, particularly its self-management system.
But ADHD is not a behavioural disorder or mental illness and is not a specific learning disability.
People with ADHD can be either inattentive, or hyperactive and impulsive, or a combination of the two.
Most people picture ADHD as hyperactivity, like the Bart Simpson cartoon character. This type of ADHD is easier to recognise and more often diagnosed in children and men.
People who have the inattentive type tend to be forgetful, have trouble staying focused, find it difficult to follow detailed instructions, often misplace possessions, are easily distracted, and can seem like daydreamers.
Inattentive ADHD is more frequently diagnosed in adults and more common in girls and women. This is part of the problem.
Symptoms of the inattentive type of ADHD are often internalised and, therefore, more subtle and difficult to detect. It is largely misdiagnosed and can often be mistaken by medical professionals as a mood disorder, anxiety, or depression.
Without the correct diagnosis or treatment, women are likely to face significantly worse mental health conditions, suffer emotional dysregulation and develop self-esteem issues, internalising their ADHD symptoms and blaming themselves for their 'faults'.
These women grow up with labels such as lazy, dumb, spacey, sensitive, selfish or, as in Alison's experience, "a brat".
For Alison, growing up without the knowledge of how ADHD presents in women and the right tools to cope with it was "like fighting with one hand behind your back and a banana peel taped to your left foot".
"There is no information or discussion about this. Young girls and women are ignored almost completely in this area," she said.
Under the radar: the ADHD gender bias
It is estimated ADHD affects about 800,000 Australians.
Although according to the Under the Radar Report by ADHD Australia, there continues to be a lack of education and understanding around the condition.
ADHD is also the most common psychological disorder among Australian youth. The second Australian Child and Adolescent Survey of Mental Health and Wellbeing, reported 7.4 per cent of 4-17-year-olds had ADHD over the previous 12 months.
The report's findings indicate more than twice as many boys have ADHD than girls.
But ADHD is not gender-biassed, with more recent research suggesting the number of women with the condition may be nearly equal to that of men.
ADHD in girls and women is a largely neglected area of research and boys continue to be referred for clinical diagnosis more frequently than girls.
Researchers believe outdated diagnostic criteria, a referral bias favouring males and ingrained stereotypes are factors which contribute to the lower ADHD diagnosis rates in women and girls.
Psychiatrist and psychologist Dr Ulrich Schall has spent his career studying young people's mental health and is now an honorary professor of psychiatry at the University of Newcastle.
Dr Schall said not only are there differences in how ADHD symptoms present over time, but girls are often more difficult to diagnose.
"They are often misdiagnosed as 'emotional' or 'behaviourally challenging'," he said.
Dr Schall said that even though society's mental health literacy has improved and we're more open to talk about mental health, the stigma is still there.
"More public awareness of the most common symptoms would certainly help," he said. "As a mental health researcher, I would love to see more research and particularly funding to enable this research."
"We're still at the very beginning of our understanding of what does not work well in our brains when we have something like ADHD. Simply saying that we have an effective treatment is not enough."
How does ADHD affect the brain?
Current research suggests there is a link between ADHD and an insufficiency or impairment in the distribution of the neurotransmitter dopamine.
Dopamine is a chemical messenger which plays a critical role in regulating the brain's reward system and emotions. Dopamine levels can affect an individual's motivation, attention, mood, as well as the ability to organise and follow through with daily tasks.
Dr Schall said people with milder forms of ADHD often respond well to occupational therapy and changing the way of learning in school. However, he said this should be trialled first and if symptoms persist, then medication should be considered.
"Dexamphetamine is the oldest known medication of ADHD. It increases dopamine levels in the brain which supports working memory function," he said.
Dr Schall said people with ADHD quickly notice the benefits when starting on these medications; they can concentrate and get their work done.
Undiagnosed and untreated ADHD can be devastating; it can affect all aspects of life, from your education to your career and relationships.
"They struggle to perform well in school and their behaviour is often judged as 'naughty' and 'challenging'," Dr Schall said.
"They are easily seen as 'dumb' although ADHD is not affecting their intellectual ability other than perhaps limiting working memory."
Grieving her 20s
"I failed my 20s. People get jobs, people travel, they save," Alison said.
"I struggled so much ... I wasted so much time thinking I just wasn't enough."
Looking back on those years, Alison wishes she knew more about her own behaviour and how ADHD can present itself in young women.
"I knew nothing about it. I only had the Bart Simpson stereotype of a young boy who has too much energy," she said.
But Alison is not alone, and it's not just women who are falling through the cracks.
Like Alison, Tom Melville said he didn't know anything about ADHD growing up and was not diagnosed until later in life.
"My friend is a speech pathologist who mentioned in passing one evening at the pub that I have a bunch of hallmarks of someone with ADHD," he said. "It made sense to me, I have to say."
Tom, 29, is an audio journalist for ACM, based in Canberra. He lists numerous signs of ADHD, such as difficulty focusing, forgetfulness, and losing things.
"Paying attention in class was almost impossible," he said. "And I think that probably impacted people around me at school.
"I think it still impacts work colleagues to this day."
Tom said looking back he could have "focused better, gotten better grades or been a less frustrating student", but wouldn't change a thing.
"I suppose it's nice to have something to blame, but I've never felt different as if mine is a personality which needs to be managed," he said.
The double-edged sword of ADHD
When Tom was first diagnosed, he went looking for more information online and said the main attitude he found was one of "this is a problem that needs to be managed".
"I know I'm lucky in a lot of ways and everyone experiences things differently, but that is not my experience," Tom said.
Tom describes ADHD as his "superpower" and something we should all celebrate.
"I would hate to think that there are parts of me - crucial, fundamental parts of me - that I couldn't be proud of," he said.
An article by ADHD Support Australia, which highlights the positive aspects of ADHD, emphasised it's not necessarily the traits of ADHD that make it difficult to live with but rather when the condition goes untreated or undiagnosed.
The article lists many positive traits found in successful adults with ADHD such as cognitive dynamism, courage, resilience, integrity, humanity and abundant energy.
On top of this, people with ADHD are often highly creative, curious, spontaneous, and socially and emotionally intelligent.
"We can get stuff done, we can be really good in an emergency, we don't put pressure on other people," Alison said. "We can be intense but we love hard; we're loyal."
And this is the double-edged sword of ADHD: it can be your greatest asset with the correct tools and information, but if left untreated and undiagnosed, ADHD can be debilitating and makes you feel as though you're "drowning".
This story is the second part of a series on ADHD. I was diagnosed with ADHD in early 2021 aged 23. But I wish I'd known sooner. Lingering stereotypes and negative stigmas associated with ADHD can be damaging, isolating and misleading. I hope I have helped start a conversation about ADHD, foster understanding and awareness, and allow others to share their experiences without fear or judgement.