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“I’ve been married twenty five years, have three great kids, and had a decent career as a journalist, but I just got fired because I couldn’t prioritise and keep up with my work.”

This scenario is very typical for an ADHD who is not yet diagnosed. Sarah had never been fired before. After completing college, she took a job as a staff writer for a weekly newspaper, where her output of news and feature stories won her recognition as a talented and productive journalist. This continued for almost ten years until her husband was transferred to an executive position in another state. Shortly after they moved, Sarah became pregnant with the first of their two children and chose to remain at home to be a full-time mother, a task she truly enjoyed.

Over the next twenty years, Sarah nurtured her children and was active as a leader in church and community activities. After their yonger child graduated from high school, Sarah decided to return to working full-time so that she could help cover the cost of the two college tuitions. Soon she was hired as a writer for a weekly newspaper.

Sarah was enthusiastic about resuming work as a journalist, but returning after a hiatus of twenty years, she found the work much more difficult than her previous job on the daily paper. Frequent phone calls disrupted her concentration repeatedly throughout the day, and she had a lot of trouble prioritising task and using her time efficiently. Often her assignments were not ready in time for deadlines; this brought harsh criticism from her editor. Feeling frustrated and humiliated, Sarah began to experience migraine headaches. At the start of her third month on the job, she quit, saying that despite the emotional support of her family, she simply couldn’t bear the stress she felt on this job.

Sarah was afraid she would run into similar problems in any position as a journalist, so she decided to enroll in the local comunity college, where she began courses to qualify herself as a paralegal. Her writing skills and long hours of work yielded high grades that developed into a GPA of 4.0 . Soon after passing the licensing exam, Sarah was hired to work as a paralegal in the practice of an attorney in a neighboring town. Although she had done well in her community college courses, Sarah felt swamped and increasingly anxious as she struggled to keep up with the multiple demands of her new job. She was making many errors, each one escalating her anxiety and her fear of making further mistakes. The attorney for whom she was working complained bitterly of Sarah’s lack of time management skills and her failure to complete tasks within the allocated time. After three months, he fired Sarah, telling her that she was too forgetful, too disorganised, and too slow to work in a busy office as a paralegal. Two weeks later, she came to my ADHD coaching office for an initial consultation.

At the outset of our consultation, Sarah reported that she had scarcely slept the night before because she was intensely worried about the possible outcomes of our session. “I’m hoping you will find that I have ADHD, because if that’s not it, then I probably have early-onset Alzheimer’s. And that would be terrifying!”

As she told the story of her efforts to return to the workforce, Sarah emphasized the embarrassment and shame she felt in not being able to do work that she had considered much less challenging than tasks she had done quite successfully twenty years earlier. “It takes me so long to get started on tasks, and I get distracted and sidetracked at every step. I feel I’m constantly fighting brush fires, fighting to get one controlled and then discovering that two or three others are now flaring up. I can’t keep priorities in mind, and often I totally forget what the boss has asked me to do if I don’t write it down right away. I’m not that old; and my memory is a siever!”

As Sarah described her current situation, it certainly did not sound as though she was in a state of general decline. She reported good health and appeared quite lively and energetic, she spoke of her planting and maintaining a huge vegetable and flower garden every year. She told me about her running several miles two or three times a week, reading voraciously, and enjoying getting together often with a group of good friends. She noted that her enthusiasm for these activities had been dropping considerably over the past couple of years, but she was still pushing herself to keep up most of what she had always done, even though she had been feeling increasingly depressed.

Doctor’s evaluation:

To learn whether Sarah had struggled with symptoms of ADHD earlier in her life, I asked about her experiences in school. She reported that she had done well in high school, carrying a B average and successfully completing several advanced placement courses. Following high school, she entered a competitive liberal arts college, planning to prepare for medical school. After struggling with several math and science courses, she decided to follow instead her strong interest in reading and writing. She gained recognition for her contributions to the campus newspaper and literateur magazine. This paved the way for her working in journalism after she completed her degree.

When I, doctor evaluated her with questions about her current functioning, I found that Sarah clearly was suffering from severe impairments of those executive functions – usually impaired in ADHD like the following:

She complained of much difficulty in getting herself started on tasks until they were becoming an emergency.

She found it virtually impossible to focus for long on any task that was not realy interesting to her.

She felt unable to prioritise tasks, often spending excessive time on unimportant tasks while avoiding more urgent responsibilities.

She often got stuck on one task, unable to set it aside and move on to something else that required her attention.

Often she had difficulty sustaing her effort for tasks that could not be completed quickly.

She reported that her memory for somethings from long ago was surprisingly strong. Yet her ability to keep things in mind moment to moment was frustratingly poor.

She also reported that over the past couple of years, she had often found herself unable to recall names of people she knew well or a word she needed to express a particular thought.

After taking this history, the doctor proceeded with diagnostic materials before Sarah finally could be officially diagnosed with ADHD.

Emotions, and struggles with and between various emotions, play a central role in the daily life of all children, adolescents, and adults. Emotions guide what we notice and what we ignore, what we focus on intently and what we carefully avoid. Conflicting emotions can cause us to disrupt engagement with a task we want to accomplish, or lead us repeatedly to do what we consciously intend never to do again. In many ways – sometimes recognized, sometimes not, subtly and powerfully- we are pushed and pulled by our emotions. Yet we also exercise some control over them: we try to distract ourselves from uncomfortable emotions; we choose how much we want our emotions to show in our words or actions, we talk to ourselves to try to tone down or jack up how noticeable our emotions are to others and to ourselves. We manage and are managed by the complexity of our emotions.

As an ADHD coach, I have seen that emotional struggles play an especially large role in the daily life of people with attention deficit disorder. The same chronic impairments that interfere with other aspects of their cognitive functioning also tend to interfere with their ability to manage and be adequately guided by their emotions. People with ADHD often suffer chronic difficulties in responding to and sustaining emotions that motivate them for important tasks.

Most people with ADHD experience the same frustrations, fears, sadness, pride, shame, excitement, and so on that spontaneously arise in everyone else in various situations. What is different is the chronic difficulty most people with this disorder experience in managing and responding to their emotions, particularly in the many situations where emotions are mixed and conflicting – being very smart does not prevent a person from struggling with these emotional problems, nor does it prevent having ADHD.

Today, we know that emotions are linked to the brain. Often people think of emotions as distinct from the brain, as being “from the heart” or “in the gut

The difficulties that people with ADHD have with emotions are similar to the problems they often have in prioritizing tasks, shifting focus, and utilizing working memory. While cleaning a room, they may get interested in some photos they pick up, soon becoming completely diverted from the job they had begun. While searching for some specific information online, they may notice a web page that draws them off the search they started and into a protracted investigation of something totally unrelated, derailing their original task. They may abandon a task that they find boring, overlooking the fact that adequate and timely completion of this task is essential to gaining something they really want, and that failure to complete the task will inevitably bite them with a painful payback.

People with ADHD report that momentary emotion often gobbles up all the space in their head, as a computer virus can gobble up all the space on a hard drive, crowding out other important feelings and thoughts.

In a similar way, many people with ADHD tend to get quickly flooded with frustration, enthusiasm, anger, affection, worry, boredom, discouragement, or other emotions, not keeping in mind and responding to related emotions also important to them. They may vent their momentary anger on a friend or family member with a hurtful intensity that does not take into account that this is a person whom they love and do not want to hurt. People with ADHD report that momentary emotions often gobble up all the space in their heads, as a computer virus can gobble up all the space on a hard drive, crowding out other important feelings and thoughts.