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understanding neurodivergence and mental illness

What is ADHD and how do you know if you have it?

ADHD, or Attention-Deficit/Hyperactivity Disorder is both underdiagnosed and frequently misunderstood. It is a neurodevelopmental disorder that is characterized by persistent and disruptive inattention, hyperactivity, and/or impulsivity. Symptoms are often different for children and adults, and can be different for those socialized as female versus those socialized as male.

Traits observed in people with ADHD include:

Inability to follow through and complete tasks

Restlessness and fidgeting

Excessive talking

Tendency to interrupt others

Difficulty waiting one’s turn

Impulsive behaviors (e.g., spending, eating)

Forgetfulness

Frequently losing things

Avoidance of tasks, especially boring ones

Difficulty with organization

Trouble getting started with tasks

Difficulty paying attention to conversations

Getting lost in one’s thoughts

Anxiety, overwhelm, and low self-worth

Hyperfocus on certain tasks

Many individuals with ADHD, especially those who weren’t diagnosed in childhood, develop coping mechanisms and strategies to address these challenges without even realizing it. Many of us don’t realize how much more challenging these things are in comparison to people without ADHD—leading to or increasing feelings of self-blame.

It is common for us to internalize the messages we receive from the society around us, which tell us we’re lazy, unmotivated, unreliable, loud, annoying, selfish, or even stupid, that we don’t have a good work ethic or don’t put enough effort into tasks. For many of us, our self-worth suffers.

It may be difficult to develop and maintain personal relationships, especially with those who don’t understand ADHD. Many of us become chronically anxious, and/or become perfectionists and overachievers specifically to address these perceived shortcomings.

Take the World Health Organization’s self-assessment if you’re curious—just know that it is neither a diagnosis nor will it tell you definitively that you do not have ADHD.

What is anxiety and how do you know if you have it?

As an emotion, anxiety is a completely normal feeling that probably developed to help early humans perceive and respond to threats. When anxiety is persistent or excessive and interferes with a person’s daily life, it may indicate an anxiety disorder.

Some common symptoms of anxiety disorders are:

excessive worry

worry about many different things

inability to relax

difficulty concentrating

difficulty sleeping

intrusive thoughts

physical symptoms, such as increased heart rate

sweating

tension

headaches

digestive challenges

Take Mental Health America’s anxiety self-assessment here.

What is depression and how do you know if you have it?

Depression is characterized by persistent or excessive feelings of sadness or emptiness, low energy, and lack of pleasure in activities that you normally enjoy.

Feeling depressed occasionally is completely normal, but people with depressive disorders struggle with many of the following symptoms on a regular or cyclical basis:

difficulty falling or staying asleep

sleeping excessively

difficulty getting out of bed in the morning

feelings of hopelessness, emptiness, or numbness

avoidance of social or leisure activities

impaired cognitive function

feelings of guilt or worthlessness

suicidal ideation

Take Mental Health America’s depression self-assessment here.

Bonus: ADHD, anxiety, and depression can work together to make things even more of a challenge

You may have noticed that both the inability to concentrate and challenges with energy level appear in multiple places above. There is a substantial overlap in symptoms, which can make diagnosis difficult, and disorders commonly present together—this is called comorbidity. Going undiagnosed with a neurodevelopmental disorder like ADHD for a long time can also give rise to anxiety and depression.

Often, a doctor will recommend treating for one condition first, to see if that addresses all of the issues present.

Speaking personally, it had never occurred to me I might have ADHD—after all, I was very successful academically. I thought my other symptoms were just quirks of my personality. But something strange happened: When I began taking antidepressants and my depression and anxiety lifted, I discovered that I began having more trouble with other things, such as managing my time and feeling overwhelmed.

I now believe the anxiety I lived with on a daily basis was, in part, a coping mechanism that essentially forced me to manage my life as well as I could—which, to be frank, wasn’t always that well! Once I had my depression and anxiety partly under control, my ADHD symptoms really became noticeable—so noticeable that I recognized them for what they were over the course of a year, and was able to pursue diagnosis.

It might be difficult or impossible to know what is causing a specific challenge in your life. For that reason, I prefer not to talk about strategies for disorders, but rather to address a specific symptom or challenge. It doesn’t always matter why it’s happening—it may feel more important to find a strategy that helps you deal with it.

How can I get help with mental health challenges?

If you would like to pursue diagnosis and/or treatment, there are options. Which you choose depends on what you need and your personal circumstances.

If you are currently in crisis:

Call a crisis hotline:

National Crisis (Suicide) Hotline:

Call 988, or 800-273-TALK (8255)

For TTY Users:

Use your preferred relay service or dial 711 then 988.

National Helpline in 240+ languages: If you are feeling depressed, lonely, or just need to talk, you can call Samaritans’ 24/7 Helpline at 877-870-4673 and speak to a trained counselor in your preferred language

Trevor Project Lifeline (LGBTQ+ support): 866-488-7386

Strong Hearts Native Helpline: 844-7NATIVE (844-762-8483)

Trans Lifeline: 877-565-8860

ZA’AKAH Shabbos & Yom Tov Peer Support Hotline: 1-888-4-ZAAKAH (492-2524)

Text a crisis chat:

National Crisis (Suicide) Hotline:

Text 988, or 800-273-TALK (8255)

Trevor Project Lifeline (for LGBTQ+ support): Text 678–678

Crisis Text Line: Text HOME to 741741

Veterans Crisis Line: Text 838255

ZA’AKAH Shabbos & Yom Tov Peer Support Hotline:

Text 888-4-ZAAKAH (492-2524) on WhatsApp

For children and teens:

Childhelp: a child abuse hotline for children, teens, and adults in 170 languages—Call 800-4A-CHILD (422-4453) or Text 800-422-4453 or chat online

Teen Line: Call 800-852-8336 (6 to 10 PM PST) or Text TEEN to 839863 (6 to 9 PM PST)

Youth Line: teen-to-teen peer crisis support—Call 877-968-8491 (Teens available 4 to 10 PM PST, adults available any other time) or Text teen2teen at 839863

Need2Talk: Text talk to 38255, 24/7

National Runaway Safeline—Call 1-800-RUNAWAY (1-800-786-2929) or chat online

For survivors of domestic or sexual violence:

National Domestic Violence Hotline: 800-799-SAFE (7233)

National Sexual Assault Hotline: 800-656-HOPE (4673)

RAINN Online Chat Hotline

National Chat Helpline for Male Survivors

DoD Safe Helpline (for members of the U.S. military and their families): 877-995-5247 or Online Chat Helpline

Some local resources may also be available to you. Try an online search for your location plus any of the below resources.

Mental Health Crisis Team

A mental health crisis team is a community-based, in-person support system designed to assist people experiencing a behavioral, mental health, or substance-related crisis. The idea behind these teams is to de-escalate and provide resources and crisis help without involving police or emergency services.

Crisis Stabilization Unit

A crisis stabilization unit provides outpatient support and resources via a team of doctors, nurses, mental health workers, and clinicians. This is a center you would physically go to for assessment, care, and referrals to outside resources.

Mental Health Urgent Care Clinic

If a crisis stabilization unit is like a psychiatric emergency room, mental health urgent care clinics are analogous to physical urgent care centers, which may not be attached to a hospital. Services at an urgent care may vary, but might include psychiatric evaluation, medication prescription, and referrals to outside resources.

Emergency Room

If you don’t have other available resources, you can try going to your local emergency room. In fact, if you feel that you or your loved ones are in danger, you absolutely should go to the emergency room. The care you will be able to access at an emergency room will vary by location—a friend recently told me that they went to an emergency room and were discharged without any help or referrals, but online resources say that an emergency room can and should be a resource. You may be seen by a psychiatrist or other mental health professional and may be admitted or referred to another hospital or resource.

If you are not in crisis, and have health insurance

Visiting your primary care doctor is a good place to start. They can usually offer referrals to mental health resources within your medical group or mental health professionals with whom they have connections.

If you are not in crisis, and don’t have insurance

If you are struggling and don’t have health insurance, know that I’ve been there. It’s extremely difficult to access mental healthcare for many of us—especially if you’re short on funds. There are still resources, but they may require more work, more time, or more waiting to access.

If you can afford to pay out of pocket for individual assessments or ongoing care:

Whether you can afford to pay, of course, depends greatly on the cost of services. Unfortunately, my experience has been that many practitioners—public and private—don’t post costs for their services online and may not be willing or able to disclose costs over the phone. But if money is not a problem for you, you do have more options.

Telemedicine

In my experience, this was the most accessible and least expensive option for accessing basic mental health care. They are not allowed to practice in every state, but this is how I got my depression and anxiety addressed when I was in crisis and didn’t feel that I could drive more than two hours to get to a mental health urgent care center.

I used Brightside, which offered diagnosis, prescription, and medication management for a monthly fee. I was able to see a psychiatrist and start antidepressants within a week. Brightside’s medication management service cost, at the time, $95 per month, plus the cost of medication (about $15 per month additional, fulfilled and mailed to me.

Private Practitioner

If you are able to pay out of pocket, you may be able to get an appointment with a psychiatrist directly for diagnosis and medication management. I looked into this option, but frankly it was overwhelming without a referral.

A common challenge for folks wanting to make an appointment directly with a psychiatrist is that many are not accepting new patients at all, and those that are often have long waiting times for open appointments. So if you are in active crisis, I don’t recommend this method without a referral in hand.

If you don’t think you will need medication or aren’t ready to pursue that yet, you can also look for an appropriate psychologist or counselor to begin talk therapy or any of a number of therapy modalities. I don’t know much about either of these, but you could also look into occupational and/or behavioral therapy depending on your particular challenges.

If you cannot afford to pay out of pocket:

If you’re low income and in need of diagnosis, treatment, or support, you do still have options.

Community Clinics

Your area should have public or community health clinics, and hopefully one or more of them will offer mental health support. In my area, the county health services required a referral from (and therefore a preliminary exam by) a primary care practitioner first. When I went in for my initial exam, I was not offered a mental health referral and was not in a spot where I was adequately able to advocate for myself and ask for it. Be prepared to ask for what you need—or bring someone who can.

Local Nonprofit Organizations

Your area may have non-government-operated mental health nonprofits that offer free or low-cost mental health services.

Local University Clinics

Some universities have counseling clinics open to the public, staffed by graduate students, available for low or no cost. Most likely these clinics would not be able to offer diagnoses or prescribe medications, but see what is available in your area.

Private Practitioners with Sliding Scales

Some individual psychiatrists, psychologists, counselors, or counseling and medical centers offer a sliding scale for low-income individuals. This option will likely take the most research, but can yield some solid results. One option is to research a low-cost therapy network or collective, such as Open Path Collective, which connects low-income individuals with therapists willing to offer reduced-cost sessions.

Rely on friends and family, if you can

When I was severely depressed, I was unable to drive. Luckily, my spouse was supportive and had a flexible workplace willing to let him take me where I needed to go. It can be difficult to reach out, but please do ask friends or relatives if they can help—with research, phone calls, rides, or just company. It may be helpful to have someone who can help you advocate for yourself, as sometimes it is a challenge to get exactly the help you need and you may not have enough energy, motivation, or cognitive function to do your best job.

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if you take just one thing away from this book

It’s not a strategy at all. Not a tip or a trick or anything like that. Because no single tip will meaningfully improve every aspect of your life, but this will: learning to treat yourself the way you deserve to be treated.

Patience: This can be a challenge, especially for those of us with ADHD, as we often struggle with impatience. I know for myself, when I make a decision I often want it done that minute. And when I come up with a realization about myself or a plan for how to improve, I want to see progress right away. But that’s not realistic. Sometimes you’ll fail or regress, even when you’ve been doing well. Sometimes it’s sudden. Sometimes your depressive episode will last longer than you expect. Be patient with yourself. You’re doing the best that you can.

Acceptance: You could also use acknowledgment here. Basically it means simply accepting your feelings, your needs, your challenges—yourself. Recognize that these things are true for you, even if only in that moment. Don’t look away nor deny it, and don’t make excuses. Simply accept that you are the way you are, and you feel the way you feel.

Non-judgment: Non-judgment means not attaching a negative label (or, sometimes, a positive one) to a feeling or action. It’s not just saying I feel sad right now, but also not criticizing yourself for whatever you’re feeling. Approach your thoughts and feelings with kindness and understanding. You don’t have to see them as positive, but remind yourself that there’s nothing wrong with you for the way you feel. You’re not bad because you have feelings. Feelings merely exist.

Gentleness: Being gentle with yourself, in my view, takes all of this a step further. It’s not just