It seems fair to consider reconceptualising neurodevelopmental disorders to a more acceptable term, such as neurodiversity
Recently, I was asked to see Bobby, a 40-year-old New Zealand European. Bobby has experienced mental health problems most of her life, including chronic low mood with frequent relapses into depression, significant anxiety, low motivation and difficulty initiating sleep. In her past, she had engaged in self-harm and been referred to a local dialectical behaviour therapy programme.
When I saw her, she was developing a significant alcohol problem, which helped her relax, manage her anxiety and initiate sleep. She struggled with ongoing chronic low mood, generalised anxiety and a lack of fulfilment as she thought she had not lived up to her potential. This dissatisfaction was striking, despite Bobby being very successful in some aspects of her life.
As a 15-year-old, she was in a New Zealand women’s team in a major sport. After secondary school, she attended a small college in the US on an athletics scholarship, after turning down a scholarship at a major Division I college. She is now a talented musician interested in mixing and producing records for other New Zealand artists.
Bobby had turned down the Division I scholarship because she was concerned about the academic requirements. Throughout her schooling, she struggled to interpret written passages and express herself in writing, and grappled with anything more than basic addition and subtraction. She carried the shame of this all her life, believing she simply wasn’t very intelligent.
However, her spoken communication indicated otherwise – she exhibited a wide lexicon, expressed herself well, and appeared intelligent and perceptive. She had progressed through school, partly due to her sporting success, and partly because she was quick-witted enough to cover her learning shortcomings.
While on scholarship, she experienced significant emotional problems relating to her inability to manage her social environment, resulting in an admission to a psychiatric unit. Upon return to New Zealand, she saw several psychiatrists in public and private practice, who tried, with mixed success, to manage her depression and anxiety. She continued to have to handle her social situation carefully, finding a recent sixweek music tour emotionally taxing because she was in constant close contact with others.
My opinion was that Bobby had attention-deficit/hyperactivity disorder (ADHD), on the basis that she appeared neurodevelopmentally abnormal, with strengths such as her prodigious sporting and musical talent, and clear weaknesses with everyday skills that most of us take for granted.
The contrast between her verbal and written communication was striking, and it was clear she had dyslexia and dyscalculia. She found it difficult organising herself to undertake complex tasks, often procrastinating and delaying the tasks she knew were going to present challenges.
She described her anxiety as being related to her “overthinking”, and her mood problems appeared consistent with chronic dysthymia combined with mood lability and frustration tolerance difficulties. She reported that her thoughts were fast and bounced between topics, despite attempts to keep them focused.
A stimulant trial combined with sleep support with melatonin was immediately successful. Bobby reported less anxiety and overthinking, improved motivation and a much more organised working environment. She has started to pursue musical projects as she is better able to manage her anxious thoughts. We are working on her medication regimen, and, once stable, her GP can prescribe and monitor this.