Something we're also extremely excited about is how the conference is continuing to expand. We've got more charities involved. And for the first year ever, ADHD Ireland are involved. And we've looked at all the work they've been doing in Ireland and actually they've already generously shared some of their research which we've been using in our media very recently. And has been significant. We're very excited. So without further ado, let me bring in Ken Kilbride, who is the boss of ADHD Ireland. Hello. Oh, and also quiet. And look, it's not it's not one of these sessions if you don't get to say that someone's on mute or has problems with their microphone. Because we can't hear you right now, Ken. It's not that bad. Oh.

Dear. And he's doing a good job. He's put his ADHD Ireland behind him, showing off off the branding. I'd say that the research that they shared with us, is very significant, and I'll let... Him off for a second. We are... This we don't shy away in the conference in talking around some of the tough issues. ADHD UK itself has funded some research on ADHD and suicide. And this evening you'll be hearing from the author of that. It's important research. It's around the core of it. It's like, we know that ADHD and suicide is unfortunately, well, Irish research showed that, well, showed that twenty percent of people with ADHD at some point try and take their own life. And sixty one percent.

Had struggled with suicidal ideation and left just nineteen percent unaffected. And they also looked at self harm and found over fifty percent of people had self harmed with an average start age of just 15. And so when we're going out talking to people about the challenge of ADHD and why there should be more support and we shouldn't have to wait in that way, it's because we're trying to avoid those outcomes. And sharing research from different charities across the world and ADHD Ireland did that with HSE, which is the equivalent of the NHS in Ireland. And it's very important. And we still struggle with not having enough research around ADHD so we can point to these issues. But it shows the sort of collaboration and how important it is.

And this evening you'll hear answering one of the big questions which is like, what's the difference between someone with ADHD who's struggling and someone with ADHD who's suicidal? And what can we do to make a difference for them? And so it's an important section, but tough. See. Alright. I'm gonna bring Ken back. I I think... Let's see how we're going. Ken has just changed his microphones? Ken's microphones are excellent.

Good. Yeah. I'm not going have a big one here beside me that I didn't have on a second ago. So I do. I have technical. I have a backup microphone over there. I have backup camera over there. Like, yeah.

Well done. Good. Yeah. It's good to have the backup. It's important. Right. Oh, Ken, do want to introduce yourself? Tell people a little bit about you? Like, one... The floor is yours, Ken. I'm handing over to you. This is a a collaboration.

Of charity, so we do generally hand over the floor. So No. Actually, thank you very much for that. And, just forgive me. But in terms of just thinking about this and, you know, the confidence that's been going on for the last number of years, jealousy is one of the motives that we, have ourselves. We looked at the first iteration of this conference and went, that's really, really good. Perhaps we should get involved in that. And so, again, you know, when we finally got around to sending an email off to Henry and Neil, So we're really, really very happy that they've taken the opportunity.

To get... Let us come on board today, and run a session here for an hour. And so, again, just to then say about ourselves, we're ADHD Ireland. We're, like most of the organizations involved in this, we are a charity. Our mission is simply to make life better for people with ADHD. Henry did mention we're funded primarily through the, the HSE, which is the... Our equivalent of the NHS. And so we we now got about fifteen, twenty staff depending on how you count people. And, again, we run about 600 events every year. And we've developed something called UMAP, which is one of the the big game changers we would see for adults with ADHD. So UWAP is the understanding of managing adult ADHD program.

So this is an online self management course for adults with ADHD. I'd like everything that we do, and you don't need an assessment. You don't necessarily need a diagnosis to get involved in it. And so, again, that's been running very, very successfully. And we have an app. You can go on your phone. It's iPhone, Android. And we've had about 50,000 downloads of its... 50,000 downloads. So, again, lot happening. Again, lot more to do. And so, again, what I'm probably here to do is just maybe just a little bit about ADHD. I don't want go on too much on that, to be honest. But, again, what I'm really here today is is to introduce, doctor Michele Hill. And so Michele Hill is a consultant psychiatrist.

With expertise in adult ADHD, youth mental health, and psychodynamic psychotherapy. And and Michele has held senior clinical leadership roles, including Massachusetts General Hospital, UCC Cork, and and the HSE. And she's established the adult ADHD service in Cork, which is... And is now the clinical lead for ADHD Ireland, the integrated care pathway with the HSE national clinical program, which aims to improve access to assessment and treatment for adults in Ireland and will be formally launched next week by the minister for, Mary Butler, who is the minister for health in the Irish government here. And indeed, what makes this unique is that it represents a true partnership between the HSE, the Department of Health, and ADHD Ireland.

Following on for her own late diagnosis at the age of 40, and she's combined clinical expertise and lived expertise, to help make sense of ADHD identity in life transitions. She brings a perspective that is both deeply personal and grounded in years of working with hundreds of adults with ADHD. And it's fair to say that her presentation to other clinical professions and to the member of government have gone a long way to changing the hearts and minds at the highest levels in Ireland. And it's now my pleasure to introduce Michele to the global conference. And like everyone else here today, I look forward to her presentation.

On hidden in plain sight, making sense of ADHD in women. And we look forward to this presentation and hopefully we'll have some questions at the end. And I noticed on the website there was tons of questions there already for you, Michele. So, how are things with you? Oh, wow. Well, thank you very much, Ken. I'm excited and nervous to be here today. I have to say, Chelsea was my final objective in contacting Henry and the team here today because we were going, really, we should be involved with that.

Exactly.... Doing something the same. Yeah. And it's it's just a really, really exciting conference won by an amazing organization and I am very grateful to be included. And I'm very grateful to you, Ken, for hiring me into ADHD Ireland because genuinely, I'm not just saying this, I I would have said it regardless. It's the organization I'm most proud of ever working in my professional career because of the service you provide to adults with ADHD in Ireland and children with ADHD in Ireland and their relatives, and also just the kind of top class attitude amongst the entire team. So... Yeah. So.

As Ken said, look. I'm a psychiatrist for twenty years. I'm the clinical lead for ADHD Ireland and the integrated care project and the founder of Reframe, which is for people who've outgrown their lives. But most importantly, I'm a proud late diagnosis ADHDer. I'm not sure that was always the case, but I can say that now. And if you're able to bring up my slides, that'd be great, or I can perhaps share them myself. Oh, okay. There you go. Black magic. Thank you. So today, I had two alternative subheadings for this talk, and I had ADHD and the toll it takes, and ADHD and the gift it gives. And rather than properly scripting my talk last night, in typical ADHD fashion, I went off on a complete tangent and started googling.

How can you do a poll online, you know, because I was really curious to know what people would resonate with in terms of would they see it as a toll, would they see it as a gift, or would they see it as a bit of both, and would that depend on the day? Because in some ways for me, depending on the day and depending on what I'm involved in, I can see it as, you know, toll, but also I can see it as a gift as well. And I think that is the case for a lot of people that I've seen in my clinics over the years. So I'm just trying to move the slide along. Okay. So three reasons for giving a talk like this. One is that I didn't miss ADHD in myself until I was nearly 40 years of age because of a profound lack of self awareness or because of.

Not being, you know, an adequately trained psychiatrist. I thought I missed it in myself because I thought I knew what ADHD looked like Until about 2013 in medicine, we were working with quite an outdated model of a stereotyped kind of young, disruptive boy in the classroom, and that's what we all thought ADHD was. And we also thought, for the most part, it was a childhood condition that people grew out of. And it was around that time when, you know, the the DSM, which is our diagnostic bible in psychiatry, recognized that actually, you know, some people can experience symptoms... Problems with symptoms that they've had all their lives for the first time in adulthood, and when you look back, you realize these traits were always there.

And so this was quite a change for us, and it took us a while for the training to catch up with that. That's the first point. The second thing was that for years after my diagnosis, it was not something I shared readily, and it was well before COVID and the explosion in awareness. So even though I knew theoretically that the prevalence of ADHD was three to five percent of the population, I didn't actually know anybody in the medical profession who had a diagnosis of ADHD. So I thought, oh, you know, I might just keep this to myself. And then obviously the explosion of awareness happened and I started doing more and more clinical work in the space. So when I was setting up the service in Cork in the HSC.

Some of my colleagues were kind of one of the issues of not being open about your diagnosis, when people tell you exactly what they think of the condition, and not all of us was positive. And one day, one of my colleagues said to me, you know, I'm getting sick of all these presentations, people coming saying, I think I have ADHD, but there's nothing wrong with them. For example, today, I actually saw a woman with a PhD who thinks she has ADHD. And I just impulsively said, I have ADHD. And afterwards, I thought, oh, why did I say that?

And, you know, she's going to think of me differently, etcetera. But funnily enough, that that colleague became one of the biggest supporters of the work that I was trying to do in adults, and two weeks later, she actually came back and asked me if I'd assess a relative of hers. So I realized, oh, that's really interesting. If you share something about yourself, it goes a lot further I think than sometimes just sharing data or research or the education in the space. Another example of that was a couple of years later and this was only last year where I gave a presentation at the College of Psychiatry Winter Meeting about my own experience of having ADHD.

And again I think that has opened up a lot more curiosity than just merely sharing statistics or saying this is the latest DSM diagnostic guidance. So that's kind of one of the main reasons for sharing it, and I'm sure anybody here I think somebody even asked a question in the last talk about sharing diagnosis and not wanting to be met with, oh, you're part of the bandwagon now or that kind of feedback. There has been an absolute explosion in awareness around ADHD since COVID and an explosion in demand for assessment, diagnosis, and treatment. And, unfortunately, that's led to a little bit of a backlash across society and even amongst the medical profession and amongst politicians. And because, really, in reality, we know that this massive.

Surge in demand and massive surge in diagnosis is actually a response to the historic gross under recognition and under treatment. And in fact, when you look at the prevalence of the condition, the prevalence of diagnosis.

In Ireland and in The UK at least, it's still lower than the expected prevalence of the condition. So even though we might be hearing about ADHD all the time and you might be hearing about people getting diagnosed all the time, it's from a very low base of where people weren't getting diagnosed at all. So sometimes you can feel very irritated about that and ask yourself questions like, well, why? Like, what kind of a person would have these negative attitudes about your condition? Why are people having these reactions to the condition? And I suppose I have to think of my own learning journey in the space because when you know very little about something.

You're usually your most confident in the level of knowledge that you actually have. So when I started working as a psychiatrist in student health in UCC, I was quite confident that I did know quite a bit about ADHD, that it was a childhood condition, that people grew out of it, but it seemed to be more common in North America than it was in our part of the world. That was the beginning and the end. It was nothing to do with me as a general adult psychiatrist. But, actually, that was around 2016.

Students are always ahead of the curve in terms of awareness and trends and everything else. So there were people coming forward saying, I think I have ADHD. Now a lot of them were coming from CAMS, either were coming from North America, but nonetheless, there were people coming. And luckily, I have a curious mind, so I went off and I did formal training in London around ADHD in order to be more informed around the condition. So to my great shock and horror, I realized at that training that number one, what I thought I knew about ADHD was a very, very narrow stereotype and did not, in any way, represent the full condition.

And number two, I realized that it was also very treatable. And number three, I realized that it sounded a lot like me, and that was just a real shock to me. So where is all this new ADHD coming from? And because, you know, everyone says this, where is all the ADHD coming from? It was never a thing. Is it to do with, you know, modern day life, etcetera? But, actually, it was always there. It just wasn't called ADHD. People gave themselves very negative labels around the condition. You often hear people saying, I'm lazy, crazy, or stupid. There's even a book written about that. Within the medical profession, we were diagnosing it as burnout, anxiety, depression, personality disorder, addiction, eating disorders. In some cases.

Those were issues that the person was presenting with them. We were treating them effectively, but obviously, we weren't getting to the bottom or to the root of what they're actually dealing with as a result of missing the fact that ADHD was there. So it was going undiagnosed or in lots of cases misdiagnosed.

So any of you here attending the conference who've ever been to Ireland, if you've been in the last decade, you couldn't not have heard of the Wild Atlantic Way. But, actually, if you came fifteen years ago, you wouldn't have heard the Wild Atlantic Way at all. And the point is the Wild Atlantic Way is not a new coastline that we suddenly developed in Ireland. We had a 188 fantastic beaches on the West Coast. We just didn't call them the Wild Atlantic Way until the last decade. So why were women in particular missed? I think this is the question. And a lot of people would be of the view that that's as a result of gender bias and the male model predominating in medicine. So to give an example, in medical training, in cardiology.

When we learn about angina and heart attacks for the first time, we always learn about what it's like for the middle aged man to present with a heart attack, which is clustering central chest pain, radiation to the left, you know, the image of the man clutching his chest. In fact, women can often present with heart attacks with indigestion, a sense of impending doom, sweating, fatigue, etcetera. That was always called atypical chest pain. It led to women being underdiagnosed, huge delays in diagnosis, and obviously knock on effects on treatment as a result of that. But, actually.

When when you look back, why are we calling it atypical chest pain if it's actually quite typical for women? So that analogy, I think, translates very well across ADHD, where young boys who are disruptive in the classroom and causing difficulties were, by and large, always treated and welcomed by the medical profession as meeting what we thought ADHD was. Girls with ADHD on the other hand, and this is a stereotype because obviously you'll get lots of hyperactive girls.

And you'll get lots of inattentive boys, but girls for the large part internalized their symptoms. They were more pro social or seem to kind of people please and try and work around that. So many of them had, like, anxiety as a result of their symptoms and were then working very hard to kind of not run into difficulty with ADHD and to sit on their hyperactivity, etcetera. So the image on the left that you see in social media is of a girl kind of treading water, and then I I think this image is very powerful because it shows adults then, you know, because of the stereotype of being a childhood condition just, you know, left to drown. And I think social media.

There's been a lot of complaints about social media. It's raising too much awareness. Everybody thinks they have ADHD nowadays, but actually on a societal level, it's probably done a huge service to people with ADHD because it has raised awareness. It's raised awareness of this kind of masking phenomenon in women, the high functioning stereotype, etcetera. And one of the reasons sometimes that I I would add into reason for speaking out about ADHD as a consultant psychiatrist is that when you're following somebody with lived experience, it's obviously really, really helpful.

And you can identify with so much of what they're describing, and some of them are just brilliant in how they describe it. But they're not medical experts, so they're very likely to throw in additional symptoms that they're struggling with or additional conditions without even realizing it. They might be talking about, like, their autism and calling it ADHD, or they might be talking about their anxiety and labeling it as ADHD. And if you're undiagnosed and listening that, you're thinking, oh, I have ADHD, when in fact you have something else. So I suppose for the purposes of this talk, I'll focus on my ADHD symptoms and try and leave out general personality quirks. Another funny.

Kind of comment that I saw on social media was this gender bias idea where the the the reason we all thought ADHD did not exist in women was that men basically delegated it to their wives and secretaries when they reached adulthood, which I think does... It's very funny, but it does also speak to that mental load that women traditionally carry in society and the fact that that tends to get heavier and heavier with additional responsibilities in life. So for example, when you go from being single to married and mostly to motherhood in particular.

And then when you become middle aged and you have aging parents, there's just more and more demands on your executive function, whereas, you know, and this is stereotyped, of course, and there's, you know, it's not always the case, but it tends to be that women are increasingly taking on those roles. So my story, as as I said, or I think Ken said, I was diagnosed around 39 or 40. I said already that I realized after training that I very likely had ADHD.

But I just jumped to get assessed at the time. And if I'm really honest, I was probably a little bit self stigmatized around it and didn't necessarily want to label. And also my life was actually kind of fine. I had a reasonable work life balance and I was managing fairly well, so I didn't think I really needed to approach an assessment. But a big opportunity came up in the workplace, a promotion opportunity, significant leadership role, and I thought to myself, oh, I really want that job. It's a great opportunity, but I know I have very strong workaholic tendencies that I've been managing for a long time, and there is a risk that they will come to the fore if I take on this job. Basically, that would trigger my ADHD.

Addictive tendencies in that in that area. So I decided to go ahead and pursue the diagnosis at that stage because I know what my values are. They're my health, they're my friends, they're my family, But sometimes my brain does actually clash with my values because it is very driven and it latches on. It latches on to areas of interest. So what does my ADHD look like? And I'm hoping this will resonate with many people in the audience here today. And because I think when you describe ADHD, there's obviously 18 different symptoms.

They can interact with a person's personality in such a way that they can present quite differently. So for example, one of them might be, do you make mistakes filling in a form? You know, some people would make an awful lot of mistakes filling it in really quickly. Some people will take forever and be very pedantic to correctly fill in the form. It's a compensatory strategy, but they still meet criteria for that symptom. In that particular symptom, I can be a little bit of both.

There's a saying that an ADHD person has more thoughts before breakfast than most people have in a day. I think it's very difficult to know how many thoughts you have compared to other people, but I do remember the first time I ever took ADHD medication realizing that that was indeed the case. I actually got a flight. My brain was never quieter, and I have to drive through my village and meet somebody to talk about a very complicated and boring heating system in my new house. And I, number one, drove through quite quietly. I was thinking to myself, well, that person's crossing the road, and they're going here now. I wasn't kind of racing ahead. What am going to do today? What's happening tomorrow? That kind of relentless mental activity.

And I also listened quite well to an otherwise very boring situation. Because when you talk about ADHD, it's not necessarily inattention hyperactivity. It's just regulated attention, dysregulated activity, dysregulated energy. And I can listen extremely well in areas that I'm very interested in, like the last two talks here at the conference, and not so well of areas I'm not interested in at all, for example. And that's the case for lots of people. It's about attention in low stimulus environments being the issue. I can actually hyperfocus and do an awful lot of very attentive work in a short space of time, which is very common for people with ADHD. My brain works very, very fast. Has.

An expression, race car engine without the brakes. Yes. Mine works very hard... Fast. I struggle with procrastination, personally. I think that's very common in adults with ADHD, waiting and waiting, relying on adrenaline at the last minute, the deadline to kind of release your own personal stimulant into your system to get yourself to do the task. You do have contradictions in performance. I can be on fire in meetings, conferences, interviews, etcetera, and sometimes I'll actually tank for whatever reason. If I'm inadequately prepared, if I'm tired, if I haven't eaten well, and if the information isn't as fresh in my mind as it should be, for example, or if I'm dipping in and out of too many areas.

I've obviously performed very well. I have a medical doctorate thesis, a medical degree. I've worked at a very high level, but sometimes that's not quite as clear. If I'm asked a question on the hop, I can sound like I know absolutely nothing, which is very frustrating. This happens to me in my everyday life as well, so for example, you know, parties or social interactions with friends. I sometimes joke Ronan is my husband and I sometimes joke that I'd like him to send him in in a week to interviews on my behalf at times or to actually talk about, say, the mental health strategy that I wrote when I was in UCC, a long time ago, and I can't really remember it when I'm asked about it.

But also in everyday social settings. So for example, my latest fad, because sometimes I will read the newspaper and go off in a complete tangent about it and research extra information. So Earl Spencer's new book caught my eye recently. Suddenly, was doing a big deep dive. Suddenly, I'm reading about his life in South Africa, then I'm into his children and what they're doing nowadays, etcetera. Then I'm at a party with friends, I'm boring them all to tears with all the latest information that I have about it. And then I could literally be asked in two weeks' time, Michele, my goodness, you had an awful lot to say about Earl Spencer and his new book the last time we met, and I'll be like, Earl.

Which can be very frustrating, and I'm hoping people relate to that. It's not just me. I I kinda know it isn't. And ADHD in me and in others can look like an awful lot of other things. I never really thought it was something that I had given that I had been reasonably academic. But I would have identified as being stressy or a kind of somebody who gets quite stressed at things. I might not be stressed at all, and then suddenly I'm quite stressed. So that's very often the case. You will see women presenting with symptoms of anxiety, and, really, it's kind of overwhelmed about trying to manage everything at the same time, trying to juggle their lives and responsibilities.

A lot of quirks. I kind of have piles paperwork around the house, and that's known as the horizontal filing system because if you put it away, it's gone, it's out of your mind. I really struggle with grocery shopping. I can go into the aisle in Lidl or Aldi or these places in particular and, you know, buy myself some diving gear that I might never use just because it looks quite interesting, exciting, and not actually follow through on the shopping list that I was supposed to break. Scheduling can be problematic, double booking during the week, that kind of thing. Conversations at the school gates, what did you do at the weekend? And you're like, could you be more specific?

And why I say that is if you ask me on the hop what I did at the weekend, I'm very unlikely to remember. Whereas if you say to me, how was that wedding you were at on Saturday? I'll say, oh, yeah. You know? And I'll have the full story about it. Deep dives, I've already told you about it. Fads, same thing. Glasses of water. I have a lot of glass of water around the house. I have one here in the study here beside me. I have one on the mantelpiece. I'll probably go downstairs and forget that I have them up here and bring up another one later.

Multiple TV channels going on at the same time. But like a lot of women, and I'm probably being quite gender focused myself in this talk, I mean, the topic is ADHD in women, but like a lot of people with ADHD, I do have a lot of compensatory strategies, and I particularly use them in the workplace because you can't be kind of chaotic and all over the place when you're practicing clinical medicine. You have to be on top of things and you have to, you know, make sure your admin is up to date, you're compliant with, you know, your regulators.

Everything else, and that you're up to speed with your work. So I tend to be punctual in the workplace. I have an awful lot of templates. I have a very specific way of taking a die... A diagnostic history. You know, I have a lot of triggers for my memory so that I don't make errors, but this can obviously be tiring for me. I think junior doctors would actually describe me as quite organized, so I suppose what's interesting is, you know, people with ADHD can actually look quite organized because they're so busy compensating that they actually develop quite strict systems around how to, you know, manage their paperwork, for instance, or their diaries. I do outsource accountability. I benefit hugely from having good admin.

And I also really do need electronic medical records. I find them much more helpful for memory and everything else. In terms of the history then, because they say ADHD is obviously a lifelong neurodevelopmental condition, and you do have to have symptoms before the age of 12. In my case, I definitely would not have been diagnosed before the age of 12. I was good in school. I enjoyed the variety of different subjects. I was a tomboy, so I was very energetic, played an awful lot of sports. I really didn't enjoy household chores, which I wouldn't say was extremely unusual for a child.

And there were also signs. I definitely had traits. I didn't like writing an essay. I didn't like any kind of homework that was two weeks in advance that involved planning an organization and delayed gratification. I didn't particularly like reading a book and doing a book report and.

That type of thing. In secondary school, they started to become a little bit more obvious. There were contradictions in my performance in different subjects. Some subjects, absolutely great straight a student without doing much work. Other subjects struggling a little bit more and being maybe a little bit more disruptive. I had a lot of wonderful mentors in secondary school who kind of pulled me along. I'd actually got an academic scholarship to the school that I was in, so the teachers expected a lot from me. A refrain I heard a lot was so much potential. So I got a huge amount of support. In our leaving cert cycle, which is kind of the a levels in school, our school was quite progressive, and we had unsupervised.

Study. And the thinking was you'll all be adults soon. You'll be out in the real world. My grades absolutely tanked, and I didn't have a hope of getting into medicine in college. So I actually moved out and moved in with Baptist minister and his wife up the road from the school where I have very kind of disciplined oversight in order to get the points that I needed in my living certificate. So I've always resorted to radical measures to manage my distractibility and to do as well as I possibly can. And I found medicine quite challenging in the preclinical years. There was a huge amount of volume of information. We weren't on the wards yet.

And I found it quite hard to take it in. Also, the fact that I was out of the adult world cooking and cleaning for the first time in my life was quite a lot to manage. I did much better in the clinical years when I was on the wards moving around in small tutorial groups with students who broke down the information really well, and I could kinda learn from them. And I did find my calling per se in psychiatry, thank goodness, And found that very interesting and started to perform as well as I had in school then again at that stage. When I moved to Boston for fellowship.

I got very kind of sucked in by the Boston work culture at the time. So I was one of those people who would actually be up at 06:00 in the morning on the exercise bike, listening to a podcast to board here and meeting an academic paper and the other, because that's just kind of almost normal in in the Harvard environment, and and it wasn't very good for me. I developed a very serious physical illness at the time, around the time that my son was born. So that really did change my life and I thought to myself, I'm never going to work as hard as that again because actually life is so short and I know what's important to me, etcetera. I enjoy being a consultant. I find the juggle of life hard sometimes.

And I absolutely love being a parent, I only have one child and I marvel at people who have several children because I find it hard to remember his timetable and to make sandwiches and do all the things that's expected of being a mother. So I tend to learn to perform in that space. That's why Dory is there. My son has called me Dory for day to day tasks. She's a fish with short term memory in Disney. I probably thought of myself as a bit of a Bridget Jones back in the day in college and in the early years of work, But luckily, I did meet my Mark Darcy. And my husband, Ronan, is a very solid egg and quite a structured person. So we're a very good match for each other. I think I bring him a lot of.

Fun and color, and he brings a lot of structure and stability into our home environment. So who am I since the diagnosis? This is something that comes up a lot for people in clinic, and I'm no exception to that. And it can be quite a relief to get a formal diagnosis of ADHD to explain so much about yourself, but it can also be a shock even if you're expecting it. It can kind of throw the cat amongst the pigeons for us. You know, what you realize is you are the exact same person, of course. You just have a new lens to understand the way you've been over the years.

So at the time I got my diagnosis, one of my deep dives at the time was Esther Perel, the sex therapist from The United States. I was reading all her books. She writes a lot about affairs, and I was thinking, do you know what? Finding out you have ADHD, it might not be the best analogy in the world, but I said it's probably similar to finding out.

First... Your spouse has been having an affair in that, you know, it was always going on. You just didn't know about it, and now you do, and now you're reexamining everything. Now you're saying, oh my god. That day, they didn't, you know, come to the hospital to see my mother. They're actually with this other person. You're kind of reliving everything. And the same thing happens in ADHD. You start saying, oh my god. That time when I, you know, went into that interview and couldn't think of any of the important points I wanted to make, but the very next day, I had them all at the tip of my tongue. That was actually undiagnosed ADHD. So it can be very helpful, but it can also be a little bit disconcerting.

In my case, it made a sense of a lot of weird contradictions that I have. You know, I really struggle with packing a bag. I find that very, very hard. It takes me forever. I'm If going to a conference, even if I'm speaking at it, I'll probably be more stressed packing my bag than about the talk, which makes no sense. I struggle with household chores. Who doesn't? But I think I probably struggle more than the average person. I struggle with questions on the hop, and it makes a lot of sense to me, all that. I think what's really useful then is to think about your values and how you want to move going forward, and what you really want to think now is.

You know, how am I going to accept the challenges that I have, tackle the ones I need to tackle, because you don't necessarily need to tackle them all. I'll say a bit more about that in a minute. And how can you embrace the strengths of the condition, the strengths of who you are? So a very common journey that I see in late diagnosed ADHD is this first step is no idea, completely unaware. You've no idea that you've ADHD. You might be giving yourself labels. You might be masking. You're often self critical of blaming yourself for some of your quirks. Then you start thinking, gosh. Could this be ADHD?

There's somebody says it to you. You see it online. You read about it. You start choosing whether or not to explore it. And I think for us as clinicians, we really have to remember that by the time the person comes to see us in clinic and says, you know, I think I have ADHD, You have to respect this huge journey they've gone on already. You know? And I think that the last two speakers were really excellent by talking about how to handle when it's not ADHD as well. Then there's the treatment and learning phase. This is often when ADHD do a huge deep dive and educate themselves, which I highly recommend, and they approach the various recommended treatments. There's a period of time of applying tools in your work relationships and routines.

Exploring new ways of being. Sometimes you see this whole identity transformation of, gosh, I thought this before, now it's ADHD, and they're almost explaining everything through ADHD. So I think it's important to be a bit flexible around that and kind of say, yes, ADHD explains some of this, but don't be limited by it either and, you know, allow us as to be the opportunity that it can be to kind of look at the life that you've built without knowing you have this. Now you know you have it. It might be an opportunity to reflect and build in a more sustainable way going forward and meet claim strengths that you have that you forgot you have. So I will say to everybody, please become an expert in ADHD.

Come back to me with, you know, information about ADHD. I want you to know more about it than I do because medication for ADHD is hugely effective, and it's one of the most effective psychiatric medications that we have and works for about seventy percent of people. But it's not without side effects. Some people do have side effects, and some people can't take them for whatever reason. Some people just don't like being on medication. And even if you take medication, all it actually does is tune down the noise in your brain in order to help you build better lifestyle and better kind of environment to support the brain that you have. So regardless.

Education is hugely important whether you can take medication or not. I recommend Ed Hallowell and Russell Barclay because I think, you know, they are experts and they also are... Their reading material is really quite accessible. Think how to Choose magazine is excellent. Put ADHD Ireland up there because obviously that's where I'm from and I'm very familiar with it. Their website is brilliant. They have so many wonderful resources. I think I could very fairly say, you know, check out your local ADHD charts. Check out ADHD UK if you're in The UK. Check out Chad if you're in The States because they have such a wealth of information. Attitude magazine is free, has amazing webinars with experts on it all the time.

I myself am not immune to social media deep dives, take or leave, and don't get all your information from them. Sometimes their information can be useful, sometimes it can be just funny. I mean, a recent example was I was telling my husband, oh, you know, I read somewhere on TikTok that if you have ADHD, you sleep with little dinosaur arms. Have you ever heard anything so ridiculous? And he actually said, you sleep with little dinosaur arms. So I think, you know, they can have things that aren't necessarily DSM, but that are actually relevant to us all. When you think about ADHD, the traits are stable and long term, but when it dips into impairment and when it crosses the threshold, we were talking about that early... Earlier.

From kind of traits to diagnosis, that can also be fluid across the lifespan. So, actually, if your life is the right balance of interest and stimulation, if you've enough scaffolding and support and structure and you're functioning fairly well, you might just be below the threshold for needing medication, for instance, instance, or even for meeting formal criteria for ADHD at that particular time. But then a life challenge comes along or hormonal change like perimenopause or postpartum or new demands in your life, for example, a major one would be going from secondary school to third level education.

Then things can change quite a bit more and you're struggling a lot more at that particular phase. So while the traits are constant, the impact fluctuates with your life circumstances, I would say. I think a really good starting base for people with ADHD is finding your why and finding your genius. At least I find that very helpful to me. I think everybody, whether you have ADHD or not, should really think about these things. Ishiga is a Japanese concept about finding your joie de vivre and the the the right mix of doing what you love, what you can be paid for, what the world needs, and what you're good at. And.

Obviously, very difficult to achieve. But I think for anybody, if you don't have enough of what you love in your work or in your day to day life, you're going to run into difficulties. And I think in particular for people with ADHD who have this interest based attention system, it's going to be a real problem. So, ideally, you aren't what you love to be what you can be paid for, and that's why sometimes people after the diagnosis or after the dust has settled two years later kind of realize they're in the wrong career or they want to make a change because they start to realize this about themselves and go, it's very unsustainable.

For me to stay in this. It's kind of similar with the zone of genius, zone of excellence, zone of competence, zone of incompetence. Zone of genius isn't necessarily something you're absolutely brilliant at. It's something that you enjoy at the time disappears. So while I'm actually enjoying this talk, I know I'm stammering and saying m quite a bit, but I do feel alive at the time it's disappearing, I think I'm doing something really meaningful. So I like having things like that in my life. I like being involved in policy and, you know, designing new services. I like doing consultancy work, and I absolutely love.

Helping people in the late stages, kinda two years after... Year after their diagnosis when the dust has settled. They've done the meds. They've done the coaching, and they're kinda like, what kind of a life do I want to build now? I love that kind of stuff. Zone of excellence is probably clinical psychiatry diagnosis and treatment. I can find a draining even though I know I'm good at it, if that makes sense. Zone of incompetence would be more, say, the administrative side, diary management, scheduling, receipts, and doing my CPD points, all that kind of stuff. And that's something that.

You know, I'm definitely better off getting help with. I sometimes don't have any help to me or can't afford it or whatever, but I can waste as much time working on that as something that would be much more meaningful for me. So you'll all have your own equivalents of that, and I hope you can think about this diagram and how it applies to you. Design your life, it's important to remember, does not mean change everything. Like, sometimes people have a complete, oh my god, what am I going to do now? I I just found this out about myself. I need to change everything. First of all, I would say don't change everything immediately because actually it is.

You know, such an opportunity, but it's also a little traumatic in some level. It's probably not the best best time to make massive changes, but just do a kind of an inventory of your life to see what you need help with. Focus on your strengths, play to them, put a bit of structure around your challenges. Sometimes people lean very heavily into their compensation strategies and want to kinda double down even more on their organizational systems and their masking on some level. But actually, if you can delegate some of the areas that you struggle with more or if you can decide, actually, they really are a problem in terms of the written ADHD symptom that causes me problems, but actually.

They don't really affect my life per se. Therefore, I don't need to focus on them so much. I think that's a really good way to go about it because if you go back to the slide with the scales on it, it's all about decreasing your load on your cognitive function. So if you can decrease the amount of demands, the amount of competing demands, particularly the draining ones, that will go a long way towards alleviating your symptoms. And, obviously, the more joy you have in your life, the more purpose you have in your life, the more kind of areas where your brain's actually locking into flow. In some cases, that can mean people require less medication to actually manage their symptoms if they can design their life effectively around that.

Self acceptance is huge, you know, having self compassion. And I do think it's possible to develop this later in life even if you're only discovering for the first time in your forties that ADHD, I think it's possible to develop some compassion around that. And it sometimes takes a while, and sometimes people need therapy around that, but it is possible. This is our little dog, Toots. She is a pug. Not everybody likes pugs, and, you know, they have health issues. They're not your typical dog, etcetera. And we really love Toots just as she is. Now we would probably be very disappointed with Toots if we had actually got her in the hope that she was going to be a star police dog. And similarly.

We would be very disappointed if a police dog came disguised as Toots and, you know, it was too late to sit in their laps in the evening. So I think sometimes what could be challenging for us as parts of the human race is that it's a hidden disability. It's not obvious a person has ADHD. So we can get frustrated with ourselves. We can frustrate... Get frustrated with other people who have ADHD because they're not behaving the way we expect a typical person to behave, whereas in fact, they're behaving in a very typical ADHD way. And if we modified the environment to suit them, we wouldn't have a problem. Environment.

Suits her. We all love sitting watching TV in the evening with her up in her lap. There's no issue with that, and we're happy enough with two short twenty minute walks a day. So if I was abandoned in Paddington Station and needed a tag to describe, you know, how to work with me, I would say some things people find easy are hard for me, for example, packing and diary management, and some things people find hard are easy, for example, writing a policy document and designing a mental health service. So... And I think that's not unique to me. Developing your own policies and procedures, your own SOPs are what make life easier when you're working with ADHD, and I'm sure you'll see a lot of talks around that over the next few days.

So recent examples of ADHD irritating me in my own day to day life despite all the self acceptance that I state that I have, you know, it it can still climb up on you and irritate you. You know, I know that I should have a single source of truth when it comes to diary management, but there I am with my kind of aspirational journal on the left, my bullet journal, which is actually all my tasks and activities, both analog. Then I have my computer diary there in front of me, but actually, it's only for one of my jobs, and I have a phone diary, obviously, as well. So I know I function much better when I put them all into one system, but sometimes I resist doing that. And I have this.

Ridiculous thought that's not based on reality at all of... It's grand, I'm sure I'll remember. And then I remember that I don't remember, and then I have to start again with the system back in place. So it is important to kind of recognize our tendency to do that and to be kind and compassionate towards ourselves when we do do things like that. That second one there is a reminder. I'm not sure if it applies outside of Ireland, but I'm sure it does. When you're booking a restaurant and it sends you off to your own banking app to kind of authorize and approve it, I have been known to get to that step. Forget to go back to the restaurant booking page and actually complete the reservation, which can be very frustrating.

The third image there is an example of lastminute.com. This is me last night editing my slides when I'm giving the talk today, which is obviously not ideal, and I rely on it too much, but, you know, it's not good for us to rely too much on deadlines and stress and anxiety in order to get our adrenaline up and running. We're much better off if we set ourselves short term deadlines and, you know, have accountability partners that go on things like Focus Nation, StudyBody, and those kinds of things to get us to function better. So is this just me? I hope I haven't communicated this story that people are listening and saying, well, that's just Michele's story. I think.

It reflects a lot of the experiences of women that I've seen over the years, the hundreds of women. But if you have met one person with ADHD, do remember that you have just met one person. So if you know one person in your personal life who tells you that you have ADHD, yes, you've got a bit of a template for what it might look like, but it might be different for somebody else as well. And what the two people will have in common is a similar operating system in their brain, but they might have a whole load of other divergent traits as well. What's commonly seen is this kind of intolerance of boredom. Boredom can feel very difficult for people with ADHD.

Ironically, a tendency to over function in some areas is often the case. In the workplace, they could be the change makers of the challengers. There are a lot of strengths. Hyperfocus is probably a superpower, out of the box thinking, strategic kind of pattern recognition. Admin burden, yes. I mean, not everybody with ADHD struggles with admin, but I would hazard a guess that a significant majority of them do. A lot of women in particular struggle with feelings of overwhelm and self doubt. Burnout and fatigue is very common. And this, I think, can be a surprise to people because you think of ADHD as being really energetic.

Lot of people have side projects on the go. One of the reasons is because of how busy their lives actually are. The struggle to relax the relentless mental activity, the tendency to say yes to things without thinking about what your diary actually looks like, tendency to perfectionism, masking, and then it can impact people around you as well. So what can you do? We ran a series of focus groups a new model of care with adults with ADHD and we said we really want to develop a needs led service in Ireland where diagnosis is not the priority, but actually we got pushback in every group where people said the formal diagnostic assessment is hugely important and that receiving a formal diagnosis of ADHD.

Moves a person from that, do I have it? Do I not? Do I have it? Do I not? To really kind of accepting it and moving on to the next phase of how can I live better with this? So we decided to leave that in our model going forward and just improve how we can access it. So does seem to be really important. Medication is obviously something to, you know, consider, and the evidence base is very strong. But as I said already, environmental modifications are first line. And regardless, even if you are on medication and you great... Get a great response, designing your life around your brain is going to amplify that response. No end. Lifestyle, sleep, exercise, spending time in nature, less time on screens, connection, meditation.

Huge self compassion, so important, trying to have a sense of humor about when things go along with it and not throwing out the baby on the bathwater. You've lived a life to where you got to at this point in time. You've done very well in so many ways, and you don't need to get rid of every aspect of your ADHD. It's just about harnessing the strengths and scaffolding the challenges. I would highly recommend getting on to your ADHD nationals charities for support, for their webinars, for their education. So finally, what would I say about ADHD?

But well, within myself, my greatest asset and my biggest curse. Years ago, I was watching Winnie the Pooh. My son was only five at the time, and we were having a really mindful moment of presence. I actually felt quite proud of myself for being able to be so present and thought, oh, to such a great mom. I actually had that thought. And I said to my son, oh, look. Kanga and Roo are snuggling there. Do you think you're a bit like Roo, I'm like Kanga? Kind of hoping he'd agree with me and validate my perception. But he said, no, mom. You're much more like Tigger. And I remember thinking, oh my god. But at least take her a bit of crack. And when I talked to my husband about would he prefer if I didn't have ADHD.

He says to me, I prefer that you didn't have something that makes you be hard on yourself and causes you difficulty from time to time. And sometimes you do drop the ball on important administrative tasks or household chores, and that can really annoy me. But I really want... Wouldn't want to lose Tigger, and I wouldn't want to either. What I would say about ADHD is that it is a treatable condition to work with, and what it gives a person as an individual is a language for the lives that they've already been living. So thank you very much. There's my contact details on my website. I've joined Instagram last week, so working on that at the moment. If you're on it, please follow me and thank you.

So thank you very much for that, Michele. It was a very interesting presentation. I have to say I've been keeping an eye on the chat and there's loads of positive things coming through there. I have to say the one that was about half an hour ago, the one from Helen was the one I really, really loved. She says that, I think I found my long lost twin.

Hi.

So we got about seven minutes left. So we're gonna... We got about 20 questions. We're trying to get through as many as we can in the next four or five minutes before Henry comes back on, waves the flag at us. But one... If I was gonna write a question, it didn't actually come in in the questions itself, so it's not my question. But I think it's really very important in terms, you know, where ADHD Ireland is and how we how we can work and things like that as well. And he says, thanks for sharing your own story. And how did your colleagues react when as a consultant psychiatrist you went, I have ADHD?

Yeah. I think some people were surprised, actually, to be honest. But I think at the conference when I gave that talk, the overwhelming response was actually very positive. You know, I've given research type talks or educational talks at conferences before and people clap and they all move on. But actually, people came up to me afterwards, you know, some people kind of hugged me, thanked me for doing it. Other people... Well, what was really... Which was obviously very, very moving. But for... You know, some people said they felt seen, but what meant the most to me was actually probably because of my advocacy hat was somebody coming along and saying that he had changed his mind about ADHD.

As a result of, number one, finding out that I had it, and number two, me sharing my story. So to me, that felt worth all the fear and and kind of anxiety about being vulnerable like that in front of your colleagues.

And and for... I I mean, I do know... I mean, I have had people talk to me and say, you know, that... And the talk you've given particularly to other professionals, medical professionals, has changed hearts and minds, as I was saying, at the very start. Yeah. And it has made a difference in terms of, you know, getting ADHD accepted out there. And just one of the questions that come in from the from the the section. Someone was saying, so many of my friends have been diagnosed in their forties and around the perimenopause. Coincidence? Or do hormones really make ADHD harder to hide?

Yeah. It it... I don't think it's a coincidence. No. I think, you know, estrogen decline does have an effect on dopamine levels in the brain and particularly kind of the perimenopause phase before you go into full menopause and they're kind of fluctuating and going up and down and up and down like that. And it can just make... You know, it just is an increased kind of biological driver as to why the symptoms might be worse at that time. Now I also have the theory that midlife coincides.

With the kind of phase in our lives when we're the squeeze middle, and we often have children or teenagers or college age kids and aging parents at the same time. So an awful lot to juggle all of the... All at once. So that kind of cognitive load goes up. So between the hormonal decline and the cognitive load all at the same time, no, I don't think it's a coincidence at all. I think it's somebody who has coped all through life, but now one of their last kind of stabilizers has been taken away and it just becomes too much at that particular time to handle it anymore.

They they look back, they're the most interesting stories because they look back and they have all these examples from when they were younger when their ADHD was impacting them, but they were able to kind of push through and grind through and they're just no longer able to do that. Okay. Probably time just for maybe one more question.

I noticed that later on during... On the schedule, there's an event for, you know, leaders from ADHD organizations around the world to have a chat about what they're doing. But I think it might be just pertinent in terms of, you know, the roles you currently have with ADHD Ireland in terms of the the new plan. And what are we doing in Ireland? How are we reacting in Ireland? Because, you know, every country has a different answer to ADHD. So what are we doing good? What do we need to do more of?

Well, I think we... Okay. You didn't ask me what we're doing badly, so I'll move up. Okay. Okay. What we're doing more of? Yeah. Okay. So I think we were late off the blocks in Ireland. You know, I think The UK were further ahead of us in terms of having a public response to adult ADHD, and certainly The United States were way ahead of us. But... So it took us a long time to get going. But once we did get going, we have actually a national response. So we did develop specialist services throughout the entire country. Now they're grossly underfunded and there's not enough staff on these teams to in any way meet the demand in Ireland. And so that was kind of... That's a problem. And.

I think since then, the partnership between ADHD Ireland and the HSE to actually actually provide psychoeducational and psychosocial interventions for the large population of unmet needs has been instrumental in kind of improving both awareness and support for people with ADHD in Ireland. And also, I think our adaptation to the new model of care where we're going to try and introduce, GP specialists across the country will be fundamental to improving access as well. And, hopefully, that will be funded and launched, you know, in the next couple of years.

Okay. Well, we're just coming up to time and it's probably time for... I don't know if Henry wants to come back on or like, there it is, Henry. Excellent. So we can say we we finished on time, is great for ADHD Conference Call. It really is. And and it's because Australia are very fierce back then. We we have to hand over.

But no, it is. Thank you. That was inspiring and wonderful. And I I, you know, I really found myself, you know, moved by. I've done a lot of it, so I got taken aback at one point because it just, like, it really resonated. So I want to... Yeah. Thank you. I was, you know, focused on women, but across as well. So thank you. Thank you both of you for all that you do, all that you're doing in ADHD Ireland. Michele, thank you so much for that. That was absolutely wonderful. And yeah, I have to just give you an applause to say thank you and say thank you. Oh, thank you. It is wonderful. So thank you so much. Thank you both. I have to say goodbye to you both. And...

Don't yeah. Worry. I'll be in the audience for about the next twelve hours. Nice.

It's... Honestly, I'm enjoying it enormously. So, yeah, do... Like, I look forward to that. Thank you. Goodbye, Ken. Goodbye, Michele. Thank you so, so much. Thank you.