I’m being assessed for ADHD and it’s a Kafkaesque nightmare – Laura Waddell

I am filling out the longest, most intrusive form of my life, fished not out of Kafka’s rejects bin but sent by Glasgow City Health and Social Care Partnership’s Community Mental Health Team. The deadline to return it has passed. Because I didn’t respond within four weeks, I’ve been discharged.

My referring GP was astute enough to suggest running out of time was commonplace among candidates for ADHD and autism, who might find such paperwork especially difficult to handle, and that they could refer me again if this happened. So here we are.

I’ve never shied away from pooling my personal experience with mental health, but a diagnosis in progress, besides still percolating in the mind, is also nobody’s business. So difficult has the early process of navigating neurodiversity in the NHS been, however, that I feel the need to document the madness-making at the system’s point of access.

A mental health diagnosis can help with self-acceptance and provide access to life-changing medicine (Picture: Olivier Douliery/AFP via Getty Images)

Both my psychologist and GP tell me my presentation and career history on paper might count against me. I performed well until the working gears of my body and mind felt completely stuck. After struggling to find equilibrium post-pandemic, when I really became very ill, I have quite recently started to see executive exhaustion and permanent existential unease might be – rather than amassed personal failings for which I endlessly mentally self-flagellate – a health concern beyond depression.

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Onto the form. How difficult could it be? The Adult ADHD Background Information Questionnaire sent to me in March is 23 pages. It begins with questions I can’t independently answer. How old were you when you first walked and stopped using nappies? Did you babble in the first year of life?

Spectacularly intrusive

Some feel like a job interview. What are your hobbies/interests? Have you passed your driving test? It gets personal. How many times have you been fired? How many previous relationships have you had – infidelity, break-ups, divorce? Difficulties getting GPs to take mental health concerns seriously in the past leave me wary writing to an anonymous reader. NHS data breaches do not fill me with confidence about this spectacularly intrusive psychological self-assessment.

Next, the self-declaration of crimes: do you have any driving convictions [ie speeding fines, drink driving etc?]. Have you been in trouble with the police? Any cautions? Any convictions? There is a tick chart for whether I’ve tried cannabis, amphetamines (commonly prescribed after diagnosis), ecstasy, cocaine, crack cocaine, heroin injected, heroin smoked, LSD, magic mushrooms, or ketamine. An interrogation room would at least have a human asking the questions.

You can't afford not to embrace neurodiversity – Angela Prentner-Smith

Juxtaposed on the same page comes “how would you describe yourself?” After this suggestive line of questioning, not optimistically. It goes on. Have I ever stolen anything of value? Have I ever used a weapon like a stick, bottle, knife or gun, or threatened someone with a weapon? Have I ever received or collected benefits I am not entitled to? Have I ever made money illegally, for example, by selling drugs or stolen goods? Have I ever been physically cruel to animals? Have I ever failed to pay debts? No, and I’m wondering what kind of profiling is happening here.

Quantifying life’s failings

Next is information difficult to handwrite in the stark, non-therapeutic context of a poorly printed form. Have you ever self-harmed [if so give details]. Do you ever have thoughts of suicide? Repeating my confessions, next come pages of tick boxes on problems at work, in romantic and familiar relationships, in social situations and education, to further quantify life’s failings. I am asked to self-assess whether I have bragged a lot or deliberately annoyed people.

Most egregiously, it then demands partner and family member input. What about those who are estranged or lonely in life? What about privacy? On a scale from “never” to “very often”, my partner must rate me on whether I appear not to listen to when spoken to directly; do not follow through on instructions and fail to finish work; talk excessively. It feels like a retrograde step to defer to a partner’s word. Was this thing written before single women were allowed to open our own bank accounts?

I have to phone my mum to ask her if I was “restless in the squirmy sense” at age seven. No – squirming would have blurred the text of the books I obsessively read. In a recipe for disharmony, nearest and dearest are then asked to subjectively rate how these things have impacted my life with immediate family, work, social interactions with others, management of money, management of daily responsibilities, and ability to drive a motor vehicle.

Life-arresting quicksand

There could not be a process more designed to completely frustrate those who have to fill it in than this 23-page form, so much of which depends on individual ability of the patient to self-report. Nobody I talk to among peers with a neurodiversity diagnosis has experienced the exact same process so there’s little continuity in community advice but someone advises me her own form was lost internally thrice and suggests recording answers.

My partner, diagnosed via verbal assessment, is incensed before I am at how fatiguing the paperwork is. My psychologist, for whom I held up the fat wedge of the form on Zoom, does not recognise it either.

I look enviously at those who say a diagnosis has helped them with two things: self-acceptance and medication that gets them through a focused day without getting stuck in the life-arresting quicksand of anxiety, fatigue and rumination. The prospect of this being the missing piece of my own jigsaw has given me a boost, but at this stage of investigating neurodiversity that sort of peace feels a long way off. The instructions attached to the form tell me the expected waiting time for follow-up in being assessed, if my form passes muster, is greater than two years.