12 Days of ADHD 12: Reports
Thursday 28th October, 2021
October is ADHD Awareness Month. I've decided that I'm going to use that as a writing prompt, and to set myself a challenge. For the next twelve days, I'm going to write something about my experiences learning about ADHD as a very recently diagnosed adult.
Today is the final day of my challenge! I started off wanting to write some interesting stuff about working memory, because I'm fascinated by the neuroscience of this all - but I got stuck in a bit of a rabbit-hole trying to try and find studies which had tested people with ADHD diagnoses using the RBANS test in particular - as that's the one I happened to do, and admittedly in not-exactly clinical settings (sat in a bedroom, probably a bit hungover?). It's one of many other psychological test batteries that could be used to support a diagnosis. Unfortunately I haven't found any papers or studies that specifically reference the use of RBANS in comparing ADHD groups (especially ADHD adults) against healthy controls, so I can't really tell what my own scores mean.
In the midst of all that, though - when I dug up my scan of the RBANS test, I also dug up a document I wrote back in February, where I've conveniently taken all of the choice quotes from my school reports and onwards. I wanted to share them here, because they really tell a story of me growing up!
If you've ever wondered about yourself and you still have school reports - dig 'em up!!! You may find that yours have a similar story which only stands out when you have a better idea of what you're looking for - maybe my reports can give some insight...
First though, I thought I'd share my results from that RBANS test:
- Immediate Memory: score of 78 - 7th percentile.
- Visuospatial/Constructional: score of 121 - 92nd percentile.
- Language: score of 92 - 30th percentile.
- Attention: score of 97 - 92nd percentile.
- Delayed Memory score of 94 - 34th percentile.
The index scores don't scale linearly against each other, hence why a score of 97 in one category might be 92nd percentile, whilst a score of 94 in another is only 94th. The percentile means, "out of all the people around the same age, gender, background, health, I score higher than this percentage of them in this category (for UK/USA)." So, I'm pretty great at visuospatial/constructional things, and ironically my attention scores are really good. My language and delayed memory functioning scores put me in the lower third of guys my age. And my immediate memory was... seventh percentile.
I will ask my friend about interpreting the results again and refrain from commenting too much - I think some of the categories are not what you would expect, and/or where Attention Deficit Hyperactivity Disorder is badly-named. Attention was tested using digit span (repeat a growing sequence of numbers after the assessor says them) and coding (match abstract symbols with numbers within a time limit). No problem holding sustained attention in those circumstances, given a task which I am intellectually invested in which my brain finds rewarding and which I have chosen to do of my own volition.
I also found it surprising that I scored as low as I did on language. The first test for that was naming things in pictures, and the second was semantic fluency - "name all the fruits and vegetables you can think of in sixty seconds". Which to me doesn't feel like testing language per se, but category recall or something. It wasn't, like, finding anagrams or thinking of synonyms or testing ability to communicate abstract information. So, again, the categories may not be what we think they are - or not what I'd assume them to be at first glance anyway.
Still though - with the caveats of OK what do I make of this - the seventh percentile immediate memory thing is really something that got my attention. The tests for that were list learning (repeat a long list of words after assessor has read them out loud) and story memory (listen to a short story and try to repeat as much as you remember, using as much as the same wording as possible). That's stuff I've always struggled with - following instructions! Following recipes! Remembering directions!
So: phone numbers and IP addresses and passwords and registration plates and postcodes: I am top dog remembering. Bunch of different people's names in a social gathering? Nul points.
These are all the choice quotes I took from my school reports, dating back to when I was in reception. They are from a mix of my regular reports, and the individual education plan I was on, which was part of the school's special educational needs (SEN) provision. Typing these out again, having had over half a years worth of research and reading and incorporating information, is quite cathartic - should I ever get that impostor syndrome about being neuro-divergent because on the surface I'm functional adult, I can look back at the work I put in getting there.
5½ years old
School Report: Owain enjoys stories but finds it more difficult to listen in class discussion times and to instructions. He will answer questions if asked directly but will not volunteer information. Owain also enjoys singing and percussion. He often sings during other lesson times too. Owain often seems to be in a world of his own. Under constant supervision he can work quite well but needs to work more independently and conscientiously. Owain does associate more with the other children now and is beginning to learn to cooperate more with everyone.
6 years old
School Report: Owain tends to be a little dreamy and he finds it difficult to listen to others. He also has difficulty waiting for his turn to speak. Owain is enthusiastic during P.E., but he needs to listen more carefully to instructions. Owain is a capable boy who could do much better if he could concentrate on his work. He is now able to sit quietly, but he still has difficulty working with a group of children. He has worked very hard at not wandering around the class when he should be sitting and hopefully this will continue. Owain wants to do well and is helpful around the class when he is asked.
6½ years old
School Report: Owain needs to concentrate on the consistency of his good work. Owain finds mathematics more challenging than language and often becomes annoyed and distracted if faced with a problem that is not straightforward. Owain has a good understanding of scientific concepts but can be impatient and cross if his predictions or investigations do not turn out as he expects. His work is lively and imaginative but he finds some cutting/shaping work difficult and gets frustrated. Owain still has a lot of co-ordination problems and finds this frustrating at times. He can get distracted at times. Owain always contributes to discussions but does not listen to others' points of view. Owain works well when he applies himself. His attitude and behaviour will need careful monitoring.
7 years, 4 months old
(This is where it becomes more outwardly obvious that I'm a bit of an Odd One, it seems 👽. I have no idea what "laterality has not been established" means!)
Individual Education Plan: Owain appears to be a very able boy who likes talking, has an excellent vocabulary with a mature expression, is reading well and writes with fluency and expression. Progress in maths is less advanced and although generally well-coordinated, laterality has not been established. His behaviour in class and playground have been giving increasing cause for concern. He has difficulties cooperating and interacting with peers, has developed various unusual mannerisms and his learning and that of his peers are being affected. He finds it difficult functioning within the class, eg. listening to and following instructions, in waiting his turn to speak and listening to other people's point of view. He becomes very frustrated and angry when constructions do not achieve his desired aim. Targets. sit in his place without being reminded, work without making noises.
7 years, 9 months old
(So this is where I start getting Disruptive and being The Annoying One in class. Interesting that it's noted that I find it difficult to make eye contact, but there's no mention if anyone asked why..! (I still don't really know why. Eyes are overstimulating I guess?). Mum says as difficult as it was back then to get GP referrals for this sort of stuff, there's even more barriers for parents these days, requiring them to sit in "what if you're just Parenting Wrong™" classes before they'll be referred...)
Individual Education Plan: Owain is now in a mixed Y3/Y4 class of higher achievers. His behaviour is not such a problem because there is room for him to be on his own on the few occasions when he has made noises and his peers are less distractable. However he finds situations like assembly, waiting for the bus for Kids' Club after school and lining up to come in after play the most difficult to cope with and does not seem aware of the effect of his behaviour on others. Questions sometimes have to be repeated. He finds it difficult to make eye-contact unless he is really relaxed at home, and seldom at school and lack of facial expression or appropriate responses in conversation can make it appear that he is not paying attention. Socially he has made an effort to join in football games and has enjoyed it. He has settled into the class readily but does not settle down to work as quickly as is required and so often does not have time to complete tasks of which he is capable. Overall presentation of work needs attention and reversals are a problem, particularly with numbers. Referral to the Educational Psychologist was discussed but was felt to be inappropriate at the moment, but it is suggested that his parents consider asking their GP for a Speech and Language assessment. Parents report that Owain has difficulty getting to sleep at night and wonder if this may be influencing his moods and performance. Of concern is his lack of awareness of the effect of his behaviour on others and his difficulty in exercising self-control in situations where he is not directly supervised.
8 years old
(So I'm still growing into an Alien 👽 at this point. I have to admit, I did laugh a towards the end of this at the somewhat exasperated tone of my teachers. Can't help but admit, unknown dysfunctions aside, I was a bit of an Antagonistic Asshole Child at times, clearly.)
School Report: Owain must recognise the importance of listening to others' ideas when working collaboratively. A recent test shows his reading age to be well above his chronological age. Owain needs to develop a clear and legible handwriting style. He must take greater care to present his work well. Owain displays very individual characteristics at school. The quality of his work depends upon the amount of concentration he employs. As he matures he will need to realise that his manner could be interpreted as rude and arrogant. In a one to one situation, it is possible to have an intelligent conversation with Owain. His idiosyncrasies sometimes lead to misunderstandings, but Owain is beginning to accept that others may have a different viewpoint. He is not always willing to concede that a different viewpoint may be just as valid as his own!
Individual Education Plan: Owain's behaviour in class and playground are improving. Targets: Respond at first hearing name. Owain has made good progress in terms of presentation. His handwriting has improved and there is no longer a reversal problem with numbers. He is settling to work more quickly. Maths is now age appropriate. There are still problems when Owain waits for Kids' Club - loud voice - and in being ready to line up to come in at playtime. He is making better eye contact and interacting better with peers. His parents say he is sleeping better but doesn't remember the names of peers he talks about at home.
(After this the reports change format a bit and went from listing my age to listing my year group)
Year 4 (8-9 years old)
(Having context of the previous report, one thing really bugs me here: Get told that I talk too much, too loud, too distracting, have odd behaviours, misunderstand, argue too much... and then my teachers are surprised when I don't participate in discussions...! The "occasional outbursts directed at himself" is the beginning of the shitty self-esteem and coping mechanisms that ADHD'ers grow into...)
School Report: Owain's behaviour has been much more appropriate this year and his occasional outbursts have been directed at himself! He has revealed a lovely sense of humour and a willingness to help himself by consciously making an effort to listen to instructions and ask if he is still not sure. He still needs to concentrate on what is going on around him and should try to participate more consistently in class discussions, as he has a lot to offer the class. His listening skills still leave something to be desired at times, but he is working hard to improve them and is making progress! He sometimes produces calculations etc. which are not required or are irrelevant because his attention has lapsed. He needs to concentrate on instructions rather than guess what is required! Owain does sometimes ask when he does not know what to do, but he needs to do this more often to save himself a lot of unnecessary work. Owain's designs are innovative and thoughtful. He sometimes has problems with fine motor skills when constructing and this can lead to a loss of temper (with himself). He is not always as attentive as he should be, which leads to his misunderstanding of instructions etc.
Year 5 (9-10 years old)
(Again, not gonna hide the fact I could be an argumentative lil shit 😅 - and whilst it's a blur to me, I am appreciative of my friends and classmates who were supporting me in my formative years, sometimes completely unbeknownst to me. Some of those kids I've known since playgroup and we still keep in touch. 💜 Evidently I got bored quickly in class sometimes - with an intensely novelty-seeking brain, and would LOUDLY argue because it is also a black-and-white thinking, highly emotional brain. And a clumsy one too, hence the reluctance in PE...)
School Report: Owain is capable of producing work of a very high standard. The majority of the time he does work conscientiously and puts much thought into his work, but he does have a tendency to "switch off" at times when he feels he can do what the class are learning. He then finds that he does not understand the task in hand, but will not accept that it his fault for not listening. Owain needs to accept that although he is very intelligent he is not always correct, and if this is the case he should not answer back or sit and talk out-loud to himself about how he disagrees. Owain has some very supportive friends who try to calm him down if he is disagreeing with something or someone and they encourage him in PE. Owain needs to put the energy he uses complaining into his work, then he will be very successful in his school work. Owain needs to use his ICT skills to produce higher quality work, not to go off on a tangent and think that he can do his own thing in the lesson. Owain lacks enthusiasm in PE although the other children in the class encourage him a lot.
Music Teacher: Owain has had a mixed year. At times he has been quite disorganized and hasn't perpared his pieces. Yet he has worked well on his Grade 2 pieces. If he continues to work in this manner I would be prepared to enter him for the exam at the next session.
Year 6 (10-11 years old)
(Pretty telling that only by this point am I making friends, and that this is something of note. I think anyone who knows me now knows I'm a pretty quiet, reserved person a lot of the time - certainly do a lot less thinking aloud! There seems to be a contradiction in this report where I'm told to slow down (take more care in work) but also speed up (be less methodical and get better at meeting deadlines). Also kinda funny to me that this outstandingly muscial, dramatic, vividly imaginative kid turned out to be a software engineer...! Not dissing the creativity of my profession, but... bit of a change)
School Report: Whereas at the beginning of the year Owain was on the social periphery of the group, as the year has progressed his self-confidence has increased. It is good to see him forming friendships. Owain is modest about his abilities and seems embarrassed that others admire his outstanding musical and dramatic talents. Owain is a complex character and his habit of " thinking aloud" can seem like challenging behaviour to those who don't know him well. He really must try not to verbalise to the extent that he does. Owain needs to continue to focus on the technical aspects of his writing where there is still room for improvement to be made with punctuation. Owain is not a natural mathematician and is easily frustrated. If he took a more active role in the learning part of the lesson and gave himself more times to think things through I am sure that he would make fewer errors. He tends to be a little impatient with the result that his recorded work can be untidy. Owain can work as part of a group but is happier working individually. He must be patient and follow instructions. He has a vivid imagination and makes the most of his ideas. His planning is very methodical and he often struggles to meet deadlines. Owain thinks that he is no good at sport and doesn't really give himself a fair chance.
Music Teacher: Owain has had a mixed year. In the autumn term we were able to build on the success of Owain's Grade 2 exam, but the spring term was very disappointing. Owain managed only 4 effective lessons in the spring term as he repeatedly forgot his music and diary. Damage to his instrument also meant two weeks without it. Summer term has been much better, and we are now working towards Grade 3 in autumn.
So - there are definitely words and phrases which spring up constantly throughout those reports. Needs to pay more attention. Easily frustrated. Can be a little impatient. Needs to listen and remember instructions better. Needs to get better at taking turns speaking. Talks too much. Doesn't remain seated. Has difficulty keeping quiet. Loses things necessary for tasks. Needs to take more care in work. Doesn't appear to listen when spoken to directly.
Hmmm... Is it just me, or do those reports tick off pretty much every bullet point relating to both inattention and hyperactivity-impulsivity in the DSM-5 Criteria for ADHD????
Whilst these are school reports, so they're focusing on performance and behaviour predominantly - it also strikes me just how much of the language is all about how I have to or need to or must improve at things - at the start it was worded differently; has difficulties with or struggles with, whereas later on it was much more focused on ways in which I had to do better.
I'm not sharing these reports to argue anything written was Wrong, and I don't harbor any resentment to teachers or anyone else growing up. The purpose of sharing them is to paint a picture of where I did have a whole bunch of difficulties, but all difficulties that presented as behavioural and conduct problems, and subsequently managed to fly under the radar - but as some of the later reports show, I was effectively coping despite myself sometimes, or at least that is how I felt. I didn't understand that I was neurodiverse, I just knew I was having trouble with X but I could do better if I just tried.
Psychiatrist's Report in 2013 (me at age 20)
(So I was sort of on the right track here! Just looking at the overlapping characteristics between ASD and ADHD from the wrong side of the venn diagram, perhaps... Looking back, when I visited the psychologist I was talking of Auditory Processing problems, periods of burn-out, feeling like a bit of an alien, hyper-focusing on personal interests, and delayed/shifted sleep cycle.)
Owain has been doing some background reading and wonders if hr has high-functioning autism/Asperger's difficulties. I asked Owain to try and produce a summary list of his current problems:
- He said he has noticed difficulty with eye contact and that this was pointed out to him when he was in the sixth form by his peer group. They noticed how difficult he found it to hold gaze for any normal period.
- Owain described difficulty in rapdily processing what other people are saying. For example, he said he is taking driving lessons and gets instructions for left and right confused, or he responds to an instruction but then does not undertake that action.
- At other himes he says he finds has has to ask someone to repeat things as it may take him a few seconds to realise that someone is talking to him.
- He says he works better when there is no-one else in the office.
- "Going in and out of depression." I asked him to break this down for me. He says he has noticed since 16 or so that he may have periods of a few days at a time when he feels low in energy, motivation, focus and concentration, although he finds if he gets into a routine then this tends to stave off these feelings. He has never experienced tearfulness or suicidality. Since the move to Plymouth he feels these depressive days have become slightly more common and at those times he will tend to have a day/night rteversal where he will stay up. Nevertheless, he seemed quite happy in his night time activities, either sitting on the internet or lying in bed having positive ideas about things. He is also feeling more worried about his sense of lack of social skills and says that he will say nothing most times in a group situation, either at work or socially. He worries that he may be seen as aloof or arrogant.
He is not particularly spontaneous and prefers to plan and organise things in advance. Of note he said computers have been a special interest, if not an obsession of his, since he was a young child, and he would happily spend all day playing or working on them if not interrupted.
(So this report got me a bit bummed out, because I read into it like "Oh, this ain't it, Chief" and felt a bit silly for barking up the Neurodivergent Tree. Psychologist had spoken and remarked that actually I was Pretty Normal, and just... Anxious. I wonder if it would have turned out differently had I had my school reports on hand then... Would they have picked up on the ADHD characteristics? Would we both have still been interpreting it through the lens of ASD? Would I have wound up with an Autism diagnosis which didn't quite fit? What if it does fit a little, still...?)
Owain presented promptly with excellent self-care. He was clearly nervous and there was some mildly decreased eye contact compared with normal but he was readily engaged with fluent speech. I detected no idiosyncratic use of language. He did not seem to struggle particularly with social cues. He said his mood was a bit low and anxious but objectively I could not find any evidence of pervasive mood symptoms. In his thoughts he has clear and high functioning goals about his working life and he is clearly enthused by this. His anxiety appears to be generalised and related to social confidence. Cognition was intact, percept unremarkable and insight good.
I said to Owain that hw perhaps had very mild Asperger's symptoms, more typical of traits than syndrome. We talked about medication for anxiety but both agreed that actually it would be better to approach it using talking therapy such as CBT.
Industrial Year Placement Report (July 2013; me at 20 again)
(I include this because it adds to the picture - some of the stuff I was told I needed to improve on as a kid was still there - bad with mornings, sometimes rushing work, coming across badly or misunderstandings, being shy and "diffident". But conversely, working really hard!! It goes to show though that there's things there that I couldn't simply "grow out of" after childhood).
Some absences that were unexplained until afterwards, consistent late arrival at work (though he did as consistently stay late). Worked hard to meet deadlines for research starting dates. Occasionally needs to take a little more care with his work, though offsetting that we did have at least one very positive user comment about Owain's work. A couple of occasions where work that was Owain's responsibility was not done, though there is partial mitigation because he would argue he didn't know he should have - we might suggest he should have, but it is true he was not told explicitly - this may be more about initiative than professionalism. Spoken to on several occasions for using Facebook on work time. On the one hand his consistent lateness and other professionalism comments would suggest a lack of commitment. On the other he has repeatedly worked late and done more than might have been expected out of hours. On balance I think the latter outweighs the former. Integrated well with other team members on the same project, including working closely on research support. Has communicated well with different customers via email. Sometimes needs to speak up a bit and try to be a bit less diffident, but has no problem getting his point across. Owain's technical abilities are strong and have increased over the course of the year. Owain is an intelligent guy who is capable of solving complex technical problems with limited supervision. This will stand him in good stead eventually. It is unfair to give him a low grade because his quality of work has been high. On standard of work I would grade him "Good" on professionalism I would grade him "Poor, but not without merit".
Psychiatrist's Assessment, February 2021
(Including only the excerpt where the psychiatrist gave their opinion, as everything else is background info. The "relatively mild" thing was disheartening at the time, giving rise to impostor syndrome, but I should think of it in terms of how well I've done, and remember how psychiatrists look at things in terms of clinical risk.)
Owain has some evidence of inattentiveness and some symptoms of hyperactivity including restlessness, difficulty falling asleep and engaging in quiet leisure activities with others although however his symptoms are relatively mild. [...] on balance we agreed probably that he is suffering with some impairment and that a trial of stimulant medication would be justified.
Yeah, this might be a bit overshare-y or self-indulgent, broadcasting my old school reports. But for me it's kinda cathartic. They will serve as a reminder to my future self to think about what things kid me struggled with, how I learnt to navigate around those struggles - and now I notice them more clearly, perhaps there are better ways to deal. Although as my adulty skull ossifies, I think I've "grown into" it quite well - thinking of it with a growth mindset!
Anyway - I've enjoyed writing these posts. I think I've got most of the me me me me bits out of my system now. I'm still pretty fascinated with figuring out how my brain ticks, neurodivergent thinking, excited by the surrounding communities. I'll probably write more in future - but I'm quite happy to have some Rest Days at last. And, next month, I might actually shut up about ADHD for five minutes 😅