As more people become educated about neurodivergence, it is only logical that the number of people diagnosed with neurodivergencies will increase, which includes those with ADHD. Some people think that conditions such as ADHD and autism are some kind of diagnostic fad whose numbers are overblown and overmedicated. I disagree, and so does the research, so I encourage you to seek reliable information rather than wasting my own time making the argument.
But that's neither here nor there. Being an American who worked for years in the healthcare industry and was raised by a licensed social worker who now has an outpatient practice, I have had more exposure to the medical world than a lot of people. And in my experience, between an Irish person and an American person with the same symptoms, the American is more likely to make a doctor's appointment while the Irish person might take a paracetamol and hope for the best. I get it. I see things a little differently in my new country than a lot of my peers, but I'm ok with that.
I also seem to be drawn to neurodivergent people, for whatever reason, and have encouraged multiple people in my life to get assessed and all but one of them obtained diagnoses. I'm like the neurodivergent whisperer. However, despite what you may read below, I encourage anyone who thinks they may have a neurodivergence to seek an evaluation and don't give up until you get one.
Shortly after my partner and I moved to Ireland, I noticed that he was really struggling with his Master's work, particularly his independent thesis. Regular classes, which came with the accountability of classroom discussions and essay deadlines, seemed to be easier to manage. However, once he was left to his own devices for the thesis, he struggled to keep up. We were on social welfare at the time, so we asked our then-GP for a referral to get him evaluated for ADHD. She seemed confused, but made the referral, possibly because she had been the GP for his entire family for decades and let's just say certain traits run in the family.
However, when it came time for the psychiatrist in the HSE Health Centre to meet with us, things went very pear-shaped. By then, we'd done some research and some reflecting. We knew he met the diagnostic criteria for ADHD. But the doctor that we met with? According to her, ADHD in adults doesn't exist. It certainly doesn't exist in people who passed the Leaving Cert (even if it took two tries), apparently. And for someone with multiple diplomas? Preposterous!
No no - according to this person, ADHD is an invention of American drug companies who want to get everyone hooked on addictive stimulant medication. And we only thought my partner had ADHD because we'd spent so much time in America and clearly had been duped by the US pharma industry. So it's no surprise that when he mentioned he'd experimented with drugs in order to self-medicate, she gave us a long lecture on the evils of drugs and from that moment treated us as drug seekers.
It will be no surprise to learn that we did not get him an ADHD diagnosis that day. The doctor said she'd happily refer him for CBT and he was welcome to anti-depressants if he wanted them, despite the fact that he had no symptoms of depression at that time. We left feeling very, very angry and helpless.
We managed to scrape enough money together for a private evaluation. The cost was more than 300 euro. He administered several tests and questionnaires, and interviewed my partner extensively. After he reviewed all of the material, he confirmed that my partner did indeed meet the diagnostic criteria for ADHD.
But he couldn't prescribe medication, as he was a psychologist and not a medical doctor. So he referred us to a psychiatrist who would have to confirm the diagnosis and write a prescription. We cycled up to the appointment, not knowing what to expect. The psychiatrist reviewed the material from the psychologist and asked a few questions to my partner. Then, very casually, after what couldn't have been more than 20 minutes, he informed us that my partner was autistic. 'Just a touch!' he said, so as not to alarm us. We were both so stunned that we didn't say much. He wrote out a prescription and asked for another 300 quid. The appointment hadn't lasted a half hour. At the time, we were so broke, that I'm sure I physically jumped. We didn't know it at the time, but this was one of Ireland's top autism experts and highly sought after. Still, he hadn't earned our 300 quid. So my pushy American kicked in and I friggin' haggled with him. And you know what? It worked. We paid 150 and it was money well spent.
Yet as we cycled home, we looked at each other, absolutely perplexed. Autism? (Or, as it was called at the time, Asperger's Syndrome.) How was that possible? In fact, he had done a whole research project on Asperger's in university and never considered that he might be on the spectrum. So we did what anyone would do: we googled it.
And let me tell you, if researching ADHD was an epiphany, seeing my partner through the lens of autism was a revelation. ADHD explained a lot, but autism explained much, much more. All these 'quirks' and oddities that I thought were unique? Nope - classic signs of autism. In retrospect, I don't know how our relationship managed to survive five+ years of neurotypical expectations.
If you think getting evaluated for neurodivergencies in Ireland is hard, well, you're not going to like what I'm about to tell you about finding supports for them, especially supports through the HSE. Generally speaking, if you can make it to adulthood and pass as neurotypical well enough to go to college, get a job, and generally appear "normal" (with the biggest scare quotes imaginable), then you will struggle to find accommodations from universities and employers, even with said institutions claim to provide them. You may technically have a disability and be eligible for disability supports from the HSE, but good luck navigating the system to access them.
The first big barrier was academia's attitudes toward supports. After completing his Master's programme, my partner was accepted to do a PhD. It's common knowledge that getting through a PhD is challenging for everyone; for someone with both ADHD and autism, it takes a Herculean effort. Add to that the stress of being evicted from our home during a housing crisis, losing our beloved cat, and then the pressures of having elderly parents. He had registered with the disability office of the university, but they didn't know what to do with him. They had nothing to offer, no accommodations and not even a counselling service. And he didn't want to talk about being a person with ADHD and autism for fear of losing respect or being seen as using them as some sort of an excuse invented for poor performance. Except that...he was struggling. And he needed some slack, not to mention editorial guidance. By the time his mother passed away, he was so far into burnout that there was no coming back. Three-quarters of the way through, he quit.
Now, we know that autistic academic burnout is a real thing and it's intense. But are things any better at that university for people with ADHD and autism? Probably not.
We managed to get a meeting with an HSE disability officer. She was very understanding. We got a referral to an organisation who helps adults with autism. However, they help people who struggle with day-to-day tasks, who need training and practice with everyday conversations and socialising, and generally from a younger age group. For someone that didn't even get diagnosed until 40-something years of age, this organisation just didn't know what to do to help.
Meanwhile, my partner became a full-time carer for his father, who was slowly dying from an unfortunate combination of physical and mental ailments, including dementia. His physical ailments may have been surmountable, but the dementia had taken away his appetite, and we essentially watched him starve while his body became too weak to ward off recurring infections. Family carers get a massively raw deal. If the person in need is elderly, you are trying to keep someone alive 24/7/365 knowing you will definitely fail. Any disability that you yourself may have gets pushed to the side. No matter how difficult it gets, you have to keep doing it because there's no other option. Respite care exists in theory, but I can say from experience that in reality, it's often not possible.
Feeling frustrated with public health options, I tried to find someone who specialised in ADHD and autism in adults who could at least offer advice or guidance on managing a caring role while having these neurodivergencies. The fees these people charged were astronomical. Thousands of euro. We simply didn't have it. So we just had to persevere.
And this has been the most frustrating thing: finding support for ADULTS with neurodivergencies in Ireland. Nearly everything is geared toward kids, and even then, neurodivergent children in Ireland don't get enough support. So you can imagine how difficult it is to live in a world that expects you to act, appear, and BE neurotypical once you reach adulthood.
It's a fallacy that autistic people don't have empathy. I fucking HATE when people use 'autistic' as shorthand to describe a sociopathic asshole or someone just generally awkward. But many people with autism will struggle with how to live in a world where they are forced to do things that simply don't come naturally to them, particularly when it comes to care roles, whether that's parenting or ministering to an elderly parent. And we, as a society, are letting them down. The lack of supports for adults leads to a lot of pain, and it also means that the people they care for needlessly suffer as well. And I'm not saying that my partner didn't do an amazing job caring for the three elderly people in his life; I'm saying that it came at a huge price and didn't always go as planned.
For me, in the middle of all this, I could no longer ignore that the books I was reading about ADHD also described me. My partner would often read about an ADHD trait and proclaim, 'That's YOU! You do that!' and I'd try to shush him and ignore the fact that he was right. And there is ADHD in my family, so really I should have put it together sooner. By the time I managed to get a private evaluation, I was 38 years of age. Upon being diagnosed, I decided to put off medication, as I was hoping to get pregnant. The psychiatrist said to get in touch when I was ready and he'd write it up.
Five years later, when that was no longer an issue, I decided to see if medication would improve my ADHD. The guy who diagnosed me had retired. That's when I discovered that no psychiatrist will prescribe ADHD medication based on another practitioner's diagnosis, which is why that doctor so many years ago had wanted to charge 300 euro. He considered that an evaluation, not just a consultation.
After waiting for six months to see a new psychiatrist and paying another 350 euro, I got my medication. And then I had to pay another 150 for a check-up... three more times before she agreed to let my GP manage my meds going forward. And let me tell you what this entails.
Ireland recently passed a law that means doctors can't prescribe more than one month of a stimulant medication. So for example, I take allergy meds. When I request a refill from the GP via email, they will typically send three to five months worth of scripts. Of course, I can only fill one at a time, but they remain on file in the chemist so all I have to do is pop into them when I need more. But with my Medikinet (slow-release Ritalin), I have to email a refill request every single month. (And if that month has more than 30 days, you need to rob Peter to pay Paul, i.e. skip a day). For someone who struggles with executive functioning, this can be a very large barrier, if you even manage to get through the barriers involved in getting a prescription at all. This paradox is beautifully explained by Jessica McCabe from the Youtube Channel 'How to ADHD':
