It’s been a couple of years now since I was diagnosed with ADHD.

While waiting for my assessment, I went out one day to run a few errands before my afternoon shift on the suicide crisis line. On the list: finding a few presents (on a tight budget) for the sixteen year old’s birthday, buying food for the next couple of days, replacing a watch battery, hunting for the Unicorn Of Trousers that would be acceptable to my sensory-sensitive thirteen year-old (along with returning the last pair that had not met the brief) and picking up Nurofen for the hip bursitis that continued to give me problems. ‘Call Mum’ and ‘Call Dad’ were scrawled across the bottom of the list.

I fuelled myself with a strong flat white and motored around the stores of a beepy-flashy-crowdy mall. I became anxious as the time ticked on and I had not found any suitable birthday presents or potential pants. I lost track of time in the supermarket, where menu ideas for the next few days kept popping into my mind, making the ‘little shop’ blew out to a couple of heavy bags worth.

I was starting to panic. I knew I had no other chance to fit in a shopping trip before the birthday. Then, a flash of inspiration: in my wallet, languishing for eight months, had been a voucher for the op shop connected with my crisis line. My hip ached miserably as I carted the heavy grocery bags to the car and drove across town, but I felt optimistic about the hope of picking up a top or two and a book about movie-making for my teenage film nerd, all for free.

At the op shop I struggled to find any good presents, but some hand-knitted jumpers caught my eye. The weather was turning, after all, and the blue was quite lovely. Better try it on though. I grabbed an unwieldy popcorn-maker. A fun birthday gift for the 16 year olds caravan? The bookshelves didn’t yield anything on film, but I started hunting for books for the other two children. If I didn’t use the voucher, it would time out and be wasted, so I decided I’d get a jump on Christmas. I had to hurry though - it was nearly time for work.

I staggered into the changing rooms, armed with the popcorn maker, my overloaded handbag and a towering stack of books, which tilted and began to fall. I tried and failed to stop their trajectory, wrenching my hip and scraping a graze on my arm with a wire coat hanger. I held the bleeding arm out and away from the jumpers while I scrabbled in my bag for something to stem the blood before it soiled anything. My hand landed on a piece of paper, which I used as a blotter. Crisis averted, I looked down to see that I was holding a referral from my GP to the psychiatrist, asking him to see me regarding assessment for ADHD. The doctor’s signature was now obscured by a pink, blooming bloodstain.

This comedy of errors is an example of what is sometimes called the ADHD tax: the costs of living with a distractible and impulsive ADHD brain. It can be literally financial, but it can also spread its sticky tentacles through many other domains of life. Tax can be paid with the extra work and effort that it can take to wrench normalcy from an ADHD brain; or to repair the messes made. Tax can also be paid emotionally through guilt, shame, anxiety or remorse. Tax can mean addiction, poor mental health, unfulfilling personal relationships, fractured work history, or entanglement with the law. Sometimes it’s a small price. Sometimes it is the largest of all. Sometimes it’s funny. Usually not.

Another story.

Early in the pandemic, my friend L lent me two bags of books. She never chased them down, even though I had them for at least a year and had long finished with their pleasant company. L and I are old friends. She knew that the books would eventually migrate down the hill to her place. But dropping them was somehow impossible, and so I carefully midwifed them through lockdown-anxiety, keeping them separate from my own books and adding ‘return L books!!!’ to list after list after list.

At some point, I transferred the bags to the car in order to move me closer to that inexplicably difficult drop off and then the bags migrated, ominously, from the back seat to the boot, where the op-shop bags for donation lived.

I was frazzled as I emptied the boot of op-shop piles into the donation bin on morning. I was tired. My back hurt. I had stepped on my glasses and they only had one arm. As the last bag left my hand, an icy realisation: it was full of L’s books.

‘What kind of moron puts a bag of books to return next to the op shop pile?’ I railed to my ten-year-old child. ‘Every moron would, Mummy’, she said loyally.

It took days, but my series of calls and emails to Anglicare finally wound their way along the sluggish veins of the system to lead me to the number of the man who emptied the bins. He arranged to meet me the next day at dawn, where I cried in the inky dark. The bin had been already emptied two days before; L’s books long pulped or sorted.

I replaced some books second-hand, bought some new, added a voucher. L was kind and I felt wretched; the tax both financial and emotional. It was not just that I had lost the books, but that I was the kind of person who would.

Still, lost books and bloodstained referrals are small fry compared to the darker risks of ADHD, which are many and varied. Those of us with ADHD have a shorter life span than those without. It doesn’t get much blunter than that.

Nearly twenty years ago, the Berkeley Girls with ADHD Study started to follow females with ADHD from childhood to adulthood. The researchers found that girls with the combined form of ADHD had markedly elevated risk for both self-harm and suicide attempts by the end of adolescence, and a follow-up study found that impulsivity significantly predicted young adulthood suicide ideation, suicide attempts, and the severity of self-harming behaviour. The risk of elevated harms related to ADHD includes eating disorders, accidents and injuries, unplanned pregnancies, chronic stress disorders and eating disorders. In adolescence, the ADHD brain is sensation-seeking and risk-taking, putting us at disproportionate risk of self-harm and suicide.

ADHD is sometimes described, brutally and neatly, as ‘action without foresight’, and impulsivity can be the trait most connected to the ADHD tax. An impulsive brain is one that struggles to prioritise and filter options. Like a spinning slot machine, it tumbles through possible choices before settling on one, seemingly at random.

I broke my back on a speedboat aged 24; not through my own direct impulsiveness, but as part of a larger pattern that saw me partnered with a reckless boyfriend who pointed a boat into heavy swell on the Sydney Heads as I shouted ‘slow down!’

Here’s how I described it in my book Mothering Heights:

Racing through the notorious surf of the Heads, I was knocked off my feet by a monster wave. Time slows as I sail backwards through the salty spray, free as a seagull, until I land, with a violent punch, on the fibreglass deck. The blow travels up my spine until it meets the fused section in the middle, where the velocity stops so suddenly that the vertebra underneath my fusion snaps like a twig. I lie, unable to move, vomiting with pain on the floor of the boat, compulsively apologising. The choppy wash of a windy day is tossing the boat about roughly. I feel a sensation of detached horror. I know that I can’t move. I know that I am here for the duration, living perhaps, on the floor of this boat forever. I certainly can see no way of ever getting off. A few plants, perhaps. A throw rug? I’ll have to make it work.

I stare up at the slowly-moving clouds while my reckless man-child boyfriend motors us to the mooring where an ambulance can reach. I am supposed to be meeting a friend for lunch in an hour. I am supposed to be moving to London next month. I can feel, already, that this moment bisects my life: there was a before, and there will be an after, and I suspect the after will not be fun.

I wasn’t driving the boat. But the series of choices that had me onboard? They were all mine, including putting myself in the hands of the boyfriend who, despite his lovely qualities, was very bad news for me, and in fact was probably himself a walking, untreated ADHD machine. (Another outcome of diagnosis is the permanent tic of seeing ADHD in all your family and friends. We travel in packs, after all.)

Like many near-misses of my reckless youth, this accident was bad, but could have been way worse. People with ADHD are prone to a bit of mystery bruising. Studies have linked it with hospital admission from accidents in which individuals involved were referred to as ‘clumsy’, and it’s possible this is due to a combo of poor balance control (a problem located in the cerebellum) combined with impulsivity and inattention.

For me, the trait of impulsiveness has caused me many problems downstream. Missed deadlines, forgotten appointments, impulse decisions. Blurted comments that should never have left the brain, or behaviour that upsets friends and betrays my own internal values, leaving me with a dissonant, nauseating sense of moral failing and scrambling to cover up and repair the mess left by these small indiscretions. I misdirected away from the hot failure. Look! A puppy! See me tap dance! The shame. The dissociation. The regret.

It’s not all bad, of course. Impulsiveness can also mean creativity and ingenuity. The innovations that may be our only chance to navigate our way through climate collapse will likely come from a neurodivergent mind. But our downfall may too. It’s a blessing, or the curse. Or, as with most things: a little of each. As Paris Hilton says, ‘Creative energy’s evil twin is a trouble making compulsion.’

The ADHD tax is the strongest argument, for me, against the notion of an ‘ADHD trend’. Sure, the architecture of a neurodivergent brain can be pretty cool, and I can see how people might want some of our sweet Focus Medicine, but these things come at a price. This brain anomaly holds a ticking bomb; and the expression of it is dependent on so many factors of nature and nurture.

I’ve made many mistakes, taken many impulse decisions, and tumbled into many shady situations. But with the privilege of loving friends and family, a childhood free of serious trauma, and the luck of the dice, I’ve avoided the particular risky behaviours that can lead to chronic health problems, imprisonment, and death.

Understanding my diagnosis - and accessing effective medication - has made a huge difference to my life. The sharper edges of my ADHD have been shaved and pruned as I better understand the machinery of my brain and operate it less like Edward Scissorhands. But I lived five decades undiagnosed; a whole history of tax after tax after tax.

I loved this recent Australian Story episode where Celeste Barber is vulnerably honest about her struggles. It reminded me of how, separately, two of my best mates expressed nervousness that I would change once medicated. They liked their loose, wild, untrammelled friend. But I feel protective of the calmer, careful person. ‘If you turn into a boring bitch I’m taking you off the pills,’ they both joked. I am, a couple of years on, a much more boring bitch. But I feel… not happier exactly, but a lot clearer about who I am. And I’m paying a lot less tax these days.

Take care, comrades! Let me know your thoughts.

ADHD series

ADHD files #2: It’s Neurobiology, Baby!

ADHD Files #1: When Perimenopause Meets ADHD