Faye and her husband call it “the space-time continuum”.
“It’s the time between when we say we’re going to go to bed and the actual time we get to bed,” explains Faye, a professional eBay vendor from Bedfordshire, England.
“Let’s say it’s midnight – we could easily be in bed in 10 to 15 minutes. But nah. By the time we get to bed, we’ll look at the clock and suddenly it’s 1am. And we’ll both be like: ‘What the hell just happened?’”
Time doesn’t function for Faye the same way it does for many people.
She says she’s not able to estimate and follow time, which leads to “blind panic” if she has to catch a train or drive somewhere by a certain point. But it’s increasingly clear that she’s not alone.
Last year, when she was diagnosed with ADHD in her early 40s, the space-time continuum suddenly made sense.
But this struggle with time perception, common among those with the disorder, is not one of the officially recognised symptoms.
A new study suggests it ought to be, along with two other indicators.
As our understanding of ADHD grows, along with the number of people diagnosed, should we be paying attention to more of these ‘hidden’ symptoms?
Spot the signs
About 1 per cent of England’s population has a record of ADHD, according to a wide study published in The Lancet in June, but the authors believe this is a significant underestimation of the true numbers.
In the US, the official rate is far higher: roughly 6 per cent of adults, or about 15.5 million people, currently have a diagnosis.
Yet even that figure is likely conservative, given more than half of US adults with ADHD weren’t diagnosed until adulthood.
Internationally, the main tool used to diagnose someone with ADHD is the Diagnostic and Statistical Manual of Mental Disorders (DSM), published by the American Psychiatric Association.
The DSM details the three widely recognised symptoms of adult ADHD – inattention, hyperactivity and impulsivity. Another three are mentioned briefly – disorganisation, forgetfulness and difficulty starting or continuing tasks.
But researchers who interviewed 11 adults who had been diagnosed with ADHD say there are “gaps in current assessment tools” and that they believe guidelines should reflect “symptoms that are more reflective of the adult experience of having ADHD”.
Writing in the Irish Journal of Psychological Medicine, the researchers say a further three symptoms of adult ADHD should be widely acknowledged:
1. Emotional lability: quickly fluctuating emotions and intensity across a range of emotions, including sadness, anger and happiness, that can leave you feeling drained.
2. Sleep difficulties: a struggle to get to sleep despite feeling exhausted, often due to racing thoughts, restlessness and hyperfocus.
3. Time perception: including overestimating the amount of time needed to complete undesirable tasks and underestimating the amount of time needed to meet a deadline.
The pool of people interviewed in the study is relatively small, but the findings are compelling, experts say.
Jannine Perryman is the founder and CEO of ADHD Wise UK, which offers screening for ADHD and coaching for those with the disorder.
Perryman, who has ADHD herself, says all three of the symptoms, most notably struggles with time perception, were common among diagnosed adults. She compares it to colour blindness and calls it “time blindness”.
“We place some moral judgement on people who struggle with time,” she says.
“I would say this is the most disabling factor with ADHD because you are shamed into managing things and you might overcompensate because you hate that feeling and therefore you become really anxious about time.
“But can you imagine what it’s like to not be well anchored in time? To not know what hour of the day it is? To not know how long things take, not know what week of the month it is? To not know what month of the year it is and actually sometimes to not even know what year it is?”
Emotional lability, Perryman says, has “mostly been documented historically in terms of people getting angry. But the reality is that the lived experience is not just anger to rage.
"It is also excessive empathy, being able to feel other people’s feelings, other people’s injustice, other people’s excitement almost as keenly as if it was your own.”
Tabs open in my brain
Prof Joshua Stott is a professor of ageing and clinical psychology at University College London and one of the authors of The Lancet study looking at ADHD prevalence.
“I think they’re all very, very recognisable as symptoms of ADHD in adults,” he says. “They’re all very widely known about in the ADHD assessment community.”
The understanding of ADHD is developing rapidly, especially when it comes to how it manifests in adults who may have lived with the condition unwittingly for decades.
Both Stott and Perryman say it is crucial for clinicians to listen to patients and recognise patterns of behaviour among adults. But, they add, it’s just as crucial that those drafting the guidelines take the time to ensure they are correct.
“Categories develop and I think that they should develop,” says Stott. “The DSM is a developing document. I’m hoping in the next iteration of the DSM, there will be changes to make it more aligned with what people’s real-life experience is.”
For Faye, finally getting an ADHD diagnosis helped give her answers to what she had failed to understand for years.
After receiving medication, she says she still feels she has multiple tabs open in her brain at the same time, but “now I can deal with one tab at a time”.
And while sleep disruption was not officially discussed as a symptom of her condition, she says she is now sleeping better than ever. For the first time in years, she feels rested.
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