5 Signs Of High Functioning ADHD (Explained by a psychologist) | Dr Mark Rackley

0:00High-functioning ADHD, it's an appearance. It's what appears in terms of this person having ADHD and what their life looks like. It doesn't give you the reality of what's going on behind it. So it's very much face value stuff. Your life would suggest, yeah, despite the challenges of ADHD, he does really well. However, they don't see the hidden struggle behind it. Dr Mark Rackley is an ADHD specialist with more than two decades of experience helping neurodiverse people with their mental health. He's back by popular demand to deep dive into the struggles of ADHD. And to help you understand yourself.

0:33We know ADHD and addiction, sadly, can go hand in hand. Well, with high achieving, it might not seem so obvious in terms of it being an addiction. It can lead people to becoming workaholics. If they're high achieving or trying to overachieve or overcompensate, they could then become that type of workaholic, which is constantly trying to spend more time in the office or being very consumed with their jobs, overly worried. They're trying very hard to be conscientious, but that comes at a huge price. How extreme can masking get in someone with ADHD? That's the truth of it, which is...

1:13Five signs of high-functioning ADHD. And I think it's a topic I wanted to cover because I've been called high functioning before i've spoken to many people who have been called high functioning and for me it feels like a bit of a invalidation towards the the struggles that can come yeah so i looked up high functioning and it said that you seem to be able to get through your day without any struggle but i think the more i thought about it it's you can get through your day without any struggle from the perception of others. But from your own point of view, there are significant hidden challenges and struggles that are invisible to other people.

1:54And I think as an example, if I go to a meeting, I could turn up to that meeting and be present and engaged and focused. But what they don't see is that I've been waiting in my car for two hours because I'm so scared of letting them down and being late. Or if I have like a Zoom meeting in the afternoon at 4 p.m. Again, I can be very alert, very focused in that meeting. But what they don't know, what they don't see is that I have been waiting all day and unable to do anything else before that meeting. And I guess that's the point of this conversation is to really shine a light on what it really means to be someone with ADHD and quote-unquote high-functioning.

2:35So I suppose my first question is how would you define high-functioning ADHD? Yeah, I'm so glad we're talking about this because these conversations are the nuances of ADHD. Because obviously we can talk about the very obvious symptoms a lot. But the nuances like this are so important because that's the day-to-day lived experience that people will struggle with, but not necessarily talk about, or it's not maybe so obvious that this is ADHD. And that's the kicker with this high-functioning ADHD label. Now, just to clarify that, that's on a clinical diagnosis. I don't think I've ever said that to a patient.

3:22Hey, you've got high-functioning ADHD. I've never said that. but I've heard it and I've often heard my patients say to me oh I've been told I have high functioning ADHD so we need to break that down what is that? what does that person mean? so high functioning let me think of okay well that means that your level of kind of functionality whatever way you're describing that is high in the space of having ADHD which if you think about it, it kind of makes no sense because one of the big symptoms and problems of ADHD is a problem with executive functioning. So how can you have problematic executive functioning and high functioning at the same time?

4:16It just doesn't align. So high functioning ADHD, it's an appearance. It's what appears in terms of this person having ADHD and what their life looks like. But it's exactly what you just said. It's an appearance. It doesn't give you the reality of what's going on behind it. So it's very much face value stuff. Let's stay with you. Where you are a very successful man, parents. You do amazing things with your life. what people don't see well what goes on behind that so I'm not surprised you get that label oh well Alex Partridge has high functioning ADHD because yeah your life would suggest yeah despite the challenges of ADHD he does really well yeah however they don't see the hidden struggle behind it so for me a high functioning ADHD like I kind of want to call it out really because I don't see that as a positive and we will talk about that a lot today hopefully that um it it's it's not necessarily a compliment to the person who hears it if in fact if anything it can be seen as pressure which is okay you you think i'm like this and of course for somebody with adhd then the pressure can be well then i have to then sustain that i have to then keep that kind of impression going which of course can put huge internal pressure on them it's so true i feel like if someone calls someone with adhd high functioning they don't mean that you've made your adhd easier for yourself you've made your adhd easier for everyone else around you and i love that yeah yeah you i mean it was really quite an emotional way of putting it because yes you can appear the perception of yourself can be hard-working high achieving yeah but you're inside in a in a state of overwhelm anxiety always on the brink of burnout yeah and i think it's exhausting right like absolutely yeah i suppose how big a conversation if we go to the first sign of adhd high functioning masking like how because that's really what it is right high functioning we could probably just rename it as high masking high masking or even the other word i would use is overcompensating yeah and what does that look like is that holding it together because it looks like if you go to work or if you're in your relationship and you're holding it together and you're coming across like you've got your life together but then that person who might have that perception of you all they see is the brilliance all they see is the smiles all they see is the is the accomplishments they don't see you getting home at the end of the day falling against your door behind as it shuts and falling to the floor and bursting into tears like how extreme can masking get in someone with adhd very extreme again i love the way you describe that because that's the truth of it which is it is um it is that person massively trying to adapt and keep it all together um so that they can function and that they can manage their life.

7:59Now, do you think I would say as well, Alex, is which is why the overcompensating piece comes in is we know with ADHD that lots of people with ADHD, they struggle with being different. They struggle with very strong feelings of shame. So a lot of the times it's trying to offset that. It's to blend in. It's to not be too much. yeah so constantly adjusting constantly adapting constantly trying to give the people what they want but that's very much to kind of like to to hold everybody else at bay so that you can then feel okay so so it's it comes in a huge personal strain to you so let's let's think about kind of what might be happening inside of that person then so they might be constantly overthinking having to rehearse what they're going to say in meetings, having to read the email 17 times so that they can reply to it properly.

9:00It's having to, I was trying to say a step ahead, be really conscious of the RSD not kicking off. So it's exhausting. It's just exhausting. And also if you put into that as well, being on time for things, having the conversations where you're not going around the houses and oversharing or staying on point. It's all that stuff. So if you're trying to keep all that at bay and then the appearance is, it's all, you know, I've got all this, then the struggle to hold all of that. And like you said, then the moments where, say if you're in the office, where you go into the toilets and you're like, this is like i'm done then you have to go back out and do it all over again or when you get home like you said and you're on the other side of your door and you're bursting into tears and it's so all the overwhelm is coming out that that that's the that's the price of it yeah but externally it looks like wow this person's got it all together because you're you're blending in you're like i say you're masking so it's very much a very high price for your body and your nervous system and your brain to do that all the time which of course is why as well it can need to burn out yeah it feels like you show up for everyone else apart from yourself you said they reading an email i can read an email with my eyes so many times and my brain is just not reading it yeah yeah yeah and the same with books yeah my thoughts my brain is i describe it like fireworks you know i've said before it's like 10 highly caffeinated squirrels barreling around but it's it's there's no chronology of time in my mind with my thoughts it's like a firework display like a thought will go off and it will last for five seconds max and then another one will go off yeah in a different part of my brain and that's like that is how my brain works and it's very difficult to have a true understanding of time when your mind works like that yeah um and it can lead to a lot of internal struggle but again it's it's the hiding it and showing up to your partner to your boss staying up all late all night like through the night trying to get a piece of work done so you don't let that person down in the morning if you're living life this way people with ADHD, RSD, you mentioned rejection-sensitive dysphoria.

11:42If you are showing up for everyone else but not yourself, and even after you put all that extra effort in, you still get a criticism or you still get a rejection. Is someone with high-functioning ADHD hypersensitive to rejection? yeah i i think again that can be the real sting in the tail which is if um like if if you're constantly doing it for everybody else so you're you're you're you're doing all of this for the validation or again just to to not to not feel the shame or to expose yourself as being different then you're not validating yourself so it's very much about the external praise it's very much about that the external validation makes you feel safe.

12:30And it's like, I'm doing okay here. This is okay. But of course, it's a risky strategy, Alex, because you're banking on the external validation that's going to keep coming, which of course is unrealistic. So if you do get some kind of negative validation or somebody kind of calls you out, and I've heard you talk about this before, Or it's that kind of, you know, the email or the person saying, can we have a quick chat later? Like, that's not a, okay, that's a, the world is falling apart. The sky is falling on my head. It's catastrophizing. Like, oh my God, like it's huge. It's huge. So that's the kind of awful side of it, which is, well, yeah, it's grand as long as it's all okay.

13:20And you feel safe and you feel like this is working for me. But then, of course, you have no control over that. And so that's why it's such a risky strategy, because then if something comes at you, it can all fall apart very quickly and it can spiral very fast. And again, just once the kind of RSD kicks off, then the emotional dysregulation will kick off, which can lead that person to, certainly in some of the cases I treat, and it's awful. It's a full-blown anxiety and panic attack. I got very anxious just hearing you say, can we have a quick chat? Trigger it! Without any context. I'm going to get fired, or your partner says it.

14:02It's like, oh, the relationship's doomed. I mean, there's a serious side to it, though, because I think we know rejection is so painful. We know criticism can feel like a punch to the stomach. And we see it when it's not even real. Like the perception of it, which in that example, if your boss wants a quick chat, you're probably not going to get fired. but you take that and you perceive it to be that you are yeah and it creates that anxiety it creates that staying up all night dreading that meeting yeah is high being high functioning is it a coping strategy is it a compensation for rsd i feel it is i feel it is definitely i feel not just for rsd but also for um that person trying to um manage big feelings of shame and difference yeah so So it's almost like it's the chameleon.

14:56It's the blending in. There's nothing to see here that I'm like you. So that will protect you from the RSD, but also for coming back to the overcompensating piece, for some, and I'm not everybody, and of course I don't want to generalize this, but for some people with ADHD, what that can lead to is it can lead to perfectionist traits. So they are holding their standards so high, which again comes back to the high functioning piece, Alex, that they hold their standards so high. And again, the reason they're doing that is because they're desperately trying to elevate the standards so that they can get that validation.

15:39But also that's to ward off any anxiety that I am not good enough. so it's a problem with self-esteem it's a problem with feeling and not not good about yourself so what you're doing there is you're you're overcompensating their high functioning perfectionism like and you see this like i certainly see this with some of my patients like again if we look at what they do they they smash their a levels they get into the best unis on the best courses. They get these enormous promotions, which is wonderful. But interestingly enough, when they achieve it, the terror kicks in. It's like, oh God, I have to do it now.

16:23And I have to succeed. And it's like, it's great. They're like, this is wonderful. But then what kicks in then is I've got to actually, I've got to nail it now. So you get this huge disparity between what looks on the outside, like, oh my goodness, this is an incredible achievement. of course it is but the person has to live it and that's when the reality kicks in which is well that's pressure of being able to now live up to that promotion or that I am going to head off to this really prestigious university and I'm going to I'm going to cope okay and I'm going to be able to look after myself so like which is why you can't go on the appearance like it's just it's not telling you the full story I guess if you've got ADHD and you're high functioning, you can achieve amazing things.

17:13But when you get there, when you get over the finish line, you don't feel any sense of accomplishment. You just kind of flip, oh, it's done. Because it's so stressful trying to maintain that level of perfection. If shame is motivating you to maintain this level of perfection and function to a standard that is high enough for you to pass as a neotypical, can that delay people getting diagnosed, picked up as potentially having ADHD. Massively so, massively so. And I'm so glad you said that as well. Because again, if we're going on kind of what we see, like, which, when you're diagnosed in ADHD and you're looking for it, yes, you are looking for the kind of very obvious science.

17:56But one of the things we have to remember with ADHD is we have, yes, the external ADHD, but we have the internal ADHD as well. And if we don't think about internalized ADHD and we only go on externalized ADHD as in, okay, is this person struggling to function, i.e. can they hold down a job? Are they going to school? What's their general behavior like? Then we can use all of that stuff. But if that's all okay because the person is, quote, high functioning or overcompensating, then you won't see any of it. And it will all look like very, very neurotypical for want of a better word. But that person could have huge internalized ADHD.

18:43And so it's all happening inside of them in terms of all the masking and the overthinking and the RSD is all kicking off. But they're not showing that. But what that can show us is anxiety or depression or it was shown in another symptomatic way. So it can be very subtle and it can look like, well, that's not ADHD because it's not so obvious. but you can't go on that because if it's more internalized ADHD then it's all happening inside and you have to ask the right questions and you have to explore that so coming back to what you just said that's how it doesn't get picked up because these are the A grade students these are the people who are doing really well in organizations and getting promoted but I know certainly from some of my patients when they get promoted, it's the last thing they want.

19:37They could be flooded with compliments. The person with ADHD who perhaps is high functioning, but what you can't see is that they're at that chronic state of approaching burnout. Oh, massive, massive. Or they don't feel it. Like other people are feeling it more than they are. Like they're all celebrating, isn't this wonderful? Like one of the things I hear all the time, and it's really sad, is like when they achieve so much, I just feel empty. I feel empty. And that's an awful feeling. Awful, where they just can't connect to that external achievement because internally they're empty because their self-esteem and their self-worth is on the floor.

20:19I feel like it can be really isolating, really lonely, if there is this separation between the external you, which is this perceived high-functioning person, and the inside version is really struggling. It can be like you're living behind a glass wall. There's a separation between what's going on in your head, the internal chatter, those highly caffeinated squirrels, those firework thoughts, and the image you're putting out into the world of handing in the work on time, turning up to that meeting on time, graduating from college, whatever it is. How much of loneliness can that impact someone in this story?

21:00massively so. One of the things I was thinking of as you were talking there is, you know, the idea of imposter syndrome. So for somebody with kind of high-functioning ADHD, that's sitting in there. Is I am going to be found out. I am going to be exposed. Somebody is going to see that this is all a massive mask because I'm not going to be able to sustain this. so the loneliness piece is is exactly that it's because they're they're they're not that that connection to oneself where you have that self-esteem where you have that self-confidence then that that gives you a sense of i'm good enough that i i i validate myself but if that's missing then you're already without this i'm gonna go down a psychological road here which is relevant But you're already in a lonely relationship with yourself because you're not in a relationship with yourself where you're able to feel that sense of I am good enough.

22:10I have value. So when that goes outside, that's why it doesn't land. So, yeah, you can have all of this praise, but you feel lonely because that just doesn't connect with you. So it's that idea, isn't it, where loneliness isn't just about the absence of people. So you can be surrounded by people, but the loneliness piece is just not connected to them. And for people with ADHD, unfortunately, because again, they're living in a neurotypical world that isn't designed for them, then there's already that sense of disconnect anyway. So if you add in this piece, then it just intensifies the disconnection, which then can feed that loneliness.

22:55And it's very sad stuff. Like, this stuff is terrible for your mental health. And that's why, like with ADHD, it can then facilitate people having unfortunate mood disorders where in these kind of circumstances, people can get very depressed because it's all very difficult or can get very anxious because they're just trying to sustain all of this high-functioning performance. A quick word from our sponsor. We've all had that nightmare. You're on that final warning from that friend. If you miss their birthday again, your friendship is over. Finito. And you do miss it. Even worse, you miss their wedding and you were giving the speech.

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24:16Timo offers an incredible new voice transcribing service making it even easier to use it's almost so simple that it feels like a cheat code to play life on easy mode give it a go and use the link in my bio for 30 off just a note though this code is only applicable on the web browser not on the smartphone back to the show the loneliness is is quite an underlooked part of the conversation i feel because you want to have your true self the internal self seen and validated but like you said you can be in a room full of loads of people and if you're putting on a character, I've said before, I think people with ADHD are the world's best actors.

24:53We're really good at playing this character called normal. But as a consequence, we don't put our true self out there. How severe can that loneliness get? Can it turn into depression? Yeah. What we know about loneliness is yeah, absolutely. It can cause depression, but also it can cause people to be suicidal and they don't want to live any longer. So it's really serious. And there was that really interesting study as well that came out. I'm not sure how they did this in terms of the impact on health. But this particular study showed that the impact of loneliness has the same impact as if you were to smoke 15 cigarettes a day on your body.

25:39Wow. I think it came out of Colorado, I think. This is interesting. And I want to dive into a potential solution, if there is one. If someone is feeling lonely and there is this disconnect between what they're putting out into the world and the internal version of themselves, how do they close that gap? Yeah. Great question. So first of all, you've got to recognize that you're feeling lonely. And that's not an easy thing to recognize because obviously, if you're somebody who, say, is masking and you appear to be really, really extroverted, then it's going to be very hard to then say, actually, I'm really struggling here.

26:25so I think it's very important that you first of all recognize that this is the reality of what's going on but then you identify somebody you can say that to who's not going to judge you and is going to support you to be able to then talk about what that feels like do the thing I would say is don't assume you understand what that what that loneliness means for that person listen to them because we can assume well loneliness is just the fact you need to hang out with people more or you know that you need to do more things it it's not that that might not be what what's what's missing for that person it could be the fact that they feel desperately um sad or they feel they're sitting with very strong feelings of inadequacy or shame it can be all of those things so let the person talk and get into the feelings because it's very it's very easy to go on what you see which is well this this person doesn't doesn't come on come off as if they're they're lonely but this again is internal so you got to listen to what what they're saying what their thoughts are what their thoughts are what their feelings are and then you can then then support them once you know what's actually going on for that person so it's creating that space and really not judging that person or not going in with solutions, obvious solutions, which might have nothing to do with what is happening for that person.

27:57ADHD masking was described to me once as like a swan on a lake. Yeah, yeah. I was thinking something similar earlier. It's such a nice visual and I think it's so true. like a swan on a lake, completely graceful, calm, but under the surface, under the water, the dogs are flapping like crazy. If you do ignore it and you do just kind of plow on, you kind of feel your body giving you signals that they're struggling, but you just keep going. You keep working through it. Is there like an event? What would an implosion look like? That could be any number of things. So let's come back to the height functioning.

28:37So say if that person has been very successful, has all the plates spinning, is sleep deprived, their nervous system is shot to pieces because they're running on adrenaline, running on cortisol, there's so much happening internally. and then there's an event, i.e. say they have to give a big presentation or something happens in their personal life, then what you see there is that they run out of resilience. They run out of coping mechanisms. And then the energy needed to deal with that just isn't there. It's just that step too far. And so what the person is expecting is that, well, I can just keep pushing through.

29:22I can just keep doing what I'm doing because it's worked for me so far. But it gets to a point where the body and the brain goes, no, this is it now. This is the line. And when the person tries to cross the line, expecting that they can, then again, because the body is a biofeedback system, the body pushes back and says, we're not going there. And then you see the crash or the burnout. And when that hits, then now the body is calling the shots. not the person. So one of the things I always say to my patients, Alex, is your body runs independently of you. And we all, I know that sounds very obvious.

30:00Like you don't have, when you fall asleep at night, you don't have to think, do I have to keep breathing or I have to keep an eye on my heart? Like the autonomic nervous system keeps an eye on all of that stuff for you. It works independently of you. But as much as it does that, it won't let you put the body into a place where now it's going to be damaged by the decisions you're making and the lifestyle you're trying to run. It will not let you do that. And when I'm doing it again, when we get to that burnout place, I have to explain that to people and say, listen, this is happening because you've pushed it now and your body's like, we don't have the resources for that anymore.

30:38Yeah, hard lesson. Is there an opposite to all of this? We've spoken a lot about high-functioning ADHD. What does low-functioning ADHD look like? I would see that more, Alex, as kind of maybe unmanaged ADHD, if we were to give that, I don't know. So where the person isn't managing their ADHD very well for whatever reason. So say if the ADHD is undiagnosed and that person isn't, say, seeing a psychologist. Not only that, isn't in some cases. If we think about what we do to treat ADHD. So I'm going to use an example of I see loads of teenagers. So when I have a teenage patient with ADHD, then we pull in an enormous support system.

31:21So I have big conversations with the parents. I will have conversations with the school if need be. And then the person is seeing me. We may be medicating that young person. So all of these things are managing the ADHD for that young person so that then they can have that stable environment where everybody knows what's going on. The medication is doing its thing if that's what's necessary. So we create stability, we create the environments to stabilize that person. Whereas if it's unmanaged, then we don't have any of those things in place, which means that person is hugely struggling to navigate life with an ADHD brain, which is when you can see it being a bit more chaotic.

32:04but essentially what's happening there is that the person isn't being supported enough to be able to stabilize. And that's a big ask. Like, if you've undiagnosed ADHD and you're trying to cope with that yourself, and it's like really kicking off, then like that person's probably doing their best to try and cope with all of that. But without any of these additional support systems in place that we know work, we know this stuff works because it's bespoke as what that person needs. But if you have none of that, then you'll have unmanaged ADHD, which again is hugely problematic. Why do some people develop coping strategies and essentially become a high masking or high functioning person with ADHD?

32:57and someone else might not. Is there a difference in the journey of those two people? Yeah, it's a very interesting question. Because I was thinking about when you said we're going to talk about high-functioning ADHD. And one of the things I kind of thought, I need to talk about this. Because again, it might sound quite obvious, but sometimes it's overlooked, is there isn't an ADHD personality. That doesn't exist. Your personality is, you're Alex Partridge. like this is this is your personality is unique to you you might have the same diagnosis as somebody else you have adhd but they're not going to have the same personality as you because that's their personality that's unique to them so like a big practice would be personality it's the the that that person's own identity and what excites them and the things they like and they find easy and their strengths and their weaknesses which are unique to them so So with personality, we kind of break it down into the acronym.

33:59It's called, it's OCEAN. So the big five traits of personality, OCEAN, openness, conscientiousness, extrovertism, OCEAN, extrovertism, agreeableness, and the N is neuroticism. People with ADHD, they're very high in terms of personality traits. They're high on neuroticism. Now, that might sound like, oh, that's a negative thing. And to be neurotic is not a negative thing. But neuroticism is they're more prone to worry and anxiety. They're overthinkers, most of the purposes. They might be a little bit more kind of emotional because of the emotional dysregulation of the RSD. So, yes, you can kind of see personality traits that might be a bit more present in ADHD.

34:48but what you also have as well is a unique personality a unique support system so some people have amazing support systems that people around them are great we spoke about this off very level with the people that say well that's not a thing we're all about adhd you're just lazy we're going to be really critical which of course will be horrendous for our rsd so the the the combination of personality of social supports but on also as well um the unique psychology of that person will all be at play in terms of then and how they function yeah is there a link between adhd high achieving and addiction yeah that's a very interesting question because um we know adhd and addiction sadly can go hand in hand for lots of reasons to do with the dopamine receptors, but also impulsivity and then kind of trying to cope with stuff.

35:46Well, the high achieving, it might not seem so obvious in terms of it being an addiction, but it can lead people to becoming workaholics. Now, when we say that, it's like, oh God, yeah, well, that kind of sounds obvious now, doesn't it, which is, well, if they're high achieving or trying to overachieve or overcompensate, then especially in the workplace, then they could then become that type of workaholic, which is constantly trying to spend more time in the office or being very consumed with their jobs, overly worried, always trying to appear to be on top of everything or that, again, they're trying very hard to be conscientious, but that comes at a huge price because somebody who's a workaholic is prioritizing their work, is not necessarily taking care of their well-being or their sleep or their diet.