When it’s More Than ADHD: The Challenge of Multiple Diagnoses

A Q & A with writer and therapist Lisa ‘LC’ Coppola

When I’m not writing about ADHD, I write about early childhood trauma and family secrets. In 2019, I began on online magazine and community, Severance, for three groups of people who had at least one of two things in common—a separation from biological family or the discovery of previously unknown biological family. These are adoptees, donor conceived people, and those, like me, who’ve had what’s known as a not-parent-expected experience (NPE)—the discovery that a person one believed to be a biological parent is, in fact, not genetically related. Though each of the three experiences is unique, there’s much that we share, from the experience of genetic bewilderment, trauma, identity disruption, and a host of emotional reactions including shame and grief.

Through this community, I became acquainted with Lisa Coppola—who has vast experience in all these areas, and then some—when she began contributing to the magazine. A writer, licensed mental health counselor (LMHC), and an expert in the field of relinquishment trauma, she has an abiding interest in creativity and its role in healing. She was creator and program director of the Voices Unheard Storytelling Program for Adult Adoptees through Boston Post Adoption Resources (BPAR) and is the author of a reflective journal for adoptees. She looks at ADHD from a lens influenced both by multiple diagnoses and the adoptee experience and has written about the ways in which early childhood stresses are often overlooked when individuals are assessed for ADHD.

Before we get into a conversation about ADHD and creativity, tell me about your work-in-progress or, if you’re not working on a new writing project now, your most recent.

I am actually trying my hand at scary short stories. I’ve always had such vivid dreams, nightmares. And I’ve tried so many things to ease my sleeping: better sleep hygiene, sleep aids, stretching before bed, watching “something nice, and light” (aka boring) before bed. But my friend recently suggested I just try using the material in my nightmares. I also have my memoir, working title: Monster Flower, that I still edit and play around with occasionally. And I just opened a private practice in March—Coppola Counseling & Consultation. I use a ton of creative writing in my work with people!

When did you discover you had ADHD and what prompted or led to that discovery?

I got a diagnosis of ADD when I was probably around eight or nine. My mother had me tested for learning disorders at a young age, kindergarten and then beyond, and I was always on educational plans with extra behavioral support in school. But for me, I now feel pretty strongly that my impulsivity and difficulties at times with concentration have to do more with early loss and stress response brain formation from my experience as an adoptee as well as from early childhood trauma in my chaotic home life. None of that was ever discussed or acknowledged during sessions with testers or educational counselors. This was in the eighties and nineties; we knew less then about the imprint of early loss and how it shapes the brain. I do believe that things would have been different in my early education years if trauma was considered with this diagnosis. For example, when I was in a classroom back then, I was usually worried about everything going on around me relationally, and my body was clenched, hypervigilant, and at the same time I was exhausted by the hypervigilance, so it was very hard for me to concentrate if I was forced to sit in the front of class. Typically someone with ADHD might be encouraged to sit in the front of the class, but someone with relational trauma— complex PTSD (C-PTSD) or PTSD—would be able to focus more if they sat in the back and could see everyone and everything and feel less in the spotlight

Would you describe yourself as primarily inattentive, hyperactive, impulsive, or a mix?

I tend to be impulsive and inattentive. I get hyperfocused, impulsive, and then tired. But as I mentioned, what is trauma response and what is ADHD? Are they connected? I still don’t know the breakdown of things and I probably never will. Things I do that feel more like ADHD to me than trauma response: When I leave stores with my girlfriend, occasionally, not rarely, I try to open the door to some random car if we are talking because my brain thinks it’s their car, even when it looks nothing like their car. Or if I’m driving and someone in the car with me is engaging me in an interesting conversation, I have been known to slow the car down to a full stop until they remind me that I need to keep driving. Not the safest. I’m working on it.

Did you expect the diagnosis—was it not surprising—or was it a lightbulb moment that suddenly made everything seem to make sense?

Since I was diagnosed so young, it didn't surprise me. Everyone around me in the adoptive home I grew up in had a handful of diagnosable conditions. The lightbulb moment for me was in sobriety when I was diagnosed with obsessive compulsive disorder, which did feel very relieving, and PTSD. As an adult, I struggle a bit with adding ADHD to the mix because, jeez, how many labels can one person have? I’m not sure why the OCD label brings me such relief, but the label of ADHD kind of frustrates me. I think it’s the lack of trauma education or even acknowledgement I received as a kid. OCD is more easily discussed as an adaptive response to trauma. I guess that’s what it might be.

What was your initial emotional response to discovering you had ADHD?

I think at the time as a young kid I felt kind of ashamed, but not surprised. Like I was broken, but I already knew that, (said the wounded child in me). Now I just think of the salad of diagnoses I have as one messy ball of symptoms that are really adaptations that my youngest self and my ancestors had gone through to survive. And now I don’t think there’s anything at all to be ashamed of.

Do you consider the experience of being diagnosed with ADHD transformative in any way?

These days, now that I’ve worked on my relational trauma quite a bit, I’ve been able to really utilize the executive function skills that so many people were trying to teach me back when I was in middle school and high school. Those skills have, it turns out, been able to change my life. I get to be both creative and organized—well, organized most of the time.

Perhaps it could have been transformative much earlier if it had been accompanied by trauma-informed care, but then I wouldn’t be the me I am now, I guess. Though I really wish it was similar to … like how cognitive behavioral therapy has a trauma-informed branch, I believe ADHD diagnosis and treatment should also routinely include an understanding of trauma. I wish it were standard practice for ADHD specialists and therapists to assess for trauma and provide related education. I’ve always been someone who seeks to understand the “why” behind things, so knowing the roots of my behavior and experience would have made a big difference.

If you’ve told others you have ADHD, have there been any helpful or unhelpful responses?

Most of my social circle includes people in addiction recovery and fellow adoptees, and quite often the people I love and spend the most time with also have an ADHD diagnosis, (and I might add are also usually trauma survivors as well).

What frustrates me is when people don’t look beyond the diagnosis—as if ADHD is the whole story. I feel the same way about addiction. To me, the behaviors that get labeled as ADHD or addiction are often maladaptive responses to toxic stress or trauma—sometimes even passed down through generations.

That said, I know there are people out there who don’t have a trauma history or any family history of these major trauma and still receive an ADHD diagnosis. I just haven’t met many (or any) of them.

Do you have a writing routine or do you find a routine to be incompatible with your experience of ADHD?

I would love to have a writing routine someday. Sometimes I will go months without writing, but in those months, I’m drawing or doing something else creative regularly.

Once you knew you had ADHD, did you alter or attempt to alter your writing process to accommodate your new understanding of the way your brain works?

I feel like there’s a time for brainstorming bigger ideas, and then there’s a time to get down to the details. These two processes can both want to run the show at the same time, and that’s when I get into trouble. So, when I’m ready to start on scenes or details and I know generally what I want to write about, I then make a general outline and sit down with my planner and insert small specific sessions to write throughout the week or month. So, for example, right now I’m working on a scary story. I have down in my planner for this Thursday to simply work on the short scene with the dogs, and specifically how the dogs looked on the floor in the barn. It’s in my schedule and so my brain can wander to creating that scene throughout the week. I also have a 30-minute chunk at the end of the week scheduled to allow for more creative idea-bigger idea brainstorming about the story. So if there’s an idea percolating, I can give it more attention then.

Do you believe ADHD gives you an edge creatively? If so, in what ways?

My impulsiveness has allowed me to take risks, which is essential for creativity.

What aspects of writing does ADHD complicate or make more difficult? (For example, choosing or sticking with a topic, keeping a writing routine) Do you have a top five list of the biggest challenges?

Since it’s hard for me to decipher what’s trauma reaction versus an ADHD symptom, I’m just going to list here the top things I struggle with in general with writing.

1. I often get flooded with ideas that I’m excited about, and it can feel overwhelming.

2. I can miss major and minor details with grammar.

3. I really wanna write in the morning, but I’m so exhausted in the morning due to hours of vivid dreams and nightmares.

4. Sometimes it’s hard for me to express the point I’m trying to make because it’s hard for me to sort out what writers or observers might already know or not know and how to meet them there.

5. Occasionally, I’ll still get stuck on wanting to avoid rejection or judgment, and if I start to let fear guide my writing, then I’m in trouble.

Is there anything you’ve tried that has not helped? And if so, why?

Um, alcohol worked for me for a short time (not recommending!), but stimulants didn’t. I was a C to F student in high school. My anxiety was through the roof then and I was on stimulant medications for my ADD, which it’s clear to see in retrospect, was making my anxiety much worse. After high school, my drinking took off, and that temporarily helped ease my anxiety when I worked on homework and studied, and, shockingly, I got straight A’s my first semester at community college. But, since I drank to blackout almost every time, the consequences did not meet the payoffs (of anxiety relief) that the alcohol gave me. Fifteen years ago, I got sober and was prescribed an SSRI for my anxiety, which allowed me the same level of concentration that I found alcohol could give me temporarily. Once my anxiety was eased. I was able to actually learn and use the executive function skills they try to teach you in school when you have an ADHD diagnosis.

If you write both fiction and nonfiction, are the challenges/benefits of ADHD similar or different?

Love this question.

I think it’s harder for me to stay focused when it’s fiction. So whenever I’m writing fiction, I’m usually pulling in pieces of memoir and true stories. Fiction pieces usually start out for me like, oh my God, here’s this great idea. But since I haven’t lived through it, it sort of loses steam when I’m trying to describe it. I need more practice in this area!

Do you believe ADHD has affected your overall career as a writer?

I mean, being an impulsive person has certainly helped as a writer. But to come through with a finished product, with limited funds for assistance, I really had to learn those executive function skills. Skills like planning and structuring my day and scheduling little bits made it possible for me to get big projects done. During COVID, I wrote a 70,000-word memoir. I don’t know if it would’ve been possible for me to do that without the level of planning I was able to do around structuring my writing. I’m actually really glad that I’ve had to learn these skills at this point. I remember for so many years finding that kind of skill talk so boring, and I had no interest in really learning about it.

All writers face rejection, and most on a regular basis. And while it’s not fun for anyone, people with ADHD often experience it acutely. If that’s your experience, how do you cope? What keeps you putting yourself out there?

It’s a brain shift. Occasionally the younger parts of me think I must suck and everyone else knows it, but the wiser parts of me see problems and challenges as opportunities. I think the addiction recovery world taught me that.

Are there any self-care practices that for you ease difficulties associated with ADHD in general or with writing with in particular?

I feel like the answers to this question would differ from person to person with ADHD. For example, I have friends with ADHD who thrive in chaotic environments. For me, I need a calm place to write, like a quiet coffee shop. Some distractions are great, but really loud noises throw me off guard for sure. Breaking creative projects down into small sections and then scheduling those sections is a key skill I use that really helps with procrastination. In order to complete something, I’ve had to accept that planning and scheduling structuring will be like 30% to 40% of the work. And I’m okay with that now; I actually really look forward to sitting down with my planner.

If you could recommend just one thing—a book, a podcast, a Substack, whatever, what would it be?

Your Substack, Kate. I really appreciate your take on creativity and ADHD. Also I like Gabor Mate’s take on ADHD in Scattered Minds: A New Look at the Origins and Healing of Attention Deficit Disorder.

Thank you! What do you think are the biggest misconceptions people have about ADHD?

That is it a “thing” or a "disability" in itself and stops there. It’s here for a reason.

If there’s anything you want people to understand about ADHD, what would it be?

Self-compassion is essential. This is not “your brain is broken.” And then this too: it’s 100% your responsibility to shift how you are functioning, if you even want to shift it. I would want people to know that the skills can work if you give them a real shot. You have to really want that kind of change. And if you go there, remember, progress not perfection is the mindset.

Finally, if you could give up your ADHD, would you?

No. I wouldn't change anything that’s ever happened to me. Even the worst things that have happened in my life have brought me to become who I am, the way I move in the world, and the impact I have on my external world. And I’m proud of what my life is shaping into and in who I am becoming. I didn't always feel this way, and I had to do a ton of grieving and learning about many things. But, I do believe all of it had to happen for that to happen. I guess it’s a bit spiritual. I was born with a messy deck of cards and I get to figure out how I might use them.

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Lisa ‘LC’ Coppola, LCPC, LMHC, M.Ed., is a licensed therapist, writer, and educator. She’s the founder of Coppola Counseling & Consultation, LLC. Coppola specializes in the intersection of adoption and addiction, working with adult adoptees, foster care alumni, and their family members. Her writing has been featured in Severance Magazine, Chicago Story Press, The Fix, and Adoptees Voices. She’s the author of the 2022 book Voices Unheard: A Reflective Journal for Adult Adoptees. Learn more at her website and find her on Instagram.