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‘Everyone in my life has noticed’: How Denmark’s Covid-19 lockdown helped people with ADHD

A Danish researcher found that some people with ADHD responded positively to disruption to their daily lives caused by the Covid-19 pandemic and resultant lockdown in the country in Spring 2020. In some cases, they had coping tools that others lacked. Her findings could prove beneficial for post-pandemic working environments.

'Everyone in my life has noticed': How Denmark's Covid-19 lockdown helped people with ADHD
A deserted commuter train in Denmark in March 2020. Photo: Liselotte Sabroe/Ritzau Scanpix

For Zachary Helms, a 31 year-old American man who lives in Copenhagen, living with ADHD has meant structure and scheduling has always been difficult. Adults living with Attention Deficit and Hyperactivity Disorder often struggle to develop an innate awareness of time and an ability to track its passing.

As such individuals with ADHD often live with a phenomenon known as time-blindness, that makes sticking to a schedule and being on time particularly difficult. 

The Covid-19 pandemic brought new attention to the phenomenon of time-blindness when adults without ADHD started experiencing its symptoms. An article in New York Magazine by Bridget Read in April of 2020 titled “What is ‘Time Blindness’ and Do You Have It?” highlighted the ways that the changes in structure of time and routine during lockdown led neurotypical individuals to start experiencing time-blindness. 

“Without the usual time-marker cues we might use to divide up our days — the school bus arriving, standing on a crowded train platform, the line at the coffee shop, weekend nights spent at restaurants with friends — we’re swimming in a sea of sameness,” wrote Read. People featured in the article felt days blending into each other and began to struggle to stick to a schedule or be on time for meetings. 

It would be a reasonable assumption to think that the increasing experience of time-blindness for neurotypical adults during the pandemic would mean that individuals with ADHD who normally experience the phenomenon would have worsened symptoms. 

But new research by Danish researcher Gitte Vandborg Rasmussen of Aarhus University’s HOPE Project suggests the opposite.

In fact her conversations with 21 adults living with ADHD during the first lockdown in Denmark last year indicated that the changes in time structure during the pandemic not only relieved some adults living with ADHD of some of their symptoms, but that many of them had tools to cope with the new structure of daily life that neurotypical adults lacked. 

Rasmussen conducted qualitative anthropological research for the HOPE Project last spring through a series of interviews with adults who had been diagnosed with ADHD. The HOPE Project, based out of the Department of Political Science, is an interdisciplinary research project examining the interrelationship between the trajectory of the COVID-19 pandemic, the decisions of governments and international organizations, the decisions of media and social media landscapes, and citizens’ behaviors and well-being. 

READ ALSO: Danish enthusiasm for Covid-19 jab increases after start of vaccination programme

Rasmussen decided to conduct research on adults living with ADHD during the pandemic as an extension of her existing research focus on the role of time and scheduling in the lived-experience of ADHD. In March of 2021, the project published a work-in-progress report on her findings that several of the included adults with ADHD experienced a relief of symptoms during the first lockdown.

This finding surprised Rasmussen, who expected her subjects to really struggle with the lack of structure created by the pandemic.

“Living with ADHD, you are often challenged around your time. One of the main core treatments or coping strategies for living with ADHD is to make a plan. You have to use your schedule, you have to use your calendar for structuring time every day,” she explained.

With routines and schedules substantially disrupted, she worried her subjects’ ADHD symptoms would worsen.

“I thought, whoa, now everyone’s calendars are empty. Structure is gone. Nothing is the same. I was worried about that. I was concerned about the wellbeing of these individuals. What surprised me was that it didn’t seem to matter that much to the interlocutors. It seemed to me like they were relieved that the calendar was gone” Rasmussen elaborated.

In our interview about his experience with ADHD during the pandemic, Zachary Helms, who works at the Copenhagen-based consulting firm Voluntas, echoed these feelings of relief. He spoke positively about managing his ADHD symptoms during the lockdown and described how working from home gave him the space and time to strengthen coping mechanisms.

“Working virtually has been a huge benefit. It’s forced me to structure my time and take advantage of my calendar. My scheduling has improved, and everyone in my life has noticed,” Helms explained. 

Prior to the pandemic, structuring time was a struggle for Helms. The flexibility of the work day and the remote format made it easier for him to be on time and present during the lockdown.

“The nature of travel means that I always had to plan when I needed to leave, so I was often late. During the lockdown, meetings came straight into my home — it’s hard to be late to a meeting in my living room.”

This experience was common amongst the subjects Rasmussen interviewed for her project. Many of the adults she spoke with felt actually able to be more productive in their work lives without the pressures of having to be physically on time to different meetings and obligations throughout the day. 

“I got stories about the time being less demanding, which connects to the calendar and the schedule. The time allowed for things to be done when they fit. It’s not that the subjects didn’t want to do their routines. They went to work, brushed their teeth, and got their grocery shopping done. There was just a relief of not having to be timely, precisely, not having to schedule everything,” Rasmussen said. 

The temporal flexibility afforded by lockdown not only helped her subjects stay on top of their tasks and actually stick to their schedule, but the extra time allowed them to explore hobbies and try new things. This was interesting to Rasmussen, who expected that an increase in free time might lead to an increase in restlessness for adults diagnosed with ADHD.

READ ALSO: Expat stories: How I made my closest Danish friend

“I could see that having more time could bring more restlessness, but actually people came on the other side of that. Some of them started reading books and even doing meditation. They were like I’ve never read a book before and now I’ve read seven in the last two weeks,” Rasmussen said.

Zach Helms described something similar in our conversation, noting that he enjoyed the control he had over his time during the lockdown. The ability to choose how he spent his time was actually liberating for someone who struggles with structure. 

“The lockdown has given me opportunities to explore things that I find interesting, and my symptoms make it difficult for me to focus on things that I don’t find interesting. I’ve learned programming, something that was always on my bucket list, and I’ve had ample time to work on myself and develop better habits. For someone who never focuses, habits are essential to keeping up with everything in daily life. I don’t trust my memory, but I trust my habits. Otherwise I’d never find my keys, phone, or wallet,” he explained.

The idea that the less structured workday created by the pandemic might be beneficial for well-being and productivity has been garnering a lot of attention as many countries have been transitioning out of lockdown. But the findings of Danish researcher Gitte Rasmussen and the experience of individuals like Zachary Helms suggest that re-structuring the workday to allow employees more agency over how, when and where they conduct their work can have profound implications on the severity of ADHD symptoms.

One of the things Rasmussen considered after reflecting on the conversations with her subjects was that in times of collective crisis, it could be important to look to those with disabilities and different learning styles. People with disorders like ADHD or who struggle with mental health under “normal” circumstances might have some coping mechanisms that would be useful to the more general population when those “normal” circumstances are dramatically altered. 

Living with and managing ADHD often means you have practiced coping strategies in order to navigate insecurity and anxiety, according to Rasmussen. This is one of the reasons that Rasmussen thought that her subjects with ADHD handled Covid-19 better than she would have anticipated. 

“I think this showed that who we thought would be vulnerable, actually seemed to be the ones with some extra resources.” Rasmussen said.

“The pandemic really made people reflect on their own life, but also on politics and how we create our world and how we structure our world, which was really inspiring.”

Rasmussen’s research suggests that as we adjust back to normality it might be worthwhile to bring some of the flexibility of the pandemic work environment. Doing so might make work more accommodating and accessible for people with different ways of learning and thinking – like those living with ADHD. On the other hand, in times of crisis we might choose to look to non-neurotypical individuals for thinking creatively and adapting to new ways of life. 

READ ALSO: ANALYSIS: Why are Denmark’s politicians criticising university researchers?

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EXPLAINED: What to do if you face a long wait for healthcare in Sweden

Sweden theoretically has a "healthcare guarantee" limiting your wait to see a GP to three days, and to see a consultant to three months. The reality is somewhat different. Here's what you can do if you face a long wait.

EXPLAINED: What to do if you face a long wait for healthcare in Sweden

What is Sweden’s ‘healthcare guarantee’? 

Sweden’s “National Guaranteed Access to Healthcare” or vårdgaranti, is a right to care, protected by law, that has applied in Sweden since 2005. You can see the latest version of the relevant laws here and here. Here is a summary of the guarantee on the website of the Swedish Association of Local Authorities and Regions (SKR).

Under the system, all patients are guaranteed:

  • contact with a primary care centre by phone, in-person, or by video-link on the day they seek care 
  • an appointment with a doctor, nurse, physio, or psychotherapist within three days of seeking help 
  • an appointment with a specialist doctor or consultant within 90 days of seeking help 
  • treatment or operation within 90 days, if the specialist considers this necessary 

Does the guarantee mean I have a right to treatment? 

No. If the doctor at the primary care centre, after examining you and questioning you, decides that there is no reason to refer you to a specialist doctor, they do not need to do so. 

Similarly, if the specialist doctor, after examining you, decides that no treatment is necessary, then your case is considered completed.  

Can the waiting times to see a specialist or to get treatment be longer than 90 days? 

Absolutely. In fact, they very often are. 

According to the Swedish Association of Local Authorities and Regions (SKR), in February, 32 percent of patients had been waiting 90 days or more to see a specialist, and 43 percent of those who had seen a specialist had been waiting for treatment for more than 90 days.  

The situation in primary care was a little better, with 80 percent of those seeking care in contact with their primary care centre on the same day, and 83 percent having their case assessed by a doctor or nurse within three days. 

In addition, if you agree with your specialist doctor that you are willing to wait longer for an operation, then that wait doesn’t get counted in the statistics. 

So what can I do if I’ve been waiting longer than the guaranteed time? 

In reality, it’s actually less a guarantee than a target.

In primary care, there is no way for individual patients to complain that they have had to wait too long to see a doctor or nurse, or to cut their waiting times by citing the guarantee. 

“There’s no system for enforcing that guarantee,” says Emma Spak, the primary care doctor who doubles as section chief for SKR’s healthcare division. 

It would make no sense to set up a complaints line for those who have had to wait too long for phone contact with their primary care centre, she points out, when they could instead talk to patients seeking a primary care appointment in the first place. 

“It’s more of an incentive system for the regions,” she explains.

Every primary care unit and every region reports their waiting times to the national waiting time register, and then as part of the access agreement between SKR and the government, the regional health authorities receive a bonus if they meet their waiting times goal, or if they improve their waiting times. “That’s one way of sort of enforcing this guarantee,” she says. 

When it comes to specialist treatment, though, patients do have the right to demand to be examined or treated by an alternative specialist or hospital if they’ve had to wait longer than 90 days.

If your primary care centre issues you a referral to a specialist, and the specialist cannot then offer you an appointment within 90 days, the specialist, at the same time as offering you a later appointment, will often put you in contact with a unit at the regional health authority who will offer to find you an alternative specialist, either within the region or elsewhere in Sweden. 

The regional health authority will then have to reimburse any extra travel or hotel costs incurred by the patient.  

Similarly, if after examining you, a specialist cannot offer you treatment within 90 days, they will normally put you in contact with the same unit. 

Some regions have a phone line for people who have been waiting too long, or else you can contact your specialist or primary care centre and ask for information on seeking an alternative specialist. 

What happens if I don’t want to travel to see a specialist or get treatment? 

If your regional health authority offers you an alternative specialist, either within your region or in another region, so that you can get treated within the 90 day period, and you are unwilling to travel, then you lose your rights under the guarantee. . 

“If you’re in Gothenburg, and they say you have to go to Stockholm to get your treatment, and you say, ‘no, I want to go here, then then you’ve sort of forfeited your right, and you have to take what’s on offer,” Spak says. 

What happens if I agree with my specialist to wait longer? 

If your specialist says that they can treat you in four months, but also offers you treatment elsewhere within the guaranteed 90 days, and you choose to be treated by your specialist, then that counts as a patient choice, which will not then be counted in the statistics. 

“The specialist might say, ‘I don’t think you will get any worse for waiting two months extra, and if you wait five months, then I can make sure that you get your surgery done here, and we can make sure that you get all the aftercare and everything here as well,” Spak says. 

But these patient decisions are also counted in the statistics, and if a region sees a sharp rise in patients choosing to wait, SKR will tend to investigate. 

“If some region all of a sudden has a lot of patients choosing a longer waiting time, then we will call them and ask what’s going on here, because patients don’t tend to want to wait extra,” Spak says.  

Can I get financial compensation if I’ve been waiting too long? 

No. 

What other ways are there of speeding up the wait for treatment? 

Don’t underplay your symptoms

When drawing up their timetable for treatment and assessment, specialists will tend to give different patients different wait times depending on the urgency of their case.

For this reason, it’s important not to underplay your symptoms when visiting a primary care doctor, as they will tend to include a few lines on the urgency of your case when they write their referral. 

Stress your flexibility 

If you are unemployed, a student, retired, or have a very flexible job, it is worth telling your primary care doctor about this, because they may write in your referral that you are able to make appointments at very short notice. The specialist may then put you on their list of people to ring if one of their patients cancels. 

“Sometimes I write in my referrals that this patient could easily come at short notice, so please put the patient on the list for people you can call if there’s a time slot available,” Spak says. 

If you haven’t told your primary care doctor this, it’s not too late. You can ring the specialist yourself and tell their receptionist that you are very flexible, and ask to be put on the back-up list. This is particularly useful if you’re waiting for a scan, but you could also potentially work even if you’re waiting for heart surgery or a hip replacement. 

“If they’ve accepted you as a patient, and they’ve made sure that you fulfil the criteria for having that scan or whatever, then you can call them and say, ‘I have a really flexible job, I can come anytime if you have a gap,'” Spak says.

“A lot of people do that, because they can have [back-up] waiting lists. If you tell them ‘I work around the corner and I only need 15 minutes to be there’, then they might call you if someone doesn’t show up.” 

Ring up your specialist 

The queue system tends to be quite ad hoc, with no strict rules over who should be treated first, so it is often possible to reduce your wait by ringing up your specialist a few times a month, just to bring your case to their attention. Sometimes the receptionist will remember a slot that has just come free and bring forward your treatment while you are still on the telephone. 

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