Almost everything that you know about “Attention Deficit Hyperactivity Disorder” is probably wrong
NOTE: If you have the slightest suspicion that you may have undiagnosed ADHD, and you do just one thing about it, take this test.
DISCLOSURE: I write as someone who was diagnosed with with the “Combined” subtype about 6 months ago, after decades of seeing myself as “different” from most people around me but never understanding why until now. I’ve dedicated much of my spare time since this diagnosis in research and reflection to understand ADHD in general and my ADHD in particular as well as defining and experimenting with practices that can enhance my neurodivergent life.
We now return you to your regularly unscheduled blog post.
No, really.
Unless you’ve spent hours and hours reading about ADHD, if you believe that you know anything at all about ADHD, you probably think it is about being a “space case” and a “spaz”.
“Attention Deficit Hyperactivity Disorder” does not involve a deficit of attention. “Hyperactivity”? It’s not even present in all cases of ADHD! “Disorder”: A broad term that can imply any durable undesirable way of functioning? Sure. Why not?
ADHD, is a neurological developmental disorder that tends to occur by age 7 as a result of either or both of genetic and environmental factors. However, because ADHD is poorly understood, many people do not receive a diagnosis until much later in life, if ever!
People with ADHD experience both hyper-focus and distractibility — sometimes at the same time! If anything, this “inattentive” aspect of ADHD is better described as a lack of control over focus.
Doctors, sometime in the past 20 years, in their infinite wisdom, thought that it would make sense to take ADD, ADHD, and then confuse all of us by doing this with them:
- ADHD = ADHD (Because that, at least, has the property of an identity. This one is easy)
- ADHD = ADD (Wait, what?)
- ADHD = ADD + ADHD (Ok, who put the LSD in the DSM’s Wheaties because now we’re way out in left field, because, logically, just no,)
Sure, I hyperbolize because it’s fun. But, now, instead of “ADD” and “ADHD” there is now:
- ADHD, Inattentive subtype: previously ADD
- ADHD, Hyperactive subtype: previously, ADHD
- ADHD, Combined subtype: previously, this would have been a combination of ADD and ADHD
If you had to identify a single pattern, ADHD behavior is a constant search for stimulus.
The variable focus and impulsiveness of ADHD is thought to be due to the ADHD brain’s constant hunger for dopamine. Dopamine is a neurotransmitter, a natural chemical in the brain, that is part of how brains experience pleasure. The ADHD brain is Pac-Man for chasing dopamine hits.
Anxiety and depression? For ADHDers, often a lack of dopamine.
Getting lost in conversational topics? Dopamine.
Fidgeting? Dopamine.
Become a founder and make your own company? More dopamine!
Novelty seeking? So much dopamine!
Focusing, for hours, intently on playing a computer game, needlepoint, painting, or any other activity that benefits from concentration? Dopamine.
And then immediately hopping from activity to another and another and another and…? Dopamine, dopamine, dopamine.
That dopamine need drives ADHDers to all manner of self-destructive behaviors. We’re objectively more likely to commit traffic violations (as teens), commit violence, and to develop addictions.
That inner Pac-Man manifests in all sorts of ways:
- Anxiety
- Depression
- Monologuing: speaking at length and finding difficulty presenting ideas coherently
- When speaking, getting lost in tangential topics
- Short-term memory issues
- Difficulty starting tasks
- Almost compulsively focusing at length on a single task: the hyperfocus that can lead students to believe that ADHD is somehow a super power (narrator: it isn’t)
- Becoming agitated/amgry from their focus
- Leaving many tasks partially completed
- Fidgeting frequently
- A tendency to act/speak impulsivey
- “Time-blindness”: a lack of awareness of the passing of time leading to frequently showing up or completing tasks late.
The National Institute of Health acknowledges 4.4% of adults yet 11% of children having ADHD. As current science demonstrates ADHD to be a developmental disorder of the brain, ADHD is unlikely to disappear with time. It is therefore likely that many adults avoided inclusion in this statistic due to lack of usage of American mental health services.
Untreated, ADHD can make for a challenging life but there is hope! While there’s no silver bullet that turns an ADHD brain into a neurotypical one, medications are 70–80% effective across the ADHD population. The majority of those medications, once dosage has been adjusted to the proper level, work by ensuring that the brain has enough dopamine to function with ease.
Within a few minutes of my first dose of Adderall taking hold, I felt my stress recede and took the best nap I’d had in years!
But those first couple of weeks with medication are the honeymoon. I’ve heard other ADHDers describe a profound sense of peace but it never lasts. After the honeymoon, for those who find success with medication, what can remain is more awareness of the attention, more choice over where that attention sits, and a mood less subject to anxiety and depression.
What do you do with that new-found self-control? Well, that’s entirely up to you! In my next post, I’ll tell you how I’ve been hacking my ADHD with mine.
