This morning, I started making my bed. In the middle of making it, I looked at the closet and noticed that my overnight bag was in the wrong place, so I picked it up to put it away in the other room. On my walk to the other room, I noticed I hadn’t finished washing the dishes, so I put the bag down to clean them. In the midst of all of this, the washing machine had signaled that the laundry was done. I reminded myself to put the clothes in the dryer but immediately forgot. Hours later, when I finally sat down to do some work on my computer, after starting and stopping a few tasks and completing others, I remembered.
I know I’m not alone in starting one task only to be pulled away by another. Given the sheer number of distractions we have in our lives, the gadgets programmed to command our attention, and the responsibilities often piling on, it’s challenging to stay focused and present at any given moment.
Attention Deficit Hyperactivity Disorder, or ADHD, can exacerbate difficulties with focus and attention. It has also received more attention recently, both because as the conversation around it expands, more people are seeing themselves in the symptoms and seeking treatment and possibly because our modern world has made it seemingly impossible to focus.
This article attempts to better understand ADHD from all angles, as there is a lot of competing information out there right now. So, if you’re wondering if you or a loved one have ADHD, we hope to shed some light on the diagnosis and how to respond to the symptoms.
What is ADHD?
To start, it helps to know that there are three different subcategories of ADHD in the current Diagnostic and Statistical Manual of Mental Health Disorders (DSM), which is what all clinicians and providers use to diagnose ADHD. ADHD with Combined Presentation, ADHD with Predominantly Inattentive Presentation, and ADHD with Predominantly Hyperactive/Impulsive Presentation.
The inattentive symptoms include:
- Difficulty with close attention or details.
- Making careless mistakes.
- Challenges staying focused for a prolonged time.
- Not seeming to listen when spoken to.
- Not following through with instructions or completing tasks.
- Difficulty organizing tasks and activities.
- Struggling with tasks that require sustained mental effort
- Losing things
- Forgetfulness.
The hyperactive and impulsive symptoms include:
- Fidgeting or tapping.
- Struggling to remain seated.
- Restlessness.
- Difficulty engaging with tasks quietly.
- Being unable or uncomfortable to remain still.
- Talking excessively.
- Interrupting others.
- Difficulty waiting.
- Talking out of turn.
To be formally diagnosed with ADHD, an individual must exhibit a specified number of symptoms in these categories, and the symptoms must have been present for at least six months and be present in more than one setting (e.g., home, school, work). The symptoms must also interfere with functioning and development, and several of the symptoms need to be present before the age of 12.
ADHD is complex, with a wide range of severity levels, and it can co-occur with other conditions like generalized anxiety or depression. For a long time, ADHD was considered a childhood disorder, and signs of ADHD can manifest in elementary school but can also be seen in children as young as 3. But we now know that it’s not just a childhood disorder but a diagnosis many struggle with throughout their lives. To be diagnosed with ADHD in adolescence or adulthood, the symptoms must be traceable before age 12.
How is ADHD Diagnosed?
ADHD is having another turn in the spotlight. For years, there were concerns that it was being overdiagnosed in children, especially in young boys. More recently, the pendulum has swung in the other direction, and many are concerned that it is underdiagnosed, especially in girls and women.
In researching this article, there is still so much conflicting information, including how ADHD manifests and how it gets diagnosed and treated. According to a few sources, the most recent version of the DSM changed the diagnostic criteria for more adolescents and adults to qualify. The symptoms of ADHD can also often look like the symptoms of other mental illnesses, including depression, anxiety, and PTSD. And often, people with ADHD may experience other mental illnesses too, including autism, depression and/or anxiety.
Like autism, depression, anxiety, and other mental illnesses, ADHD also exists on a continuum. Everyone occasionally struggles with attention and restlessness, and many may struggle to sit still, especially when bored. To get diagnosed with ADHD, these symptoms must impact your functioning negatively, but that’s not as easy as marking yes or no on a questionnaire. It’s subjective and messy. Providers often rely on self-reporting, observations, and information from family members or other observers to gather their data, but diagnosing is not a one-size-fits-all process.
Cultural factors and gender-related differences can also influence how ADHD is expressed and recognized. Cultural norms can affect whether certain behaviors are seen as a problem, and gender stereotypes can lead to underdiagnosis in women.
What Does ADHD Look Like in Women and Girls? And Why is it Often Underdiagnosed in Women and Girls?
Until recently, almost all research on ADHD has focused on boys and men, and this research often focused on hyperactive and impulsive symptoms. Other presentations had been largely overlooked in both clinical and research settings, and studies support that while girls frequently display inattentive symptoms, including forgetfulness, trouble paying attention, and problems with organization, the hyperactive/impulsive symptoms, like blurting out or being unable to sit still in class, get noticed more easily by parents and teachers.
For those children, often girls and later women, with inattentive presentation, their symptoms may be missed entirely, leading to a delayed diagnosis and years of struggle. Additionally, societal expectations and gender norms may lead to different expectations for behavior in girls. Girls are often expected to be more organized, attentive, and compliant, so they may work extra hard to mask their symptoms.
Finally, many women with ADHD internalize their symptoms and may experience anxiety, depression, or low self-esteem because of their challenges. These emotional and psychological struggles may become the primary focus of concern while the underlying ADHD remains undiagnosed.
How Does ADHD Present for Nonbibary People?
Unfortunately, the research on nonbinary and gender-nonconforming individuals and ADHD is still very sparse. One small study of individuals experiencing gender dysphoria found that the majority of participants also had a diagnosis of ADHD. While the correlation is still unclear, one investigator suggested that because many people with ADHD perceive the world differently, they may also understand that many of the expectations placed on them are arbitrary and, therefore, are more primed to explore their gender identity. If this is the case, how ADHD presents in individuals who are gender-nonconforming and nonbinary may likely also vary.
How does ADHD Affect the Brain?
ADHD is associated with specific patterns of brain functioning and structure, though the exact underlying causes are not fully understood. Research has shown that individuals with ADHD may have differences in how their brains are structured compared to those without the condition. These differences are most commonly observed in areas of the brain involved in attention, impulse control, and executive functioning. The prefrontal cortex, which functions to control decision-making and impulsivity, is one such area that may show structural differences. The prefrontal cortex in people with ADHD has been found to have reduced activity and connectivity, which is linked to the impulsivity, forgetfulness, poor planning, distractibility, and hyperactivity symptoms that many people experience.
The brains of people with ADHD also tend to have imbalances in certain neurotransmitters like norepinephrine and dopamine. These neurotransmitters are central to regulating attention, motivation, and impulse control. Dysregulation of these neurotransmitter systems can contribute to inattention, hyperactivity, and impulsivity. Scientists have found that ADHD can affect the brain’s reward system as well. This can result in individuals with ADHD being more sensitive to immediate gratification and less responsive to delayed rewards, which may contribute to impulsive decision-making and difficulty with tasks that require sustained effort.
What’s the Relationship Between ADHD and Mental Health?
As previously mentioned, ADHD can coexist with or even lead to the development of various other mental health conditions. Many individuals with ADHD experience anxiety. The challenges of managing symptoms, such as forgetfulness, impulsivity, and difficulty with organization, can lead to worry and apprehension. Contending with the symptoms of ADHD, especially for those who have an awareness of their neurodivergence, can be incredibly distressing, so it’s no wonder people with ADHD are also commonly diagnosed with anxiety disorders like generalized and social anxiety.
Depression is similarly found in conjunction with ADHD rather frequently. The symptoms associated with ADHD can contribute to feelings of frustration, low self-esteem, and underachievement, which may increase the risk of developing depression. The chronic stress associated with coping with ADHD-related difficulties can also contribute to depressive symptoms.
Impulsivity is a prominent symptom of ADHD and can lead to excessive spending, risky sexual behaviors, or substance abuse. In fact, impulsivity, in addition to the neurotransmitter deficiencies that prompt people with ADHD to engage in dopamine-seeking behaviors, leads to a higher incidence of substance misuse and abuse amongst those on the ADHD spectrum. Studies have found that among adults being treated for alcohol abuse disorders, up to 25% are reported also to have ADHD.
People with ADHD also commonly experience emotional dysregulation, specifically with regard to irritability. A major complaint of those with ADHD is feeling easily irritated or agitated. Trying to function with ADHD and meet others’ expectations while simultaneously struggling with executive functioning, inattention, sensory overload, and other challenges can be overwhelming and lead to feelings of frustration that could be externalized due to impulsivity.
In many cases, someone with ADHD may simultaneously present several mental health challenges. It can often be hard to disentangle which symptoms are associated with which condition, leading to many misdiagnoses or delayed diagnoses of ADHD.
Finally, while it’s not a formal symptom of ADHD, many people who experience ADHD also report rejection sensitivity dysphoria. They are particularly susceptible to perceived criticism, rejection, or disapproval from others, making it difficult to engage in social relationships and to feel secure.
What Causes ADHD?
What causes ADHD is one of the many points of contention in the literature about ADHD and in popular culture. The exact cause of ADHD, like many mental illnesses, is not fully understood. It is believed to result from a combination of genetic, neurological, environmental, and developmental factors.
While it is clear that ADHD impacts the brain and brain functioning, researchers do not know what specifically contributes to its development and what doesn’t. Additionally, ADHD is a heterogeneous condition, meaning it can present differently in different individuals. Strong evidence suggests that genetics play a significant role in the development of ADHD. ADHD tends to run in families, and studies have shown that individuals with a family history of ADHD are at a higher risk of developing the condition.
Some researchers and psychologists theorize that ADHD is a collection of coping mechanisms resulting from stress or trauma. Gabor Mate, a leading physician, writes that children with ADHD are highly sensitive and develop tuning out and distractability as emotional defense mechanisms against distress.
What are Some Common Misconceptions About ADHD?
Many misconceptions about ADHD can make the diagnosis of the disorder a controversial subject in some circles. Some people believe that ADHD is not an actual condition and that what’s occurring instead results from laziness or lack of discipline. And many others think an ADHD diagnosis has just become an excuse for bad behavior. People with ADHD may exhibit impulsive or hyperactive behaviors, but these are symptoms of the condition, not willful misconduct. It’s important to understand that individuals with ADHD often struggle to control their impulses due to differences in brain function.
Now that we have increased information about the disorder, many more people are being diagnosed with ADHD as adults. ADHD is a chronic condition, and while symptoms may change or become more manageable with age, they don’t generally disappear entirely. However, with appropriate support and treatment, individuals with ADHD can learn to work with their symptoms.
Another common misconception is that people with ADHD are unintelligent. This couldn’t be further from the truth. Many people with ADHD are incredibly intelligent and creative. They may struggle in school and at work, but not due to a lack of intelligence. Rather, they have difficulties maintaining the focus, organization, and impulse control needed to be successful. There are many accomplished, satisfied people with ADHD who have found success by working with their ADHD. And there is research that highlights the strengths of those with ADHD, including that adults with ADHD report more real-world creative achievements.
How Can I Manage ADHD?
If you’ve read this and you either suspect or know that you or your loved one are struggling with ADHD, I hope you feel comforted knowing that you’re not alone and that while untreated ADHD can make things difficult at times, ADHD may also offer strengths and gifts. So much of the anecdotal reports and research supports that when you work with your ADHD, it can be more than worthwhile.
Get to know your ADHD:
Is there a time of day when you find you’re able to focus more easily? Is there a time of day when it’s impossible to sit still? Get to know your body and try to work with it. Some are most productive when energized at the start of the day. This is when they can complete tasks without too much effort. For others, exercising before sitting down will help them be more present with their tasks. Dr. Edward Hallowell, an ADHD expert, explains that ADHD does not mean a deficit of attention but that one with ADHD may struggle to shift their attention or not hyperfocus on what is most interesting. Once you understand your ADHD and how it manifests, you can learn to work with it, not against it.
Have compassion for yourself:
For many with ADHD, they have struggled with the stigmas associated with their differences and with how they manifest. Many share about receiving negative feedback on report cards and being told they just weren’t trying hard enough. It’s hard not to internalize those messages, which makes things more difficult. For many, a diagnosis of ADHD offers relief, as they finally recognize that they did not cause their challenges and were doing their best. Offering yourself compassion for your history pre-diagnosis and your current difficulties won’t fix everything, but it will likely provide a balm and make it easier to move forward.
Befriend your ADHD:
More than most people, those diagnosed with ADHD need to find a topic highly interesting to focus on. If you can pursue your interests and allow this to guide you, fantastic. Otherwise, you may need to find ways to work with your ADHD. This could look like sandwiching boring tasks between exciting tasks, as was recommended by an expert in ADHD. Another thing to experiment with is creating rewards for yourself for completing tasks. Chunking work into smaller, more manageable pieces can also be beneficial, and there are many other strategies that can help you work with your ADHD once you get to know it better.
Consider meeting with a professional:
So much of the research asserts that medication in combination with mental health treatment is the most effective response to ADHD. Choosing to meet with a psychiatrist for a medication evaluation and/or meeting with a therapist or psychologist for support in responding to ADHD can be worthwhile, as experts can help you better understand your ADHD, can also help you understand your options, and can help you forge a path forward.
ADHD is a complex and multifaceted diagnosis, and navigating it is complex, too. It’s not just a diagnosis for children or little boys; it comes in many different forms. Some of the most brilliant minds have ADHD, but it can be challenging to manage without the proper support. If you are wondering if you have ADHD, or need support managing the symptoms of ADHD, please remember that you’re not alone and that there are professionals eager to help. Please reach out to us; we would be glad to help you identify the support you need.