Welcome back to DIRT FROM THE ROOTS, your monthly blog for discovering new perspectives on interesting, insightful, and obscure topics within the mental health and psychology fields. Today, we discuss the condition that Nick knows best– perhaps all too well.
TOPIC OF THE MONTH
ADHD
“Well I try my best to be just like I am
But everybody wants you to be just like them
They say "sing while you slave!" but I just get bored."
-Bob Dylan
Misconceptions begin at the very name.
If we renamed other conditions in the way that we named attention deficit hyperactivity disorder, we could possibly have such conditions called:
Maladaptive Pseudo-fear Disorder
Pleasure Deficit Disorder
Chronic Perceptual Instability Disorder
Luckily, we do not label other conditions as such, and instead we have paranoia, depression, and anxiety. What makes this nomenclature even further misleading is the fact that, well, ADHD is not necessarily an attention deficit. In reality, individuals with ADHD are actually very likely to have hyperfocusing abilities that are not seen in neurotypical brains. While it is surely harder to focus on things when we do not experience a neurotypical dopamine response, the idea of an attention “deficit” immediately sends assumptions in a misleading direction.
ADHD is actually still a relatively mysterious condition– to explain most simply, all we can truly confirm is that it is a genetic condition that creates differences in cognition and behavior due to a brain that is set up differently from a neurotypical one with key differences in dopamine regulation. Dopamine is the reward chemical, and it is the lack of a typical completion-reward cycle which creates most every irregularity that we see as ADHD symptoms.
It’s important to mention here that ADHD, ADD, and a combination variant of both attention deficits exist, but for convenience of writing, I will only use the label “ADHD”. While symptoms present differently based on this labeling, the general treatment and understanding of the condition is more universal.
BUT WHAT ACTUALLY IS ADHD?
Much of the condition's misconstrued beliefs are due to overemphasis on external (ADHD) traits. And these well known symptoms– hyperactivity, lack of attention, impulsivity, restlessness– are very legitimate. But what this discludes is the internal (ADD) symptoms, such as racing and intrusive thoughts, insomnia, emotional dysregulation, low self esteem, daydreaming/dissociation, and similar features. One symptom often leads to another in ADHD, and like all mental health conditions, exist on spectrums.
I’ll begin by explaining my own experience— and crucially, this is just my own experience, and not a universal one– as I do meet almost all criteria listed by the DSM to constitute ADHD-C, which encompasses all symptoms of both ADD and ADHD.
Some is what you would expect– I will present as fidgeting, restless, and sometimes higher energy than is typical to a situation. My executive functioning is certainly affected, as I am often forgetful, scatterbrained, and aloof, and perhaps most pronounced, it can be very difficult for me to stop talking.
However, these external symptoms are not the largest detriments to my quality of life, and a grand majority of other individuals with ADHD have echoed this sentiment as well. Most prominently, I do not think in a linear fashion and I cannot stop thinking. I often have 4, 5 or even more streams of thought co-occurring at the same time– if this does not seem fathomable to you, not having thoughts is something that seems unfathomable to me! These thoughts may race, may include intrusive thoughts, and also contribute heavily to issues with insomnia, as they can often get worse at night. I am never sure how I will feel emotionally when I wake up each morning, and the large range of short-lived emotions that I feel will often hit at large intensities. In my and countless others’ cases, a spacey, daydreaming and imaginative childhood was not officially diagnosed until 19 due to never presenting as the stereotypical hyperactive child.
While these symptoms are (well, mostly) manageable, I will typically get a surprised response from people upon disclosing and occasionally even a challenge that perhaps I have a different condition. While I can certainly understand this assumption based on the societal perception of ADHD, these moments are also the ones which highlight the misunderstandings of what living with the condition actually entails and unfortunately prevents many suffering from internal ADD symptoms to understand what may be happening within themselves.
WHAT ADHD IS NOT
ADHD is not caused by the environment
ADHD is CERTAINLY exacerbated by environmental factors, namely culture, SES, and family life. But the condition itself is a developmental disorder (along with autism, cerebral palsy, Down's syndrome, and others) rather than a mental illness, indicating that ideas of ADHD deriving from eating too much sugar, poor parenting, overexposure to technology, or similar environmental scapegoats are just a myth. What makes this important is that it indicates that ADHD brains work differently, and therefore require different needs and ways of understanding and cannot be “fixed”. Additionally, the source gives an objective counter to the harmful stigma that ADHD is a ‘punishment’ for someone’s own choices.
ADHD is not something children 'grow out of'
ADHD was actually not even seen as a real condition until more recently than one might think. As may have been inferred from the above paragraph, the initial societal reaction to the existence of the disorder was seen as an excuse for bad parenting, bad behavior, or a way to dodge accountability. Along with this is the fallacy that ADHD is only present in childhood; the truth is that ADHD is very much a lifelong condition of which I have worked with persons aged from 5 to 60. Ironically, symptoms can actually often become more difficult or pronounced in adulthood, particularly regarding executive functioning and emotional regulation.
ADHD is neither overdiagnosed nor something “everyone has a little bit of”
While the percentage of the population diagnosed with ADHD does increase year by year, this is likely due to stigma reduction and greater advancement in our understanding of the disorder rather than an “outbreak” of sorts. ADHD actually may simply be more common than previously thought, and has a wide range of presentation and intensity. This being said, on behalf of myself and fellow ADHDers, it is important to note that this does NOT mean that everyone has ADHD when they do something described as a symptom, nor are trivial lapses in a day comparable to the condition. There is a large difference between misplacing your keys every once in a while and experiencing constant anxiety in transitions due to chronic history of losing keys and dealing with repercussions, and this common saying does overlook the challenges and disvalidate the seriousness of the condition.
ADHD affects far more realms than just work/school/production activities
Another misperception, unfortunately even from professionals at times, is that ADHD is purely an issue of focus or concentration, and therefore only presents barriers in those realms. In fact, one of the most common discussions I will have with adult ADHDers is how it can be hardest to manage the condition on a day when we do not have anything to do. Personally speaking, I am far more problematically affected in relationships, organization, and managing free time– stimulating activities are typically more regulating.
ADHD is not a male-dominant condition
Once again, early misunderstandings of the condition have led to large blind spots in the present day. The most common and grand majority of ADHD diagnoses in the past labeled hyperactive boys as ADHD– likely correctly, but in complete oversight and to the detriment of the many individuals who suffered through the condition without it being identified. A 2015 study highlighted how children with ADHD diagnoses were reported at a 2.3:1 ratio of boys to girls, but adult ADHD diagnoses seemed to have an even split between men and women.
WHAT ADHD IS
ADHD is heavily intertwined with sleep
(or lack thereof)
Some have even posited that the entire condition may be a sleep disorder, and from personal and professional experience, this wouldn’t be inconceivable. Sleep is almost always a prominent, cyclical issue in ADHD, and there are multiple different reasons for such. Most prominently, hyperactivity and racing thoughts can keep one awake until the morning easily. But additionally, individuals with ADHD might feel more productive, clear headed, or awake at night, leading to more productivity in the late hours. There is then the concept of “sleep protest”, which occurs when individuals sacrifice sleeping time for extra leisure time after a long busy day that did not include enough. Medication is often the first culprit from assumption– which can certainly be true. I have, however, also heard dozens of accounts from ADHD individuals that used stimulants to help sleep. And of course there is the report that I get occasionally but consistently: “I think sleep is boring. I would rather be doing something more fun”.
ADHD runs in families, for better or worse
ADHD is genetic, and therefore you can see full families affected by the condition more times than not. This is possibly better recognizable as the trope of the ‘super active family’, the ‘quirky space cadets’ or similar stereotypes. While this structure certainly works in many positive and effective ways, it is also not too hard to see how a family full of emotional regulation and executive functioning challenges can also run into some explosive dynamics. A common misunderstanding that occurs in current day contrast to older perceptions of the condition is the idea that the parent “was able to get through it”, and therefore so should the child. Maladaptive strategies can be a product of the same unmanaged issues, creating a difficult guilt and shame cycle.
ADHD creates a gateway to other conditions
2 out of every 3 persons diagnosed ADHD has shown to also have a comorbid condition, commonly ODD, learning disabilities, and Tourette's Syndrome. Mood and anxiety disorder symptoms are also common, though if you recall my initial post around diagnoses, another view of this would be that traditional ADHD symptoms can manifest into atypical behaviors typically associated with other conditions. While symptoms of depression, anxiety, and self-esteem issues may be individual, co-occurring conditions in some cases, they also occur as a quite unpleasant medley in reaction to ADHD emotional swells, rejection sensitivity, and/or continuous negative reinforcement.
ultimately, IT'S an emotional regulation issue
In the end, there is no solidified science on ADHD to share anything concrete on its origin or precise functioning at this time, but one constant throughout all variations of the condition seems to come down to emotional regulation. The inconsistent dopamine results in an increased drive to seek dopamine– whether this be through physical movement, impulsivity, substance use, hyperfixation, talking, or countless other coping methods, it is all in an attempt to re-regulate. On the opposite end, it can be very difficult to regulate in times when societally expected, and further exacerbated by outside pressure and expectation to do so. Even in the case of executive functioning, the largest barrier to improving coping strategies is often the emotional one within.
ADHD is a major advantage IN MANY WAYS
But all this being said, ADHD truly does have its perks– when something is very interesting, individuals have hyperfocus, or extremely extensive and perhaps even infinite focus in certain cases. The silver lining of living in a world that was not set up for the condition is that it fosters empathy, resilience, creativity, and spontaneity in a way that not only is appreciated by ADHDers, but by all. ADHD has shown correlation to more charisma, better conversation skills, and better social understanding. While ADHD may lack attention at times, there seems to be an increase in observance, creating unique and potentially more effective approaches to interactions.
REJECTION SENSITIVITY
Another extremely common symptom, technically seen as the comorbid condition of ‘RSD’, is rejection sensitivity. This creates an extremely tough contradiction with the cruel combination of a heightened negative reaction to failure and rejection in a world that is constantly redirecting ADHD adjustments to do things in a more neurotypical-geared fashion. Much of the resilience built comes from overcoming constant negative reinforcement, but much of the emotional challenge lies around how much more difficult this task becomes once emotional dysregulation has begun. Amongst other complications, rejection sensitivity ultimately leads to issues in motivation, as great anxiety can create massive barriers in completing tasks and initiation.
ADHD vs TRAUMA RESPONSE
The most important consideration in regards to whether symptoms are actually rooted in ADHD is ruling out the possibility of trauma response symptoms mimicking the condition. Trauma responses are adaptations to unmet needs in childhood which persist into adulthood, and can include many similar presentations such as restlessness, impulsiveness, rejection sensitivity, motivation issues, etc. While many ADHD strategies can be effective in managing symptoms, it is important to distinguish the two because the roots (genetic vs environmental) are still completely different. This is also important in potential medication options, as we will cover next.
ADHD TREATMENT–
A LOADED TOPIC
While certainly medication (or just drugs in general) is a forever-controversial discussion, ADHD meds have gained especially large amounts of notoriety. You’ve likely heard and may even have a strong opinion on the issue of giving ADHD medications (typically amphetamines) to children or even adults, and the issue does seem to do justice to the complexity of the situation.
Starting with its street name– speed– amphetamines get a very misleading rap. What amphetamines actually do chemically involves creating more dopamine reception– quite the benefit to those who lack neurotypical regulation, but quite overwhelming to those who do function in a neurotypical way. This has created a false perception that amphetamines will only exacerbate symptoms due to its response in a non-ADHD brain. In reality, most individuals with ADHD find life more calm, collected, and manageable on these stimulants.
While information still is limited on ADHD medication, studies have shown minimal long term effects and actually reported better health in ADHD individuals that took amphetamines than those who did not in the long run. There is great reason for hesitance around medication, and certainly with younger individuals when considering that individuals with ADHD are more prone to substance use due to the lack of dopamine. An important and perhaps counterintuitive statistic to consider with this is that children who are medicated for ADHD are actually less likely to develop substance use disorders later in life due to better management of dopamine regulation.
While medication is an individual question for each person seeking treatment, the most important facet to consider in this realm is that people with ADHD will typically have a staggeringly different and opposite response to the medication than a neurotypical person would.
HELPFUL STRATEGIES FOR ADHD (FROM SOMEONE WITH ADHD)
It does work differently;
that is THE MOST IMPORTANT PART!
One of the most striking comments I have ever heard was in school from a therapist who worked with ADHD, stating that “[people with ADHD] never think they are good enough, even though they almost always are”. While I admittedly can relate to this strongly, it is also one of the symptoms I have seen the most reduction around over time managing the condition. A lot of self esteem is lost when growing up with expectations of learning things from a neurotypical lens, but significant relief can occur through simply adjusting life around ways that things have worked differently or focusing on things we do enjoy.
Life is completely overwhelming as a whole, manageable in pieces.
While this is perhaps an obvious statement, it is typical for the ADHD brain to forget that, become overwhelmed by seeing something as one large whole, greatly reduce ability to complete the task, and sometimes shut down from the issue in absence of regulation. Taking situations in smaller pieces will make things more manageable and allow more time for emotional regulation.
Structure feels like a prison…
but is also necessary.
Perhaps the sole unifier amongst individuals with an ADHD diagnosis exists in the relationship with structure. While structure is a necessary feature for a brain which relies so much on regulation and struggles to do so consistently, structure also creates limitations, inflexibility, monotony, and prevents spontaneity– a surefire list of things to create potential anxiety, depression, and constraint on ADHD brains. While this bind is an unfortunate paradox that we must deal with, there is also a balance that can be attained. Though tricky, it is still possible to have a structured routine that still leaves ample room for flexibility, and hold autonomy in deciding the schedule. And therefore…
Organized Chaos is the most effective strategy I have seen.
The concept of organized chaos is genuinely the most effective strategy I have seen in my career to this point. It’s a simple concept: do what you need to do when you can do it. With caveats to deadlines, sometimes the greatest motivator for ADHD task completion, much of the inability to complete tasks comes from anxiety around the expectation to get those tasks done. Organized chaos suggests that if mornings are hard for a person yet they find themselves wired at night, simply shift tasks to the nighttime. We often do not even realize the subconscious societal deterrent to doing things in a “weird” way– doing chores after midnight for example– and therefore feel a need to do things in a “normal” fashion, even if nobody is watching. Considering the irregularity of dopamine and inconsistent emotional patterns, organized chaos not only empowers autonomy to reduce anxiety around task completion, but also allows an ADHDer to produce their best efforts when completing tasks.
Exercise is particularly helpful.
Another theory on the origin of the condition that I appreciate is the evolutionary hypothesis, which sees ADHD brains having a differing chemistry from neurotypical brains due to being better suited for life in the wild as nomadic, active creatures. The modern concrete jungle which requires extended focus and reduced physical movement is clearly much more challenging to a brain equipped for traversing nature, and this creates a heightened benefit from exercise. Not only is exercise good for short and long term health and wellbeing, but also can be extremely effective in creating more dopamine and sustaining more consistent positive emotions.
CONCLUSION
And in the end, I would never trade my life for a non-ADHD one!
While the focus of this article was to highlight the misconceptions and underlying problems of the condition, the benefits can certainly outweigh the detrimental effects in many situations. Some measures suggest that the percentage of ADHD diagnoses in professional athletes are nearly double that of the general population, and a long list of celebrities and creatives can be found expressing ways in which the condition led them to their success. Harnessing ADHD can lead to an extremely successful and fulfilling life, and traits such as high energy, non-linear thinking, and risk-taking can be seen as valuable in as many situations as they are seen problematic.
If you feel that you may have ADHD because you find yourself relating to these symptoms– it is probably true! Given the advancements in research, it is likely much more common than reported, and can be completely self-regulated at mild levels. As with any symptoms or mental health condition, the only real concern is centered around the effect that these traits may have on your quality of life. While many of us do find ways to self-regulate, we also may find that small tweaks can make large improvements when viewing the source from a new perspective.
WHAT’S COOKING FOR NEXT MONTH
NICK TALKS AUTISM SPECTRUM DISORDER
Next month, Nick will discuss the condition he has worked with longest and one that may be even more misunderstood than ADHD in Autism Spectrum Disorders.
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