If you’ve ever struggled to finish an assignment on time or blurted something random and unrelated
out in a conversation, you may have described yourself as being “so ADHD.”
But ADHD isn’t just being absent minded, and it’s certainly not the same as being "random."
Academics and clinicians actually prefer to reserve the word random for “quirky” Instagram
influencers doing literally anything a normal person does on a daily basis.
ADHD is a lot more nuanced.
For me, it’s shown up in pretty much every aspect of my day-to-day life since I was a kid.
There was the obvious stuff, like getting distracted and needing extra time on school
projects, and the unexpected stuff like not getting up to use the bathroom for hours because
I literally could not stop reading the deep lore of the Hanna-Barbera cinematic universe.
It’s happened more times than I care to admit.
Hi, I’m Bethel Afful, and welcome to Misconceptions.
Today we’re talking about Attention-Deficit Hyperactivity Disorder, also known as ADHD.
We’ll discuss symptoms, stigmas, and whether we can truly say this condition is over-diagnosed.
And this should go without saying, but it’s a lot more complicated than getting distracted
when a squirrel runs by.
Let’s get started.
People with ADHD have no attention span.
It seems counterintuitive that a person with ADHD could be excessively immersed in a
task for hours on end, but it’s actually fairly common.
this symptom—which isn’t actually an official diagnostic criteria—is called “hyperfocus.”
It’s not unique to ADHD, either; it can also occur in other conditions like autism
and schizophrenia, and in neurotypical people.
Some adults may experience hyperfocus with work-related tasks when they have a deadline coming up.
Others may hyperfocus on feelings, like those at the beginning or end of a relationship.
Children can hyperfocus on tasks that build their cognitive skills and coordination, like
reading or playing video games.
In that context, hyperfocus can be beneficial, but it can also have negative side effects.
If someone is in hyperfocus mode, they may miss an appointment or a deadline.
In her book Adventures in Fast Forward: Life, Love and Work for the ADD Adult, Kathleen
Nadeau describes a woman with ADHD who hyper focused on a paper she was writing, and didn’t
realize her house had caught on fire.
In cases like that, a person with ADHD might have such a strong attention span for one
particular activity that they become unaware of pretty much anything and everything else.
The “attention-deficit” part of the acronym still rings true for some things, but it doesn’t
apply to every single task.
A recent paper in the journal ADHD Attention Deficit and Hyperactivity Disorders looked
into hyperfocus in adults with ADHD, noting, “Perhaps the higher prevalence of [hyperfocus]
in ADHD is an issue of attentional control—that ADHD may not be an attention deficit, but
rather an attention dysfunction or a ‘maldistribution of attention’ …” And though people with
ADHD sometimes have difficulty maintaining attention, we’re not the hyper-distracted
caricature that many people have come to equate us with.
Any lack of focus equals ADHD.
A study conducted by two Harvard psychologists published in 2010 found that the average American
adult spends approximately 47 percent of their waking hours letting their minds wander.
As therapist and mental health counselor Lily Main Ewing explained in an interview, “Zoning
out is seen as an old brain function for survival, similar to our fight-flight responses.
There’s actually a third survival instinct which is to freeze when there’s no way to
fight or flee our way out of the threat.
Instead, our bodies and minds opt to partially shut down in order to survive.”
Some of these “threats” that our bodies register, while not inherently detrimental
to our survival, can include sleep deprivation, stress, and information overload.
So if everyone is zoned out half of the time, does everyone have ADHD?
No.
The difference between ADHD and an occasional lapse in focus is that ADHD isn’t occasional at all.
It’s a sustained pattern of inattention and impulsivity.
According to Shanna Pearson, founder and president of Expert ADHD Coaching, “having ADHD is
so much more than being easily distracted.
It involves a lifetime of living with a brain that isn’t able to easily compartmentalize.”
People with ADHD might misplace things, have trouble paying attention to detail, or have
communicative difficulties like returning texts and staying on topic during conversations.
To be clear, people without it can have the same difficulties at times—it’s the persistence
and frequency of those issues that might lead to an ADHD diagnosis.
Occasionally losing steam during a boring work meeting or walking into a room and forgetting
what you went in there for is just a part of being human.
Everyone with ADHD is hyperactive.
There are multiple presentations of ADHD.
There’s the predominantly hyperactive-impulsive presentations, in which people have more trouble
with hyperactive and impulsive behavior (like interrupting people mid-sentence, or not being
able to sit still) than they do with inattention.
Its inverse is the predominantly inattentive presentation, in which people may have trouble
concentrating, but often don’t exhibit hyperactivity.
What people most commonly refer to when discussing ADHD is the combined presentation, in which
people exhibit both inattention and hyperactivity/impulsivity.
And while this is the most common form, not everyone with ADHD displays these symptoms.
I have predominantly inattentive presentation ADHD, so I’m not constantly “bouncing
off the walls,” as people tend to assume.
On occasion, I’ll fidget by bouncing my leg or tapping my pen against my desk.
Other times I may feel restless and need to go for a walk, but that’s the extent of
my hyperactive symptoms.
Everyone experiences symptoms differently, so you can’t assume they’ll exhibit them
the exact same way.
ADHD only affects children.
It is incredibly frustrating to search for ADHD management tips online and have most
of the results be directed towards parents of young children.
I’m not putting myself in time-out.
I am a grown adult who pays taxes and rent.
It was estimated that in 2020, 6.7 percent of adults worldwide had “symptomatic adult
ADHD.”
That’s around 370 million people who won’t put themselves in time-out, either.
According to retired clinical psychologist Dr. Russell Barkley, though, symptoms typically
do tend to “ … arise, on average, between 3 and 6 years of age.”
Only about 20 to 35 percent of people who had the disorder as a child outgrow it and
don’t exhibit any symptoms in their day-to-day adult life.
ADHD symptoms often differ between adults and children.
Many children with ADHD show symptoms of the predominantly hyperactive presentation.
This could be because they aren’t at the age where sustained attention to certain tasks
is necessary.
As people with ADHD get older, they more commonly exhibit symptoms of inattentive or combined-presentation ADHD.
ADHD in older teens and adults can appear as difficulty prioritizing tasks, trouble
in personal relationships, negative self-esteem, and lack of motivation, among other factors.
Adult ADHD may also coexist with depression, mood disorders, and substance abuse.
We know that ADHD is overdiagnosed.
A 2015 study in the Canadian Journal of Psychiatry describes overdiagnosis in psychiatry as occurring
“where patients are identified with a mental disorder when they do not have significant
impairment and would not be expected to benefit from treatment.”
Overdiagnosis can be harmful because it can lead to overtreatment.
This may be one of the reasons some people report bad experiences from being medicated
for ADHD as children; they may have been thought to exhibit signs of ADHD when they were really
exhibiting signs of … being a kid.
A 2016 study featuring children ages 6 to 17 found that the youngest third of students
in a particular year were more likely to take stimulant ADHD medications than their older peers.
This suggests that, for those kids, age may have played more of a role than pathology.
Experts are still on the fence about whether or not ADHD is truly overdiagnosed.
It’s clear that ADHD diagnoses are becoming increasingly common in some countries.
One 2019 study in the U.S. estimated that adult ADHD diagnoses increased more than twofold
within the last decade.
But that, by itself, doesn't necessarily imply an overdiagnosis epidemic.
It may be that rates of ADHD genuinely are increasing, or that fewer undiagnosed cases
are slipping through the cracks.
However, the general consensus is that it’s frequently misdiagnosed.
That is to say, it is incorrectly diagnosed in some people, and completely overlooked in others
Some studies suggest that ADHD is under-diagnosed in communities of color, and diagnoses can
be made more difficult because of pre-existing beliefs or biases about how ADHD is "supposed" to look.
A kid who gets out of their seat and runs around the classroom, for example, is more
likely to get an ADHD diagnosis than the kid who quietly struggles to pay attention.
An American Academy of Pediatrics study reports that “factors increasing children’s risk
of an ADHD diagnosis [include] being a boy, being raised by an older mother, being raised
in an English-speaking household, and engaging in externalizing problem behaviors.
Factors decreasing children’s risk of an ADHD diagnosis included engaging in learning-related
behaviors (e.g., being attentive), displaying greater academic achievement, and not having
health insurance.”
As you can probably guess from that analysis, it’s difficult to disentangle genuine risk
factors for increased prevalence of the condition from characteristics that merely make a diagnosis
more likely.
Dr. Margaret H. Sibley explains that since ADHD appears with different symptoms in various
groups, “doctors often miss ADHD in women and girls, older adults, people from minority
backgrounds, and people who are successful, smart, or likable.”
Can confirm the older, female, minority background part, as my ADHD diagnostic process was super
frustrating and unnecessarily long.
Experts have not, annoyingly, weighed in on whether I am successful, smart, or likable.
Believe me, I've asked.
The difficulty that comes with diagnosing psychological conditions that are defined
largely through self-reported symptoms as opposed to biological markers makes it difficult—if
not impossible—to say whether ADHD is truly overdiagnosed.
ADHD can be self-diagnosed.
In some cases, like mine, it can be hard to get a proper diagnosis.
So instead, some people resort to self-diagnosis.
Maybe you’ve seen a super-relatable video or social media post where someone describes
an innocuous habit as a “symptom of ADHD.”
While it’s OK to relate to these behaviors, and a lot of people do, that’s not a substitute
for a legitimate diagnosis.
A lot of those posts contain blatantly false information that oversimplifies the condition.
No, randomly shivering isn’t a documented sign of ADHD.
It could be something called an anxiety shiver, or just a sign that you need to turn your
heat up a couple degrees.
ADHD diagnoses aren’t based on whether or not you exhibit a few quirky traits or lose
your train of thought mid-conversation.
Diagnoses are performed through a deep dive of one’s personal history, behavioral screening,
and cognitive assessments.
Some criteria for ADHD are so broad that there’s not really a distinction between mental illness
and normal behavior, which is why self-diagnosing based on a few shared traits can be dangerous.
For example, executive dysfunction—having trouble starting tasks you know you need to
complete—isn’t a diagnostic criterion for ADHD, even though many people with ADHD
suffer from it.
Another danger with self-diagnosis is that certain symptoms may be indicative of a different
issue, especially if they haven’t existed since childhood.
According to Dr. Barkley, “ ... should these symptoms develop for the first time in adulthood,
other mental disorders rather than ADHD should be suspected.”
Again, I recognize that legitimate ADHD diagnoses can sometimes be inaccessible to a lot of people.
In those cases, self-screening can be a valid tool to help guide next steps.
But the best way to explore treatment options is to talk to a medical professional.
ADHD is a learning disability.
While ADHD can cause difficulty in academic and professional situations, it’s not actually
a learning disability.
A learning disability is a neurological challenge that can increase difficulty in things like
reading, writing, or math, for example.
ADHD on the other hand, as described by Dr. Barkley, “ … is a performance disorder.
You can’t perform the things you know how to do.”
Someone can have ADHD AND a learning disability, but they’re two distinct things.
ADHD doesn’t only affect work and productivity in a particular discipline.
It affects relationships, personal organization, mood, behavior, and executive functioning.
The common misconception shared between ADHD and learning disabilities alike is that they
are both a reflection of someone’s intelligence, which simply isn’t true.
IQ is an imperfect measure of intelligence, but for what it’s worth, both learning disabilities
and ADHD are distributed evenly along the spectrum of low-to-high IQ individuals.
As Dr. Barkley explains, “[ADHD] is not a knowledge disorder.
Most people with ADHD know about as much as anybody else from their neighborhood with
their education and that school at that age, but they can’t use it.”
People with ADHD just need to try harder.
The stereotype of people with ADHD being slackers is not only stigmatizing, but in most cases,
it’s false.
The problem isn’t whether or not people with ADHD are putting effort into their work
or their relationships, it’s that, as Dr. Barkley notes, “ … the person with the
disorder cannot organize to the delayed future, but only to the imminent future … no one
has any patience with this because they see this as a moral failing.”
The condition’s variability provides an extra layer of difficulty that sets it apart
from “slacking off.”
On one day, a person with ADHD might perform their tasks accurately in a short amount of time.
On another day, that same person might only be able to perform tasks in short, semi-productive
bursts while making lots of mistakes.
So if someone with ADHD knows all this, why don’t they just plan ahead?
It’s not that simple.
ADHD makes it difficult to plan in advance, according to Dr. Barkley, because “ ... ADHD
destroys the sense of time.
Adult ADHD is the consummate disorder of time management … ” It’s hard for someone
to manage something that they have difficulty conceptualizing in the first place.
So if your friend with ADHD is constantly late to plans, maybe cut them a little slack.
What misconception about ADHD did we leave out?
Let us know in the comments below.
And if you think you have ADHD, talk to a trusted therapist or other medical professional,
and know that you’re not alone.
Thanks for watching!