MORE THAN JUST SHINY THINGS: Why We [Still] Need ADHD Awareness

October is ADHD Awareness month! And in a move that is very on brand for my personal experience of ADHD, I am just a teensy bit late in submitting this article. Now, before you roll your eyes and bemoan, “everyone is a little ADHD”, I’m going to remind you that these subtle forms of ableism are precisely why ADHD awareness month exists. And in light of cultivating more awareness, let’s take a deeper look at this diagnosis and the myriad of ways it may (or may not) present. Now, I could wax lyrical about ADHD for hours. But I’m going to try and condense the runaway thought train that is my brain into a somewhat concise overview into this form of neurodiversity. So, read on! And please hold all applause, questions and biases until the end.

Despite thousands of published studies on ADHD and its correlations, certain misconceptions about the condition have continued to permeate mental health circles & broader society alike. Some of these misconceptions include statements that ADHD is: 

  1. present only in boys/individuals assigned male at birth (AMAB) 
  2. something made up by pharmaceutical companies that is vastly over diagnosed and overmedicated 
  3. exhibited solely as an inability to sit still (insert “ooh, a squirrel!” joke here)

The only things these myths have accomplished is reinforcing a barrier that prevents a disproportionate number of individuals living with ADHD from accessing support for it. But if ADHD isn’t accurately represented by the aforementioned statements, then what on earth is it?! 

The label Attention Deficit/Hyperactivity Disorder is defined as a condition that predominantly effects the prefrontal cortex of the brain. It is marked by symptoms such as executive function challenges, forgetfulness, impulsivity, overactive motor output, emotional regulation challenges and a reduced ability to focus. And while it’s true that everyone experiences these traits some of the time, consider the following: ADHD isn’t really a disorder or deficit of attention at all. The ‘deficit’ part is related specifically to the reduced levels of dopamine & norepinephrine that regulate functionality of the prefrontal cortex of the brain. The prefrontal cortex acts as a filtration system for sensory information. It processes stimuli and then plays an important role in deciding how to respond to that stimuli. Individuals with ADHD have a loose and wide filter that lets in a lot of sensory information all the time. Trouble begins with knowing which information to respond to, and which to ignore. And that’s really exhausting, because this filter is always switched on.

ADHD illustration

Some theories suggest that ADHD is an evolutionary neurological leftover from our hunter-gatherer days which became slowly bred out during the agricultural revolution. As we no longer needed to pay attention to every sound & movement in the bushes that could be prey or food, ADHD became viewed as a recessive ‘disorder’ rather than an adaptive function. Some of the current controversies around ADHD stem from the surge in childhood diagnoses during the 1990’s as researchers developed a deeper understanding of potential psychosocial impacts associated with children learning inside of a classroom for 6-8 hours a day. And due to disparities within gendered models of socialisation, certain symptoms within the diagnostic criterion became far more easily observable than others. 

And so, from these new findings the childhood ADHD stereotype was born. This often looked like the child who displayed symptoms to such extremes that both their own classroom learning as well as that of their peers became disrupted, therefore making symptoms far more noticeable. Anyone who did not fall into this particular category or displayed traits of impulsivity & inattentiveness in subtler ways often went unnoticed, often being labelled as chatty, daydreamy or just plain silly. Kids just being kids, ya know? Except with one notable difference: individuals who go on to be diagnosed with ADHD later in life often report knowing from a young age that something was “off” about the way they interacted with the world. Many report feelings of shame for having to try harder than their peers at daily tasks, instead making adjustments in order to not feel othered by these struggles at the expense of their own mental health. They may have achieved the same result as their peers, but the energy output to get there was far greater. Often these struggles are internalised, leading to a slew of additional challenges including self-harm behaviours, substance misuse, and an increased risk of experiencing intimate partner violence. For those who acquire a late-in-life diagnosis with ADHD, there is often a common experience of relief & grief. Relief that there are finally some answers and with them some hope for new ways to survive in a Neurotypical world. Grief for all of the jobs, relationships, and opportunities we may have lost in thinking we’re just not as good at this whole ‘adulting’ thing as everyone else.   

ADHD scribbles

During the early 1990’s, researchers estimated that ADHD was nine times as common in boys/AMAB individuals than girls/AFAB individuals. Today that gap has lessened to approximately 2.5 times. So, what’s changed? New research around the biological & environmental factors that can contribute to ADHD has paved the way for a more holistic view of the condition and variety of ways it may present. That is to say, no two people with ADHD experience the condition in exactly the same way. Currently, the accepted view of ADHD is essentially an umbrella diagnosis comprising three different types: Hyperactive, Inattentive (formerly known as ADD), and Combined (both Hyperactive & Inattentive). Within these three types, an infinite grouping of traits may exist that create a distinct, individual profile. Some individuals experience Rejection Sensitivity Dysphoria and some do not. Some will hyper focus on activities to the point of obsession while others find the idea of focusing on anything for prolonged periods of time tedious. An individual may require near constant bodily movement and experience periods of zoning out/daydreaming. Some thrive on routine while others abhor even the thought of it. 

Because there is no one-size fits all way of diagnosing or managing ADHD, it is not entirely surprising that scepticism continues to surround its legitimacy as a form of Neurodivergence. Humanity does not sit well in uncertainty, and so for those on the outside looking into ADHD purely as an observer, this chaotic cluster of symptoms can seem well…fake. But those of us who live with the condition are all too familiar with chaos, and so it makes perfect sense that even just the diagnosis is tricky to conceptualise. As clinicians, it is our responsibility to take the time to understand how our clients experience their ADHD. The work done with clients living with ADHD must be tailored to personal experiences from a strengths-based framework in a way that celebrates the gifts bestowed by neurodiversity and validates the challenges associated with it. What works for some clients to manage those challenges will not work for others. And that’s okay! Don’t be afraid to get creative and remember that the strategies that don’t work are just as important as they bring you both closer to the ones that do. 

Sources & Further Reading: 

Stephen P. Hinshaw (2018). Attention Deficit Hyperactivity Disorder (ADHD): Controversy, Developmental Mechanisms, and Multiple Levels of Analysis

Dein S (2015) Hunters in a Farmer’s World: ADHD and Hunter Gatherers. Anthropol 3: 150

Rene Brooks (2019) “Could You Not?” 6 Things Not to Say to Someone with ADHD

Rodrigo Pérez Ortega (2020) Under-diagnosed and under-treated, girls with ADHD face distinct risks

Written by Dana Swann.

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