ADHD: What Is It, and How Does It Work?
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When you think about ADHD, what do you imagine? Perhaps you visualize an elementary schooler fidgeting as they complete their math homework or a young boy playing with a pen, focused solely on taking it apart and putting it back together.
If one of these is your mental image of ADHD, you're not alone. Because of media representation and a historical focus on ADHD in men, many individuals focus on children, and specifically boys, when they imagine ADHD. However, ADHD can look different across ages and genders. This article focuses on the definition of ADHD, how it presents itself, and the severity of its impact on one's daily life.
The Science of ADHD
Attention Deficit Hyperactive Disorder, or ADHD, is a result of several neurological changes, which cumulatively lead to the symptoms of ADHD. For instance, one of the things that has some effect on how ADHD changes the brain relates to dopamine and norepinephrine. Simply put, your brain wants to turn dopamine into norepinephrine because norepinephrine is the reward it gets when you accomplish the things you need to survive; your brain will first put the dopamine into transporters that will then take it to the part of your brain that transforms it into norepinephrine. But for people with ADHD, it's not that easy – they don't have enough transporters for dopamine, which means they can't turn dopamine into norepinephrine as efficiently. Current studies have hypothesized that this results in impulsivity and inattention, two of the main symptoms of ADHD.
Outside of brain chemicals, the frontal cortex, limbic lobe, and basal ganglia have a massive effect on the presentation of ADHD. Generally, the frontal cortex regulates your impulses and attention, the limbic lobe affects motivation and emotions, and the basal ganglia affects your ability to make a plan and follow through with it. As you might imagine, altering these regions can massively impact your ability to get things done. Specifically, changes in these areas make it difficult for people with ADHD to get their work started – and when they've finally started their work, changes in these areas make it difficult for them to concentrate. Additionally, these changes often make it difficult for people with ADHD to work on multiple things at once.
All of these things result in the symptoms of ADHD.
How Is ADHD Diagnosed?
Attention deficit hyperactive disorder has existed as a concept since the late eighteenth century, but it wasn't until 1902 that mental health professionals created an 'official' diagnosis. At that point, it was an immensely flawed diagnosis, being that it was discriminatory and didn't consider the perspective of anyone with ADHD.
Since that point, the symptoms and methods for diagnosing ADHD have significantly changed and the symptom list to be diagnosed with ADHD has been updated to be far more comprehensive. Hundreds of people accomplished this over several decades but it took until 1987 for the term 'attention deficit hyperactive disorder' to be created and for professionals to formulate a clear definition of ADHD. Since then, the symptoms of ADHD have evolved to become known as what they are today; for many people with ADHD, these include difficulty paying attention, having a hard time sitting still, and forgetfulness.
Now, psychiatrists diagnose ADHD with the symptom lists found in the DSM-5. The DSM-5, or Diagnostic Statistical Manual of Mental Illnesses, is essentially a dictionary for terms used when diagnosing brain-related conditions such as ADHD. This source states that to be diagnosed with ADHD, you must have five or more symptoms (six or more in children aged sixteen or younger) of either inattentiveness or hyperactivity-impulsivity.
As shown below, the different symptom lists each have a recurring 'theme' – the first list shows the symptoms associated with the 'attention deficit' part of attention deficit hyperactive disorder, whereas the second list shows more symptoms for the 'hyperactive' part of ADHD.
Symptoms Of ADHD
The following are lists of symptoms, noted by the CDC, that break down the various clusters of symptoms related to ADHD. These lists are not a substitute for professional diagnosis and are not all-inclusive.
Inattentive Symptoms:
Often struggles to pay close attention to details and/or makes small mistakes in schoolwork, work, or other activities.
Often has trouble holding attention on tasks or play activities.
Often does not seem to listen when spoken to directly.
Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (e.g., loses focus, side-tracked).
Often has trouble organizing tasks and activities.
Often avoids, dislikes, or is reluctant to do tasks that require mental effort over a long period of time (such as schoolwork or homework).
Often loses things necessary for tasks and activities (e.g. school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones).
Is often easily distracted.
Is often forgetful in daily activities.
Hyperactivity-Impulsivity Symptoms:
Often fidgets with or taps hands or feet, or squirms in seat.
Often leaves seat in situations when remaining seated is expected.
Often runs about or climbs in situations where it is not appropriate (adolescents or adults may be limited to feeling restless).
Often unable to play or take part in leisure activities quietly.
Is often “on the go” acting as if “driven by a motor.”
Often talks excessively.
Often blurts out an answer before a question has been completed.
Often has trouble waiting their turn.
Often interrupts or intrudes on others (e.g., into conversations or games).
Additionally, these symptoms must:
Have been at least partially present before the age of 12
Be present in more than one setting (ex: at home, at work, during school)
Interfere with one's ability to function
Not be better explained by another disorder (psychiatrists will often investigate common comorbid diagnoses to be confident in their cause)
What's Wrong With This List?
Unfortunately, despite the updates that this list has gone through, it doesn't tell the complete story for many people with ADHD.
One group often discriminated against in this diagnosis is people raised as women (referred to as womxn). Many womxn experience very different symptoms from those socialized as men, primarily because of differences in societal expectations that we teach each of these groups to follow. These teachings mean that womxn will often mask their symptoms – or hide their symptoms to seem 'normal.' Masking one's symptoms can lead to issues such as sleep deprivation and increased stress, as well as making it harder for one to get diagnosed. Additionally, many sources say that womxn are more likely to experience more symptoms of inattentive ADHD than hyperactive ADHD, which is far less externally perceivable. This lack of research into ADHD and how it changes for womxn often means that they aren't diagnosed until far later, which can lead to anxiety and depression.
Not only is it more difficult for many womxn to get an ADHD diagnosis, but adults who were not diagnosed with ADHD as a child will often have a far more difficult time understanding their symptoms. This is due to the lack of research into how ADHD changes with age and the symptoms of ADHD in adults. For many adults, getting diagnosed with ADHD can be a difficult journey, as it can change your perspective on life. However, getting a diagnosis can also help you understand the things you've always struggled with and help you overcome them.
Challenges and Benefits of Living With ADHD
Challenges Of ADHD
Outside of dealing with stereotypes like those described above, living with ADHD has many challenges. For instance, many people with ADHD will struggle in school, and these struggles often translate to difficulties with work later on. Symptoms of ADHD – including not being able to sit still and struggling to focus on tasks for extended periods – can make school incredibly hard. Later, when people with ADHD enter the workplace, forgetfulness and an inability to be as productive as their co-workers make them potentially more likely to face negative consequences.
Rejection-Sensitive Dysphoria (RSD)
ADHD is often comorbid with something known as Rejection-Sensitive Dysphoria (RSD). When most people with ADHD feel that they have been 'rejected,' they feel a strong and even overwhelming sense of discomfort or pain. RSD can lead many people with ADHD to struggle, as it has huge effects on their interactions with others.
RSD leads many people to work harder, as they think they will never feel rejected if they work hard enough. This idea can lead to perfectionism and severe anxiety as they constantly struggle to meet the incredibly high expectations they've set for themselves. Because of these effects, many people with ADHD will struggle emotionally, as they don't have enough energy to take care of their needs. RSD can also make people's relationships suffer, as it often results in them assuming the worst of their partner and can lead to them hiding their true selves to seem 'perfect'.
Benefits Of ADHD
Surprisingly, there are far fewer studies on the benefits of ADHD than on the drawbacks. However, this is thought to make living with ADHD more difficult, as the extreme focus on the negative allows little room for positive thinking.
However, there can be clear benefits to living with ADHD. For instance, many people with ADHD will have higher levels of energy than neurotypical people, which can give them more drive to do well. For example, this level of energy can lead to hyperfixations, making it possible for many people with ADHD to do incredible amounts of work in a short period. Additionally, ADHD can result in higher levels of creativity, making people with it more able to approach problems in different ways, which is a highly valued skill in many workplaces.
In a qualitative study done by the British Medical Journal, participants were asked to describe the positive aspects of their ADHD. These responses could largely be sorted into four categories – the dual impact of diagnosable ADHD characteristics, unconventional thinking, having more drive to pursue new experiences, and the ability to resist and grow. Within each of these categories, there were many different positive characteristics that people with ADHD cited as improving their lives including a drive to learn, a higher capacity to empathize, and the ability to easily create relationships.
What Should You Do If You Think You Have ADHD?
If you think you may have ADHD, consider talking to a therapist. Therapists can help you determine whether what you're feeling is ADHD and have resources to help you get an official diagnosis if you figure that you do have ADHD. A therapist can also help you understand how to work with your brain instead of against it, which can be immensely beneficial to your mental health.
At Trust Mental Health, you can get support from therapists within 48 hours. Trust Mental Health is an organization conducting therapy in San Jose, California with a specific focus on including people who often find it hard to connect with a therapist due to their culture or background. Within Trust Mental Health, you can find Cognitive Behavioral Therapy (CBT) in California, coping strategies worksheets, and an abundance of other tools that can help you both cope with the challenges and celebrate the benefits of your ADHD.
Key Points
ADHD is caused both by changes in neurochemistry and brain structure
The symptom list for ADHD has changed to be more inclusive and comprehensive over time
Despite these changes, the process of getting an ADHD diagnosis is still deeply flawed
FAQs
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If you think you have ADHD, work through the list of symptoms and articles like these to understand why you may think so. Talking to a professional will help you get a diagnosis and the support you’re looking for. Trust Mental Health offers service within 48 hours and has many different types of therapy to suit your specific needs.
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First, assess your symptoms and consider if they seem to align with those on the ADHD symptom list. If they do, talk to a medical professional for another opinion on whether or not you should seek a diagnosis. After this, consider which mental health professional would best suit your needs in getting a diagnosis. Once you have done this, you can complete an evaluation for ADHD. Learn more at: https://add.org/how-to-get-diagnosed-with-adhd/
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Supporting your friends with ADHD is primarily about listening to them and understanding tangible ways you could help. This support might look like doing your work in the same area as they are, texting them about grabbing lunch if you think they might forget to eat, and thinking of challenges you can both do to stay motivated.