9 Common Myths About Attention Deficit Hyperactivity Disorder (ADHD)
*this post contains amazon-associated links as well as links to free resources and printables
There are many myths and stereotypes about Attention Deficit Hyperactivity Disorder (ADHD) and as a Certified Professional ADHD-Clinical Services Provider, I’m going to tell you about a few of them. If you or someone you care about has ADHD it can be frustrating facing these stereotypes or not understanding why you may experience some of these symptoms, so hopefully this article can clear up some things.
First, lets briefly cover what ADHD is and the 3 types. According to the Diagnostic and Statistical Manual of Mental Disorders, the DSM-5, ADHD is a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning and development. According to the NIH, studies estimate around 9% of children and up to 5% of adults are diagnosed with ADHD. For a point of reference, under 2% of the population has red hair. ADHD is diagnosed in 3 categories:
1) ADHD presenting as predominantly hyperactive-impulse
2) ADHD presenting as predominantly inattentive (formerly called ADD)
3) ADHD presenting as a combination of inattentive and hyperactive-impulsive
*it’s important to note that as symptoms can change over time so can your presentation type
These symptoms must exist consistently in more than one setting such as work, home, school, etc. and they must impact one’s development and/or ability to function. So it can’t just occur in one setting, for example a toxic or stressful environment at home could cause someone to have difficulty focusing, become forgetful, react impulsively, or have difficulty staying still and feeling safe. Those trauma and anxiety responses from an unhealthy home environment can look like ADHD and even carry through to school at times, which is why full evaluations for ADHD are very important.
Having ADHD could also look like an inability to make appointments, being consistently late for work or school, missing payments due to forgetfulness, or having difficulty managing time. It would include activities you enjoy as well as those you don’t. It can also look like an inability to maintain friendships, relationships, or having an increased rate of impulsivity that causes financial, physical, or emotional harm. While there may be a generalized view of each of these categories, it is not a one size fits all in terms of presentation of symptoms and that is where some of these myths are rooted.
MYTH 1- YOU CAN TEST FOR ADHD
Unfortunately there is not a single test, blood test, or MRI to diagnose ADHD. Instead, it’s an overall evaluation of current symptoms, symptom history, behavior scales, and rating scales performed by a specialist as well as symptom scales self-reported by individuals in the client’s life settings- such as a student’s parents, teachers, and general practitioner. To avoid any of the myths that I will continue to discuss, even in the professional field, it can be important to seek out a psychiatrist trained in current ADHD research for a diagnosis or that you work with a therapist trained in ADHD for behavioral therapy, interventions, and coaching.
MYTH 2- ADHD IS AN INABILITY TO FOCUS
ADHD is not an inability to focus, it’s an inability to regulate focus, so there will be times when an individual with ADHD seems to be able to focus very well. That’s because one difference in an ADHD brain is that it has an issue with dopamine. An ADHD brain has a defect in the DRD2 gene that makes it difficult for neurons to respond to dopamine. Dopamine is a neurotransmitter involved in the feeling of pleasure and the regulation of attention. When the brain has low levels of dopamine it can be easily distracted or prone to zoning or hyper-focusing. The unmedicated ADHD brain underproduces dopamine which causes it to continually seek it out. We can receive dopamine when we are interested in something and with ADHD that is often a distraction when we’re bored because the ADHD brain becomes bored more easily and quickly than a neurotypical brain. This is also because when an ADHD brain does produce dopamine it loses it at a much faster rate than a neurotypical brain, so an ADHD brain needs to constantly find new stimulation to focus on. For example, the rush that someone might get from receiving a reward or a gift may last awhile for them, but can fade rather quickly for an ADHD brain.
Activities that increase dopamine production though can become a great source of focus for the ADHD brain, which is why individuals with ADHD are able to spend hours playing many video games, watching suspenseful shows, or scrolling through videos because it is producing constant sources of dopamine and stimulation.
So how would a classroom lecture compare to a video game for dopamine production? Simple, it doesn’t. This is just one reason why treatment so often includes medication, because behavioral interventions for ADHD need to be addressed at the point of distraction and that can often be very difficult in classroom settings, as well as still not being as effective of a treatment as medication, but we’ll get into that in a moment. An example of an intervention at the “point of distraction” for an adult could look like having a computer program in place when you send work emails. It can tell when you write the word ‘attachment’ in the body of an email but that you have no attachment linked to the email when you hit send. It will then ask you before sending if you meant to send this email without an attachment. This is an opportunity to catch an action at the point of distraction. Classrooms are using more technology now, but not consistently to the extent that adults with ADHD are able to benefit from.
A secondary myth of this is that individuals with ADHD can’t be avid readers or enjoy quiet or calming tasks. This is especially untrue for the inattentive subtypes of ADHD. If reading is producing dopamine for the individual when they are choosing books that interest them, it can definitely become a source of stimulation for them. Individuals with ADHD have the ability to hyper-focus- to intensely focus on an interesting activity or project, which can last for hours. It can be so intense that unless someone or something interrupts it the individual can easily fail to notice the passage of time, sense hunger cues, socialize with others, etc.
MYTH 3- YOU CAN “CURE” ADHD WITH MEDICATION
Medication is considered the gold-standard of treatment for ADHD in children and adults. It has repeatedly been shown to be the most effective form of treatment to reduce ADHD symptoms and stimulants are the most tested form of childhood medication for mental health. There is no “cure” for ADHD though. Many individuals taking stimulant medication for ADHD can feel it as the medicine begins to wear off at the end of the day. We also know that ADHD in childhood often persists into adulthood. Symptoms in adults tend to be more subtle and can often be overshadowed by comorbid diagnoses of Anxiety or Depression. Also, stimulants are not the only form of medication for ADHD, but it will be the medication type I reference most in this post.
Medication and therapy are forms of management of ADHD symptoms. 70-80% of children with ADHD that are taking stimulant medication will see a reduction in their symptoms. Behavioral therapy with a trained ADHD specialist can assist the client and their family in understanding ADHD, their symptoms, their awareness of unhelpful coping strategies, and teach them to build helpful behavioral interventions to assist with routine, skill building, family communication and support, executive functioning, and reducing maladaptive behaviors. Learning about the impacts of dopamine seeking on our behaviors, our eating, sleeping habits, and our health risks can be incredibly important. They can also discuss the connections between our gut health and dopamine loss as more than 50% of dopamine in the human body in synthesized in the gut.
MYTH 4- ADHD MEDICATION USE IN CHILDHOOD LEADS TO SUBSTANCE ABUSE
The truth is that untreated ADHD increases one’s risk for addictive, impulsive, and compulsive behaviors. The most destructive coping mechanism for ADHD amongst teens and adults is self medication through drug and alcohol use. Adolescents with ADHD have an increased risk of substance abuse compared to peers without ADHD. They also have an increased risk of an earlier age of onset for substance abuse as well as a more chronic path [Kousha et al]. The use of stimulant medication in childhood for ADHD, though, has been show to reduce the risk of substance abuse and smoking in those adolescents. [Connor, D]. It has also been shown to promote brain growth in the ADHD impacted areas of the brain through a process called neuro-protection when used consistently with an early intervention [Ivanov.l.et al]. This means continuing to take your medication on weekends and during the summer.
MYTH 5- ADHD IS CAUSED BY BAD PARENTING
The exact cause of ADHD is not fully known, but it is thought to be a combination of genetics and other factors. Those factors can include brain injury, exposure to environmental risks (like lead) in utero or early childhood, low birth weight, and alcohol, tobacco, or drug use during pregnancy. Genetics though, is considered to be a significant factor in the development of ADHD and it’s often seen to pass through blood relatives with the rate of heritability at 77-88% (National Institute of Health). 26-45.2% of the siblings of an ADHD child will also have ADHD. That number rises to around 50% in twins. This is also why the idea that ADHD will always look a certain way can lead to the needs of some children to be overlooked if they have a sibling with more outwardly presenting symptoms, often leading to a later diagnosis for those with ADHD inattentive type, sometimes not until adulthood. Also note, that this means there is a good chance that adults with ADHD are also raising children with ADHD, so behaviors and habits can also be modeled that may further exacerbate symptoms. Earlier diagnosis and intervention can assist the family unit as a whole.
MYTH 6- IT IS MAINLY A MALE DISORDER
ADHD Inattentive type is the most common presentation for girls and therefore can take longer to diagnose. Many girls are not diagnosed until their early 20s. Also symptoms in girls can be expressed differently, for example hyperactivity in younger girls can be excessive talking and fidgeting instead of leaving their seats or climbing as often seen in boys. It can also initially be described as an ‘internal hyperactivity’ with racing thoughts, impulsive speaking or actions, fear of rejection, lying or fabricating stories, and difficulty maintaining friendships even if they easily initiate friendships. Some of the reasons for these differences are biological in nature as well as socially reinforced, as girls have often been expected to repress some of the outward behaviors that were more generally accepted in boys. Therefore girls are considered more likely to mask their symptoms, but possibly to the detriment of other areas of their mental health.
Girls with ADHD often have co-occurring Anxiety and/or Depression which may be diagnosed and focused on initially or mask their ADHD until later in life.
MYTH 7- YOU CAN’T HAVE ADHD AND GET GOOD GRADES
Satisfactory work or achievement does not rule out ADHD. ADHD has nothing to do with one’s intelligence, but it can impact one’s performance and ability to learn, especially if you factor in the increased stress, anxiety, or depression that untreated ADHD can bring. Individuals with above average and high intelligence who also have ADHD can more easily hide executive functioning deficits, especially if they have fewer hyperactive-impulsive symptoms. This overcompensating can come at an emotional and mental cost though, continuing to impact internalized stress and anxiety levels.
Many scientists, artists, writers, and entrepreneurs, etc. with ADHD have very successful careers. The awareness of their needs and their ability to hyper-focus and manage their symptoms can lead to very successful achievements. Also many individuals with ADHD can unknowingly gravitate towards parents, friendships, and partners that have very high executive functioning skills that can help them balance and regulate their symptoms.
MYTH 8- YOU CAN’T HAVE ADHD AND MAINTAIN A ROUTINE
Individuals with ADHD thrive in environments with routine and structure. Once established, it can be a learned behavioral safety net that adolescents and adults with ADHD faithfully follow to help manage their ADHD. That routine and structure helps to reduce the stress and anxiety surrounding forgetfulness and lack of motivation that often accompanies ADHD. Even with structure ADHD symptoms can still be seen. For example, ADHD individuals can get into periods of hyper-focusing on a certain routine. This can look like wanting the same thing for lunch for a month and half straight before suddenly hating the idea of eating that meal again. This can occur with food, interests, relationships, hobbies, and purchases, etc. The consistency of something enjoyable, the feeling of purchasing something, and/or the concept of collecting something can all be quick dopamine producers that fuel this hyper-focus until the dopamine responses stop producing and the activity or project is dropped. This can unfortunately leave an individual feeling overwhelmed, depressed, and frustrated with their investment of time, finances, and resources. This is why we often discuss establishing core routines to help counteract the negative impacts of this. It also means, though, that their ability to learn and collect a variety of skills and resources can be significant. The concept of the “Renaissance Man or Woman’ often comes to mind for me when discussing these traits to clients.
MYTH 9- THE LACK OF FOLLOW-THROUGH IS LAZY OR PERSONAL
With my ADHD clients, we’re always working on building awareness of their habits and building accountability for actively addressing them, because the impact of their ADHD has a strong likelihood of still being present in adulthood. Their ability to catch and plan for the way their ADHD can impact their daily lives is very important for their overall happiness. That being said, the idea that forgetfulness or a lack of follow-through is laziness or personal not only hurts the individual with ADHD but also the important people in their life. I have had many clients discuss how they desperately want to remember to complete a task and that they know it would make their life easier if they could just complete it, but they can feel frozen from moving towards working on it. Dopamine can affect our motivation on a critical level. It isn’t enough to know that we will upset others or ourselves when our brain is working against us in that moment. It is like the ADHD brain can get stuck in modes. Although it is not a diagnosis, many individuals with ADHD describe a form of ADHD analysis paralysis, where overstimulation or emotional overwhelm can shut down their ability to concentrate, focus, and perform tasks despite their desires to do so. These are all some of the reasons medication is the front line of treatment for ADHD. ADHD medications directly impact the brain’s dopamine and norepinphrine to level out their production.
Individuals with ADHD children, partners, and friends can have an extremely hard time understanding that it isn’t an active choice of those with ADHD to forget what was asked of them, to not complete a task as asked, or to have a hard time listening to other’s conversations. Often the things that can easily frustrate someone with ADHD (ie long winded conversations) can be a regular trait that they also exhibit. This can lead to feelings of resentment or frustration among peers. But imagine for a second the struggle that someone with ADHD is experiencing.
Picture how hard it can be for you, a non-ADHD individual to completely change a major routine- for example, changing eating habits- would be. Lets say you suddenly discover that you can’t have any form of dairy anymore for health reasons. Starting that moment you need to cut out all dairy from your life, fridge, and cabinets. That would be a mentally, emotionally, financially, and physically impactful change on your daily life. Maintaining it each day and week can feel draining but lets say you are driven by the impact it has on your health. You now have to remember to check the label on each prepackaged meal you consume, ask for help at restaurants, or actively plan to spend time planning meals to avoid the added stress of a busy lifestyle because if you don’t there can be consequences- in this case it can be stomach pain. That would still be a big task though and its pursuit wouldn’t necessarily leave you feeling happy when you succeed but you know it’s important to do. This is what ALL SMALL DAILY LIFE REQUIREMENTS can feel like for a nontreated ADHD individual. Individuals with ADHD can constantly be hearing about what they did not do or did not complete, being asked to conform to others ways of functioning or order, and feel misunderstood by others as well as themselves. They need to preplan instead of relying on their brain to recall steps or needs last minute. They have to constantly check in with themselves, which is difficult to do at an adults level, let alone a child’s. It is so incredibly important for someone with ADHD to feel seen and their stress load to be acknowledged. Improving your understanding of ADHD if you have it or if you care about someone that has or may have ADHD is critical. In fact, I believe whether you’re aware of someone in your life with ADHD or not, it is important to have a well-informed awareness of ADHD as you interact in this world so you can better empathize with the other people in it.
For more information you can check out some of the free links through my ADHD pinterest board, my videos on my youtube channel, and these great books below.
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Article References:
Connor, D. (2014) Medications for children. In Barkley, R.A. (Ed.) Attention Deficit Disorder: A handbook for diagnosis and treatment. New York: Guilford.
Ivanov, I. et al (2013, in press). Cerebellar morphology and the effects of stimulant medication in youths with ADHD.
Kousha M, Shahrivar Z, Alaghband- Rad J. Substance use disorder and ADHD: is ADHD a particulary “specific” risk factor? J Atten Disorder. 2012;16 (4):352-32.
