Towards a Deeper Understanding of ADHD

Written by: Becky Ward, Tutor Doctor Education Experience Specialist

I was a high-achieving student, but I had to work really hard for my grades. I was identified as gifted, but I struggled to keep on top of everything. I couldn’t organize my workload and often left things to the very last minute, pulling all-nighters or making up excuses to explain why things were late. To the outside world I was doing fine, I was successful in school and in my career, but they didn’t see how hard I was working to make myself seem fine. Inside, I had little confidence, spent a lot of time ensuring my work was perfect with no mistakes, and felt that I was lacking something integral to my makeup. Why couldn’t I find the motivation that others seemed to have? Why did I set goals and then abandon them or only achieve them after seemingly much more work than my peers? Why was I working so hard, but not getting as far as I should for my efforts? When I was in my 30s, I finally got some answers. I have ADHD and my brain works differently.

Attention Deficit Hyperactivity Disorder (ADHD) is a neurological disorder and it impacts the way the brain is structured and functions. It’s considered a developmental disorder and it can cause delays and/or impairments in the development and maturation of parts of the brain, especially the frontal lobe which is responsible for things like executive function and self-regulation.

ADHD is broken down into 3 presentations:

  • Primarily Hyperactive and Impulsive – This is the more stereotypical presentation and it’s the one that is most likely to be noticed and result in an ADHD diagnosis. When presenting as hyperactive and/or impulsive, the person may seem to be always on the go and/or struggle to sit still. They may speak quickly and with few pauses, interrupt others, or blurt things out. They may struggle with self-control and engage in risky behaviors.

  • Primarily Inattentive – This is the quiet ADHD that is often overlooked or which the person learns to effectively hide, which means it’s far less likely that a person with a primarily inattentive presentation will be diagnosed with ADHD and get the support they need. It used to be called Attention Deficit Disorder (ADD), but it’s now understood to be part of ADHD, and ADD is no longer a recognized disorder. When presenting as inattentive, people have trouble regulating their attention and focus. They may be easily distracted, make careless mistakes, be forgetful, have trouble with working memory, have difficulty following instructions, and/or struggle with organizing plans and tasks. They may have a long to-do list (and might have lost the paper it’s written on) that only seems to get longer and a ton of partially finished projects and tasks that are never completed. They likely struggle with long-term planning and then with following through once they do get a plan in place.

  • Combined – People with a combined presentation show 6 or more of the 9 diagnostic symptoms of the hyperactive and impulsive presentation AND 6 or more of the 9 diagnostic symptoms of the inattentive presentation.

Being diagnosed with one of these presentations doesn’t mean that we fit into a nice, neat ADHD box and the symptoms of that presentation are the only symptoms we will ever have. People will have days where they are more hyperactive, days where they are more inattentive, and days when they are both. The presentations just describe how ADHD impacts us most often. I’m primarily inattentive but some days I can’t stop talking, feel endlessly restless (how hyperactivity often impacts adults), or have a lot of difficulty controlling my impulsive behavior. Our primary presentation can also change over time, especially as we grow and mature.

As an outsider, you might not see someone’s ADHD, especially as they get older. People who have ADHD learn to mask their symptoms and internalize their struggles in order to fit into a world that wasn’t designed for our unique brains and which isn’t always very understanding of our challenges or needs. We also learn to utilize strategies to get by and reduce the impact our ADHD has on our lives, at least so far as other people can see.

Most people think that ADHD is all about not being able to pay attention to things. That comes in part because of the stereotypes surrounding ADHD, but also from the disorder’s name. Attention Deficit Hyperactivity Disorder is a misnomer. It implies that we are lacking attention, but really ADHD is all about challenges with regulation. We have difficulty regulating our energy levels, attention, emotions, behaviors, and/or impulses due to the differences in our brain structure and function. So, it’s not that we can’t pay attention, it’s that we have trouble with focusing our attention on the right things and in the right ways. When you are doing something uninteresting, like paying bills or sitting through a lecture, you no doubt experience distractions; more interesting things that are vying for your attention. A non-ADHD brain can stop, identify that thing as a distraction, decide to ignore it, and return to the task at hand. An ADHD brain struggles to inhibit the response to a distraction, meaning that we are more likely to give that item at least some of our attention and once we have done so, our challenges with working memory mean that we can lose sight of our original goal making it hard to return back to the task we were working on. Our difficulty in regulating our attention levels means that sometimes we struggle to give enough attention, but other times we struggle with too much attention. When something is really interesting or urgent, we can hyperfocus. When hyperfocusing we give all of our attention to our task and the challenge becomes breaking that focus. We might find that hours have passed when it only feels like a few minutes, or that people have been speaking to us and we didn’t notice, or even that we have not felt our body’s physical cues and have forgotten basic self-care, like eating. In these times, we actually have too much attention, not a deficit.

Ok, but everyone has days where they struggle to regulate their attention, emotions, impulses, energy, and/or behavior, right? Does that mean that we all have a little ADHD? Usually, these instances of struggle with regulation can be easily and effectively explained, like you’re tired, not feeling well, or are just not interested in a task. The important thing to understand is that ADHD isn’t just an occasional, or even a period of, struggle regulating these things. It is a daily challenge that impacts all aspects of our lives and which is present in all situations. In order to be diagnosed with ADHD, a person has to consistently demonstrate multiple symptoms across multiple environments, those symptoms have to be having an impact on their daily life, and the symptoms can’t be explained by another disorder or life situation. In addition, for a teen or adult to be diagnosed with ADHD, they have to have demonstrated symptoms before the age of 12.

If you think you or your child may have ADHD, speak with your doctor and share your concerns. They will be best able to support you with the next steps.