The diagnosis of ADHD (Attention Deficit Hyperactivity Disorder) is getting thrown around everywhere these days. It’s so common that some parents have become suspicious of the label while others become concerned that every problem their child has may be related to ADHD. But what actually is ADHD and would it be helpful to get a diagnosis for your child?
What is ADHD?
ADHD is more than just attention problems or hyperactivity. It is a mental health diagnosis that includes a long list of symptoms that occur when children (and adults) have difficulty with executive functioning. Executive functioning is our brain’s ability to plan ahead, sustain attention, organize, and stop certain behaviors.
When your child is arguing for the one hundredth time about taking a shower and you want to yell at them to just do it, but instead you take a deep breath and speak calmly…that is your brain using executive functioning to monitor your behavior. Getting yourself to focus on work, planning out what you need to do today and finishing the dishes when you don’t want to…that is also your brain using executive functioning.
Attention problems are a sign of ADHD but there is more to it.
What are the Symptoms of ADHD?
Here are some other signs of ADHD:
Loosing things frequently
Difficulty starting tasks (Ex. Needs frequent reminders to do homework or chores)
Difficulty completing tasks or following through with instructions (Ex. Completes homework but forgets to turn it in)
Makes frequent mistakes on things that they should know
Forgets things that they have to do daily
Gets easily distracted
Fidgets constantly
Has difficulty sitting still in sitting is required
Seems to be aways on the go
Runs or climbs when it is not appropriate to do so
Not able to play quietly
Blurts out answers to questions
Has difficulty waiting turns
Does not play quietly but is always making noise
Likely your child has struggled with one or more of these items, even if they do not have ADHD. And very few children will have all of these symptoms. But if your child has many of these symptoms AND it is impacting school, their ability to make friends or making home life very difficult, then they may need additional support.
When Should I Get Help?
If you are looking at this list and your child meets more than 5 of these regularly or a specific symptom is causing significant concern, then getting an evaluation from your pediatrician or a qualified mental health professional may be helpful. Without a professional evaluation, it is difficult to know for sure if your child meets criteria. This is because there are a few other factors involved. For example, other things can look like ADHD…like past trauma, anxiety, difficulty transitioning between homes or learning difficulties.
Is Getting a Diagnosis Important?
Getting a professional diagnosis may be helpful for you to know how to better support your child and to give you a road map of what to do next. A diagnosis can help you advocate for accommodations at school, discuss treatment with your pediatrician or know how to better structure your child’s time at home.
When you’re diagnosed with ADHD, it can be difficult to discern facts from reality. The same is true if you are in the contemplation phase; wondering if you qualify for an ADHD diagnosis can be difficult while sifting through all the misinformation on social media that is perpetuated across the internet and pop-culture. Here I explain the reality behind the five main ADHD myths I encounter the most when working with new clients who struggle with symptoms of ADHD.
ADHD Myth #1: “You’re just lazy”
One of the biggest misconceptions about undiagnosed people with ADHD is that they just aren’t trying hard enough. Over half of the patients with ADHD I work with have been blamed for their untreated symptoms. Do any of these statements sound familiar?
“You’re just not trying hard enough!”
“Everyone else can get it done in time!”
“You just need to be more determined.”
These are fallacies! Not to mention incredibly damaging and demoralizing. The reality is that there is NO psychological correlation between ADHD and laziness. Lack of effort is NOT a symptom of ADHD. In fact, most people with ADHD work harder than their neuro-typical counterparts because of the symptoms they’re knowingly or, too often, unknowingly combating.
ADHD Myth #2: Symptoms include…”
If you have TikTok or Instagram then you probably haven’t managed to avoid the endless cycle of videos explaining what ADHD looks like.
Social media would have us believe that everyone qualifies for an ADHD diagnosis. Now, social media has done a great job of raising awareness about disorders that people may otherwise not have thought to explore, get tested for, and treat.
However, they also contain a lot of myths about ADHD. I’ve lost track of how many completely incorrect symptoms I’ve heard on social media, from symptoms that actually indicate other disorders altogether to “frequent tripping.”
The truth is, whenever you want to learn the specifics of psychological disorders, social media is such a mixed bag of fact and fiction that you’re likely to encounter too many of they myths we’ve discussed so far.
Instead, consult with a psychologist or the DSM. The DSM is our Diagnostic Statistical Manual, which we use for differential diagnosis. It describes the symptoms of every psychological disorder and how many of them you need to experience in a certain time frame to qualify for various disorders and specifiers.
In short, there are three subtypes for ADHD:
Predominantly Inattention Presentation
Predominantly Hyperactivity Presentation
And ADHD, Combined Presentation
Depending on how many of each type of symptom you meet, you can be diagnosed with one of these specifiers. In a future blog, I’ll break down each of these specifiers in greater detail. In the meantime, you can check the DSM (our current version is the DSM-5-TR) to learn more.
ADHD Myth #3: “Adderall is always dangerous and addictive”
A lot of people have concerns about taking medication for ADHD. This isn’t incorrect, but there are also a lot of myths about the statistics of how medication can impact you. In short, there are numerous types of medications that can be used to treat ADHD. Some of these are stimulants, such as Adderall and Ritalin, and some are non-stimulants, such as Wellbutrin and Stratera which can also be used to treat depression.
Just as psychologists are the experts on therapy, psychiatrists are the experts on medication. Your psychiatrist can provide education about the different types of medications and which may be the best suited to your specific needs and concerns.
Adderall is a class-A stimulant, which is why it needs to be carefully monitored by your psychiatrist. It certainly has the potential to be addictive, and can be dangerous due to its side effects such as appetite suppression which can lead to dangerous weight levels.
However, if used correctly and monitored responsibly, many people find Adderall to be highly effective to help mitigate their symptoms. But, then there’s the other side of the coin…
ADHD Myth #4: “Adderall is a magic pill; it fixes ADHD”
Adderall is not a one-stop-shop magic pill that will get rid of your symptoms. It won’t suddenly make you stop procrastinating or maintain focus on what you feel that you should be focusing on. However, many people find that it can give you a choice. In other words, it can help you feel capable of, for instance, maintaining attention, but that doesn’t mean that you aren’t still capable of procrastinating just like a person without ADHD can.
Some people do find that Adderall feels like this “night and day” experience that drastically helps them manage their symptoms. If you try it and find that is not your experience, remember that there are plenty of medication options and that plenty of people try various medications or dosages before finding the right fit.
I like to recall the mantra that a psychiatrist I used to work with utilized when advising patients beginning ADHD medication: start low, go slow.
ADHD Myth #5: You grow out of ADHD, it’s “a childhood thing”
This popular myth may have stemmed from the fact that, in order for a psychologist to diagnose you with ADHD, your symptoms must have manifested prior to age 12. So yes, ADHD must be present in childhood, but it isn’t confined to childhood.
Some people do find that their symptoms lessen with age. Some people needed medication while in school, for instance, but find it less necessary to take medication in later life.
Remember, however, that many people do not find that their symptoms decrease as they age. Many people report that they discovered coping mechanisms to aid their ADHD symptoms, which may contribute to them feeling that their symptoms lessened as they got older. These strategies may include the following, which I’ll expand upon in a future blog:
Breaking larger projects down into its minor components
Setting reminders for daily or important tasks
Taking regular breaks when studying or working, such as employing the Pomodoro technique
Making their work/study environment as distraction free as possible
Using rewards to motivate themselves
Identifying and utilizing an “acountabili-buddy.”
Next Steps
Separating the myth from reality is key when learning about your new or suspected ADHD diagnosis. ADHD is a diagnosis with a high percentage of comorbidity, which means that people with ADHD sometimes also have another diagnosis, such as Anxiety, Depression, or ASD (Autism Spectrum Disorder).
When the line between myth and reality becomes murky, it can be difficult to discern which diagnosis (if any) is currently impacting you. That can make it hard to figure out the best “next steps.” These next steps likely include working with a psychologist to be assessed for ADHD and learn if you qualify for a diagnosis. A psychologist will help you develop behavioral strategies to alleviate your symptoms or differentiate the impact of multiple diagnoses. Your psychologist may also help you meet with a psychiatrist to learn if medication could help you manage your symptoms more effectively. My hope is that this blog will help dispel some myths, arm you with truths, and help you begin to discern the next step that will be most beneficial for you.
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Sometimes focusing our attention feels impossible. As soon as we settle down at the computer, or into a conversation, we can find ourselves darting around, proverbially switching channels back and forth. We can start to wonder, “Do I have ADHD?”
Today we’re going to look at what actually happens in the brain when we have trouble focusing. Whether or not you’ve been diagnosed with ADHD, understanding how our brains pay attention will help you make changes so you can hold attention in a healthy way.
Here’s what’s happening in the brain when you focus attention
Your mind is constantly receiving thousands of inputs every second – from your skin and muscles (the uncomfortable chair you’re sitting in), from your ears (that air conditioning in the background), from your stomach (it’s been a while since breakfast!), from your social awareness (I’m surrounded by people right now) and from communication from others (this article teaching you about ADHD), among other things.
It’s a wonder that your mind can focus its attention at all. It needs a way of organizing a whole world of constantly changing pieces of information so it can keep you safe. The way the mind does this is really important: it focuses your attention on threats so it can resolve them and feel safe again.
Attention Neurology:
The floodgate. First, your mind measures how much information it wants to take in. Picture the difference between eating an apple on an empty stomach, versus eating an apple after an ice cream sundae. On an empty stomach, you might taste intense, complex flavors from the apple. After an ice cream sundae, however, it might hardly taste sweet. This is the job of the reticular formation. It measures how much stimulation (excitement) your brain can take to keep you somewhere between feeling bored and overwhelmed.
The emotional stamp (limbic system). Next, the information is stamped with emotion. Like a message coded by urgency (?), the limbic system tags how important this new information is to your safety and prepares your body to respond. When you feel a tinge of stomach tension at receiving an email from your boss, it’s because your limbic system told you there’s a threat to your safety: you could be in danger of being dismissed or abandoned. Your entire body responds right away, changing your heart rate, blood flow, and attention so you can be safe.
The planning center (prefrontal cortex).Imagine a rider on top of an emotional elephant. The elephant is our emotional brain, charging haphazardly away from danger and toward safety. The rider (prefrontal cortex) has to decide how to direct the elephant’s energy. The rider is a bit frustrated with the elephant’s erratic impulses! He tries to navigate the elephant in a straight line toward the main goal of connection and safety, taking into account social norms, past experiences and outcomes, contextual cues, and other emotions in ourselves and others. The rider considers two main voices: the Behavioral Activation System (BAS) and Behavioral Inhibition System (BIS). The BAS is like a forward-thinking rider. She decides how to direct the elephant’s energy down a certain path. It’s good at planning logical steps that help it achieve goals and satisfy needs for connection and safety. The BIS is like a cautious rider. She pulls the reigns to keep the elephant from running wild. She’s concerned with holding back on emotional impulses, trying to steer clear of social stigma, rejection, and shame.
The reward center (ventral striatum). Think of a party at the end of a marathon: the runner endures enormous pain, finally crosses the finish line, and feels immense relief and pleasure. He completes the goal and finally wins the needed sustenance and support. His brain is flooded with dopamine, which slows his heart rate and relaxes his muscles. Next time he runs the marathon, his mind will stay on task, knowing the reward at the end.
To summarize,
Whenever your mind receives an input, it first evaluates its strength and connection to your survival, and you feel your body become ready to respond. Your prefrontal cortex then plans what to do – to either resolve the need or suppress it and stay on task toward the current goal and reward.
So let’s say you’re writing a brief.
When the project first came up, you felt excitement. Your limbic system tagged the project as important because of your long term goal to make money – and more importantly – be included in a community and avoid abandonment (safety).
Right away, you felt engaged with the project. Your BAS was organizing your excitement and planning different behaviors to get closer to your goal. You might sit down and outline your project.
BUT THEN – you get a text. This time it’s from your partner. It says, “I didn’t feel great about how we ended last night.” You feel another rush in your body. This time, it’s not excitement but anxiety. Suddenly the project is out of your mind. If you pay attention, you might notice your BAS organizing yourself differently: “If I don’t respond right away, will they think I don’t care?” You feel the pain of an attachment strained. Your BIS then struggles to evaluate. How important is this new goal in relation to the project? How do I weigh my long-term survival against this immediate conflict? Should I stop working on the project now and call my partner?
Just then, a co-worker asks you a question. “Did you see the game last night?” Your mind is now balancing a few different bids for attention. This is where you start to feel your mind struggling to focus.
Attention problems can be caused by a few different areas
If you struggle with holding attention, there may be a problem with one or several of the brain areas we mentioned earlier.
Now, before we jump ahead, it’s important to note that the structure of your brain is the combination of your genetics, past experiences, and present experience. For the sake of simplicity, let’s say about 50% of your brain’s structure is caused by your genetics, and 50% is the result of your environment. Why is this important? Too many people confuse “brain structure” with organic/genetic causes. If you have a weakness in your reward pathway, making it difficult to feel pleasure when you achieve a goal, it might be because of an organic/genetic difference, or it might be due to the way rewards have been handled throughout your life. Both genetics and experience alter the structure of your brain.
With this in mind, let’s look at different ways you might be experiencing problems with attention.
Is my focus issue a “floodgate” problem?
Sometimes our problems in attention have to do with how stimulating our environment is. Each of us has a “Goldilocks” zone where we aren’t too bored or overwhelmed, where things are just right and we feel engaged. For some of us, reading a book doesn’t hold our attention. It feels boring and it’s hard to pay attention. For others it feels just right: a quiet room, a book, low light is the perfect amount of stimulation to hold our attention. This has to do with our floodgate, the reticular formation, that is monitoring the volume of the world around us.
Extraverts might need to add music, bright light, or tap their feet to raise the volume of the reading so they can pay attention. Introverts tend to feel overwhelmed by this idea! They might struggle to engage with reading in a loud room, needing to pull away into a quiet room to read.
How about you? If you struggle with attention, it’s possible that you’re either overwhelmed (“I can’t focus! It’s too much!”), or bored (“I can’t focus! It’s too mind-numbing!”).
Try adjusting the volume of the task by adding or removing stimulation.
Add music or exercise beforehand to make a boring task more engaging. Retreat to a quiet space away from distractions to make an overwhelming task more engaging. These volume adjustments help us focus our attention.
Is my focus issue an emotional problem?
Attention is anything but a cognitive task. Attention is mostly an emotional task that begins and ends in our brain’s limbic system (emotional center). Our emotional state is the elephant that moves our attention toward a goal to help us feel safe and connected. If anxiety and dread overwhelm you, writing a report is going to be incredibly difficult. Your mind will keep redirecting, over and over, toward your emotional state.
If you’re depressed, your concentration suffers. Your mind will keep redirecting toward your sadness. But if your mood improves, so does your attention. You’ll even find yourself being more creative at solving problems.
So what do we do? Trying to force ourselves to pay attention when we’re emotionally overwhelmed is like a tiny rider on top of that emotional elephant: it’s not gonna do much good.
The only solution is to help ourselves feel safe.
Regulating our emotions, and soothing ourselves is the first step. Sometimes this is as simple as reminding yourself of a loved one who cares about you. Other times this is about addressing emotional patterns in therapy.
Is my focus issue a planning problem?
After you feel an emotion and your body gets ready to act, your prefrontal lobe starts to plan how to achieve the goal. Sometimes it means telling yourself to stop working on other goals. Other times it means taking time to plan out each step you need to get to your goal. How you manage these two voices (BAS and BIS) has a lot to do with how others in your life have helped you achieve goals. For example, picture a child who’s trying to stack blocks, and gets frustrated. The parent who swoops in and stacks the blocks for the child, while well-intended, doesn’t help the child learn the planning skills they need. A parent that shows the child step by step how to stack the blocks will help strengthen the child’s frontal lobe, nurturing their ability to set and achieve goals.
In the same way, if we struggle with attention problems today, it might be a planning issue. Maybe it’s hard for you to take a moment to stop and plan the steps to get to your goal. Maybe it’s hard to say “no” to something you want so you can get the larger goal. This can be a powerless feeling – like there’s no way to move forward. This is where we switch attention – largely to avoid feeling powerless.
If this sounds like you, you’ll need to take the time to outsource this part of your brain to a checklist.
You might try taking time, before the start of the task, to outline the steps you’re going to need to take to get it done. You might also benefit from therapy. Addressing and understanding the feelings you have about setting goals can help you feel focused and in control again.
Is my focus issue a reward problem?
Sometimes our problem with holding attention has to do with a lack of reward. If we can hold our attention well, it’s because we know that by planning and holding out attention on a task, we’ll feel good again, relieved. Think of an Olympic athlete: they strain to hold their attention hour after hour because of the promise of winning gold. Think of a parent who spends an hour learning to bake a cake for their child: they hold their attention because of the promise of vicariously feeling their child’s joy. We hold our attention when we know there will be a reward.
For some of us, there’s no promise of reward. Maybe your own childhood involved a depressed parent who struggled to “light up” when you achieved a goal, and you felt like you could never make them proud. This experience lays pathways in your frontal lobe that influence how you experience daily tasks. Or maybe you’re living alone, so cleaning your house goes unnoticed. Maybe you have a preoccupied boss who doesn’t reward your hard work. In each of these situations, it will be a struggle to hold attention on a task, because your mind struggles to see the reward it’s working toward.
If this is the main obstacle to holding your attention, you might tend to feel tasks are meaningless, hopeless, or boring.
How do we help this issue? Some suggest giving yourself a treat when you complete a task: like rewarding yourself with chocolate. You’re welcome to try that if it works for you! For many people, however, this will only get you halfway there. The dopamine (reward) area of the brain is built around social rewards. The strongest reward we can receive is another person’s praise.
If you struggle with reward pathways, don’t think of giving yourself a treat; think of making the task meaningful.
How can you link the task with how it will contribute to your feeling connected and helpful in the world? Is there a way to include others in the task so you can receive feedback and praise? Is there a way the task could help someone else? How could you change the task to heighten these aspects?
So, do I have ADHD?
ADHD requires a diagnosis, something you can get by scheduling an assessment with one of our psychologists. Why a psychologist? Because too often, we diagnose ADHD whenever we spot an attention problem, without considering other factors, such as emotional health, life stressors, introversion/extraversion, etc.
Whether or not you have ADHD, you can rework your relationship with attention. Whether it’s about reducing/increasing the input (floodgate), regulating your emotion (making it more meaningful or less panic-inducing in the limbic system), taking more/less time to plan, or giving yourself more meaningful rewards, there are ways we can shift gears to pay attention, regardless of your diagnosis.
The effort it takes to hold attention can be frustrating. Talk with one of our therapists today. We’ll help you find your way to feel on top of your life again.
Connor McClenahan, PsyD
I help lawyers and other professionals overcome difficult emotions and experience meaning and purpose in their lives.
