The Dark Side Of ADHD
The Dark Side of ADHD
Hello, people, welcome back to the blog! Last week, I told you all about SAD, seasonal affective disorder, a depressive disorder that exhibits a seasonal pattern, usually late fall through spring, though it can have a spring/ summer pattern. I thought it was timely, since we were approaching its usual start point; symptoms seem to begin shortly after we “fall back” and winter arrives. Speaking of which, we had our first hint of winter this weekend- or at least what passes for winter here in SoFla- as temps dipped below 60 late Saturday night…. brrrrr! Sunday was kind of gray outside, but temps were really nice. Anyhoo, this week, I’m starting a new series on the dark side of ADHD, attention deficit hyperactivity disorder.
When you think about ADHD, you probably think of a 9 year old boy running around in circles, laughing his head off, totally out of control. While that certainly can be the case, the real faces of ADHD may surprise you. Think of your boss, your mail carrier, or your kid’s teacher… anyone has the potential to have ADHD, even if you don’t see what you think of as the classic symptoms. What most people know about ADHD comes from pop culture… they hear ADHD and think of that 9 year old boy, or maybe Dug the talking dog from the movie Up. Remember him? He couldn’t even complete a sentence without being distracted by an imaginary squirrel. Squirrel!! It was funny, right? Squirrel!! Maybe you’ve made a joke about being ‘sooo totally ADHD’ after you’ve gotten distracted and lost your train of thought? Hey, you’ve got to have a sense of humor to get through this life, and psych disorders sometimes make easy punchlines. But ADHD is a real disorder, and it affects real people in real ways, so it’s important that you’re informed about it, that you understand it, as that’s the basis of empathy. Empathy is where it’s at, and that’s the true point of this blog, to understand what people with ADHD experience on the daily. That’s not to say we can’t laugh about it, because sometimes it’s funny. Squirrel!! But if you understand it, you’re much more likely to laugh with, and not at, and that’s the ultimate point here.
So, what is it? ADHD is a neurological disorder, typically characterized by difficulty in sustaining attention, a lack of impulse control, and impaired working memory. There are three forms of ADHD: inattentive, hyperactive-impulsive, and combined types. By the way, ADHD is the official, medical term for the condition, regardless of whether a patient demonstrates symptoms of hyperactivity. We used to call that condition, having an attention deficit but without hyperactivity, ADD- actually some people still do- but that’s now technically considered to be an outdated term for describing inattentive type ADHD. So they’re all called ADHD now, no more ADD, and just the type or form varies. Inattentive type ADHD is characterized by a lack of attention to details, an inability to follow or remember instructions, and getting distracted easily. Hyperactive-impulsive type is marked by the stereotypical symptoms, things like fidgeting, running around, and talking too much. And shockingly, combined type is a combination of inattentive and hyperactive-impulsive ADHD types, and people with this type can exhibit both types of symptoms. Regardless of type, ADHD symptoms impact every aspect of a person’s life, and can seriously limit a person’s ability to study or work, and this can lead to stress, anxiety, and depression.
Prevalence statistics for ADHD vary widely, but it’s considered the most common childhood neurodevelopmental disorder. The symptoms of ADHD typically first appear between the ages of 3 and 6, and the average age of diagnosis is 7 years old. Squirrel!! According to the American Psychiatric Association, 5 percent of American children (ages 4 to 17) have ADHD, but the Centers for Disease Control and Prevention puts the number at more than double that, stating that 11 percent of American children carry the diagnosis. In my opinion, the actual number is closer to the CDC’s statistic, but may actually be higher still. And contrary to what some people believe, ADHD isn’t just a childhood disorder. Today, about 4 percent of American adults over the age of 18 deal with ADHD on a daily basis.
People with ADHD experience hyperactivity, impulsivity, and inattention in varying degrees. Not everyone with ADHD is noisy and disruptive. A child may be quiet in class, for example, while facing severe challenges that they do not express. The effects of ADHD features vary widely from person to person and even within a person, as they may find that their experience of ADHD changes over time. Squirrel!! Features and behaviors also seem to vary by gender; females with ADHD tend to have more difficulty paying attention, while males tend to have more hyperactivity and impulsivity. Depending on the type a person has, ADHD will have a predominantly inattentive presentation, a predominantly hyperactive and impulsive presentation, or a combined presentation that includes both types of behaviors.
This can manifest in innumerable ways, many you might not even realize unless you experience them. Some behaviors related to inattention might include daydreaming, being easily distracted, squirrel!, having difficulty focusing on tasks, making “careless” mistakes, appearing to not listen while others are talking, being late, having difficulty with time management and organization, difficulty completing projects, frequently losing everyday items, avoiding tasks that need prolonged focus and thought, and difficulty following instructions.
Hyperactivity and Impulsivity
Hyperactivity presents in any number of ways, and can vary widely, especially depending on the person’s age. In children, impulsivity often presents as conduct issues, so we think of a child “running amok” around a classroom. With age, overt behavioral symptoms usually become less conspicuous, as adults have generally learned to restrain themselves from these telltale behaviors. But they may manifest conduct issues in other ways, like blurting out things they didn’t mean to say. Some other behaviors related to hyperactivity and impulsivity include restlessness, the person seeming to be unable to sit still, being constantly “on-the-go,” running or climbing at inappropriate times, having difficulty taking turns in conversations and activities, constantly fidgeting or tapping the hands or feet, excessive talking and/or noise making, workaholism, and taking unnecessary risks.
Causes and Risk Factors
We don’t know exactly what causes ADHD, but we do know that a large component is genetic. About 85% of people diagnosed with ADHD have someone in their family who also has it. We have identified some risk factors, and these include brain injury, fetal exposure to stress, alcohol, or tobacco during pregnancy, fetal exposure to environmental toxins during pregnancy, or from a young age, low birth weight, and preterm birth. Diet may play a role, and some factors are random, just down to an individual brain’s wiring.
One question that’s asked a lot is if kids can outgrow ADHD. The answer is yes, but it rarely happens. That said, at one time, it was suggested that up to 40 percent of children outgrow their diagnosis, but recent research has proven this is wrong. Unfortunately, fewer than 10 percent actually outgrow it; the rest still meet the clinical definition of the disorder. Generally, what actually happens is that the presentation of symptoms changes as the person ages, but the underlying disorder remains. As the person matures and enters adulthood, overt behavioral symptoms usually become less conspicuous, and excessive motor activity becomes less common. Squirrel!! Hyperactivity is usually changed from being an external behavior to an internal state, so it can appear to others that the person’s ADHD has gone away, along with its most obvious symptom. But in reality, only the presentation has changed.
In other words, a 35 year old can’t get away with the same behavior that a 9 year old can, so instead of being a 9 year old running around willy nilly, laughing maniacally, the now 35 year old has an inner restlessness, and channels that into something else, like becoming a workaholic or an adrenaline junkie. Many adults with ADHD become workaholics, they like to keep their brains in overdrive. ADHD symptoms can also change for the better depending on stress levels, environment, and the amount of support a person receives. For example, establishing a routine and having understanding family members, friends, co-workers, and colleagues that can assist or help compensate for certain issues as needed are two ways to make symptoms seemingly decrease or disappear. In addition, the person may develop coping skills that address their symptoms well enough to prevent ADHD from interfering with their daily lives. Some do it so well that it appears as though they’ve outgrown it, but in reality, they’ve found working solutions. It’s sort of like watching a duck on a pond. Or maybe a squirrel! The duck looks still and serene on the surface, everything under control, but beneath the water, its little feet are paddling furiously.
I’ve seen many patients create their own little systems and methods to cope and compensate for their symptoms, to varying levels of success. I remember an ADHD patient that was very forgetful and terrible with time management especially. She had alarm clocks set to go off to remind her to set other alarm clocks, and her life was all color coded post its in strategic places to remind her to do whichever thing. I couldn’t understand it to save my life, much less keep up with it, but it worked for her. Pretty darn well, actually. But if the batteries in one alarm clock died- this was years ago, when people used alarm clocks, and they were radios too, imagine that- her entire life unraveled. She would get behind and it was like dominoes. But if her alarm clocks went off properly and her post its didn’tblow away, you’d be hard pressed to know she had ADHD. On the surface, she looked like she had it all under control, no problem, but below, her feet were constantly paddling, she was working overtime to keep it all together.
The term “attention deficit hyperactivity disorder” wasn’t used in medicine until the 1980s, although symptoms of the disorder were discussed in the early 1900’s. Back then, the diagnosis was typically thought to relate to the child having family members with psychiatric disorders, or the result of poor parenting. Squirrel! Strangely enough, some of these myths and stereotypes persist even today. We’ve busted some of those today, and next week, we’ll talk about what it’s really like to have ADHD, how it affects someone’s day to day life.
I hope you enjoyed this blog and found it to be interesting and educational. Please feel free to share it with family and friends. Be sure to check out my YouTube channel with all of my videos, and I’d appreciate it if you would like, subscribe, leave comments, and share those vids! As always, my book Tales from the Couch has more educational topics and patient stories, and is available in office and on Amazon.
Thank you and be well people!