The ADHD Algorithm Part 1: Debunking the Myths

Most of what I knew about Attention-Deficit/Hyperactivity Disorder (commonly referred to as ADHD) was wrong. I grew up in Pennsylvania’s public school system, and I occasionally heard friends speak about their ADHD condition. From my perspective, it never derailed them much from their schoolwork, but they would mention their difficulty focusing on teachers and assignments. In my naivety, I graduated believing that ADHD was that simple: an issue in one’s ability to focus that could be treated with medication. Since becoming a clinical counselor, I now realize ADHD is basically…not so basic. Topical experts estimate that ADHD impacts around 10 million people across the United States for their entire lifespan (1). When undiagnosed or untreated, it can wreak havoc in the minds and relationships of those who wrestle with it. One website (2) outlined clinical studies showing that untreated ADHD in adults increases difficulty maintaining employment, impairs relationships, and increases vulnerability toward anxiety, mood disorders, negative habits, impaired driving, and even premature death. This is a much bigger deal than a struggle to focus.

For full disclosure, although I am a clinical counselor, I am not an ADHD expert. Rather, I consider myself a student with a newfound curiosity on this topic. I write this blog series, called The ADHD Algorithm, to begin learning more about the complexities of this neurological condition. An algorithm is a set of rules scientists follow to optimize a dynamic system. That is what I seek and hope to provide readers – some structure to better understand a topic that I perceive to be misunderstood. Now, my current clinical concentrations are centered on helping clients work through trauma and addiction. However, I regularly have clients arrive for their first session who tell me they have ADHD in addition to their trauma, addiction, or other struggles. I have felt under-equipped to best help them…so it is my hope that through this blog series, I can become more knowledgeable and concurrently effective in working with my clients. The secondary benefit is that you and I can discover more about ADHD together as I explore.

Outlining the Series

The ADHD Algorithm will start with general information about ADHD, including its symptoms, characteristics, and more. I also want to utilize the first post to bust some myths about ADHD to offer increased self-awareness and improved empathy for readers who know someone with ADHD. In my second post, I will talk about ways to effectively manage and cope with ADHD, both as persons with it and caregivers for it. Finally, in the last post, I want to tackle some lesser-known nuances about ADHD, such as an ancillary predicament that many individuals with ADHD battle called Rejection Sensitive Dysphoria (RSD). I want to detail what individuals can do when they have co-occurring diagnoses, such as PTSD or mood disorders with ADHD. Lastly,  want to use that post to outline how experts are finding that stigmas exist to a greater extent in Black, Indigenous, and People of Color (BIPOC) communities with ADHD. The hope is to encourage readers to address these needs.

What defines ADHD?

Let us start at the foundation. According to the fifth edition of the APA’s Diagnostic and Statistical Manual, abbreviated as the DSM-5 (3), ADHD is a neurological disorder that exists on a spectrum wherein an affected individual shows a pattern of inattention (on one end of the spectrum) and/or hyperactivity or impulsivity (on the other end). An individual with ADHD can be primarily inattentive (formerly called ADD), primarily hyperactive/impulsive (formerly referred to as ADHD), or both. Many experts believe that ADHD is more genetically transferred than environmentally conditioned. To be diagnosed with the inattentive type, children must meet at least six of nine criteria while adults must meet five of the nine. Some examples of the inattentive symptoms are when a person:

1. Often fails to give close attention to details or makes careless mistakes,
2. Often has trouble holding attention on tasks or activities,
3. Often does not seem to listen when spoken to directly,
4. Often does not follow through on instructions and fails to finish tasks like chores,
5. Often has trouble organizing,
6. Often avoids/dislikes jobs that require sustained mental focus,
7. Often loses things necessary for tasks,
8. Is easily distracted,
9. Or is often forgetful in daily activities.

For the hyperactive/impulsive presentation, the following symptoms present themselves. They are when a person:

1. Often fidgets, taps, or squirms when sitting,
2. Often leaves a seat in situations when remaining seated is expected,
3. Often runs/climbs/feels restless in situations where this is inappropriate,
4. Often is unable to experience leisure quietly,
5. Is often on-the-go, as if motorized,
6. Often talks excessively,
7. Often blurts out an answer before the question has completed,
8. Often has trouble waiting his/her turn,
9. Or often interrupts or intrudes on others.

Importantly, the DSM-5 outlines that, in addition to meeting a certain number of the criteria above for diagnosis, one must have experienced these before the age of 12, noticed the symptoms in two or more settings (i.e., at home and school), noticed clear evidence that these interfere with everyday life, and the symptoms cannot be better explained by another disorder. If you feel you might have ADHD, an online screen can be found here for children and here for adults. I found some additionally interesting statistics on where ADHD shows up in the general population on the ADDitude Magazine website (2). For instance, boys are twice as likely to be diagnosed with ADHD as girls (by 12.9 percent to 5.6 percent), but the author notes this may be due to bias. In other words, girls may tend to be misdiagnosed because of their symptom presentation. Fascinatingly, nearly 66% of children with ADHD have at least one other condition.

Busting ADHD mythology

Before wrapping up part one, I want to talk about the myths of ADHD. This is another main reason I chose to write this blog series. First, ADHD is not actually an inability to focus; it is a difficulty using the front of one’s brain (called the prefrontal cortex) to maintain focus on mundane things or situations lacking novelty. As many of my clients would tell you, when it comes to tasks they are passionate about, they can concentrate for hours! Second, an individual with ADHD is not inherently lazy or incapable of harnessing his willpower. Instead, his mind races and jumps with such fervor that it creates exhaustion and a difficulty returning to the original thought. The individual’s struggle is in managing the operation of simple tasks such as keeping track of one’s car keys. Nonetheless, many well-known role models with treated, managed ADHD have made incredible contributions to society, showcasing a different story than this myth supposes. Finally, Dr. Jonathan Posner (4) wrote an awesome blog post on some more ADHD myths. Instead of summarizing them in my post, you can check them out here!

Conclusion

To finish, ADHD has long impacted many people in our communities, but it continues to be misunderstood and misrepresented even in our twenty-first century. This blog series hopes to shed light on this and offer a refreshing glimpse into the topic of ADHD, providing insight on its symptoms, prevalence, myths, treatments, best practices, nuances, and stigmas. For more, stay tuned for part two of The ADHD Algorithm.

References

1. Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD). (n.d.). Overview. CHADD.org. Retrieved from https://chadd.org/for-adults/overview/
2. Saline, S. (2020, April 6). ADHD statistics: New ADD facts and research. ADDitudeMag.com. Retrieved from https://www.additudemag.com/statistics-of-adhd/
3. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author
4. Posner, J. (2021, January 25). 9 ADHD myths and fallacies that perpetuate stigma. ADDitudeMag.com. Retrieved from https://www.additudemag.com/adhd-myths-and-facts-learn-the-truth-about-attention-deficit/