Adult ADHD.
Sorry I wasn't paying attention, could you repeat that...
What is ADHD (Attention Deficit Hyperactivity Disorder)?
ADHD is considered a neurodevelopmental disorder. That is, your brain is wired or put together differently. There are two aspects or branches to it. One is an attentional issue. It can mean it is hard to pay attention if something does not interest you, or you get easily distracted. It can also mean if you are really interested in something you can hyperfocus and find it hard to pull your attention away (even to eat) or switch focus easily. And can get annoyed easily if someone tries to divert your attention from what you are hyperfocusing on.
Second is the hyperactive/impulsive side. This means things like: difficulty sitting still; impatience; blurting things out; hasty acts or acting quickly without considering consequences; difficulty subduing impulses - I want it and I want it now.
There is no longer a distinction made between ADHD and ADD (attention deficit disorder) though some people still use the term ADD to describe those who don't have the hyperactive /impulsive side.
You can be predominantly inattentive type, predominantly hyperactive/impulsive, or combined type.
Estimates range between 2.5 to 11% of the adult population have ADHD. Many people are getting diagnosed as adults now because they were not obvious or were missed when younger. Also thee has been increased awareness due to social media.
Hyperactivity/impulsivity tends to be more pronounced in childhood. Many predominantly inattentive types can miss being diagnosed in childhood as they are not as obvious behaviourally and don't get noticed by teachers or parents as they are not disruptive. It may be presumed if you are not doing as well at school as expected that is because you are lazy or stupid. Or you are not listening to a parent because you are naughty or "off with the fairies". It is diagnosed less in females, though this may not be an accurate reflection of incidence in the population. Those with high intelligence tend to get picked up less as they have found ways to manage some of the worse impacts and can often do well despite inattention.
For many of those with ADHD there can be sleep problems perhaps due to an inability to shut your brain off enough to relax and sleep. So, often you will stay awake looking at something distracting until so exhausted you can finally fall asleep. You can then have problems waking up at the other end and it is not unusual to have to set multiple alarms to wake up for some.
There can be problems in sexuality due to getting distracted or bored during sex or being overly impulsive or driven.
Executive functioning problems
ADHD causes difficulties with executive functioning. Broadly speaking, executive functioning refers to the cognitive and mental abilities that help people engage in goal-directed action. They direct actions, control behaviour, and motivate us to achieve our goals and prepare for future events. Executive functioning involves:
- Planning, organising, and prioritising.
- initiating actions
- Self-inhibition
- self-monitoring your behaviour
- Shifting attention between tasks
- working memory (short term memory used while executing tasks)
For Example:
Time blindness. A good sense of time is one critical executive function. It involves knowing what time it is, how much time is left, and how quickly time is passing as well as how long a task will realistically take. People with ADHD often struggle to use time effectively, being late or underestimating how long a task takes. Eg thinking you will be able to have a shower, get dressed, have breakfast, get what you need to take with you, and leave the house ..... in 5 minutes. It is said that for those with ADHD, time is either NOW or Not NOW. This makes planning and organising very challenging.
Sequencing and prioritising. Being able to prioritise and sequence activities is also a very useful executive skill. For many of those with ADHD all information and tasks or demands come in and are experienced as on the same level. (Neurotypical people naturally prioritise and sequence tasks.) It can be overwhelming as you struggle to determine which is more important or urgent and so tend to do the easiest or most engaging first, even if that is the least important or urgent. It can lead to some items being forgotten entirely. Or procrastinating difficult tasks until due dates have passed. You may need some dire consequence to focus on getting something done in time.
Significant difficulty multitasking or being able to process an input while working on something else. Very few people can do several things at the same instant, but neurotypical people can switch focus between tasks, or back and forward between several very quickly so that it seems like they are doing several things at once. With ADHD you can find it impossible to still process both things. You have to stop one entirely to be able to focus and process the other. This also makes any distraction more impactful because once distracted you are not processing the original task or input. A neurotypical person may notice something out the window but still be listening and processing a conversation in the room.
Self-inhibition problems. It is easy for anyone when they get excited, to not be able hold themselves back at times. However, with ADHD it becomes almost impossible. This may be in the form of blurting something out before someone else has finished speaking. But even if you don't blurt, you often can't stop your mind from going off on that tangent and you stop listening to what the speaker is saying. Or another example is not being able to stop doing a task that you realise is not urgent, even though you really know you need to stop and do something else that is urgent.
Emotional regulation difficulties. What does emotional dysregulation look like in ADHD? Difficulty calming down, even if you're aware that you're overreacting. Low tolerance for frustration or annoyance. Temperamental or prone to sudden outbursts. Feeling completely overwhelmed by your emotions. For some this is the most distressing and difficult aspect of ADHD. This can also look a lot like other disorders like bipolar disorder and borderline personality disorder. There is also something called Rejection Sensitive Dysphoria (RSD) which some have suggested can be an aspect of ADHD and means you have a strong negative emotional reactions to real or perceived criticism or rejection. This may be due to growing up feeling different and being constantly criticised or yelled at for not paying attention or not sitting still. RSD is sometimes discussed in terms of being either internalized or externalized. “Internalized” means that the bad feelings and reactions are directed within you . Negative selftalk is an example. “Externalized” means that the person’s intense feelings and reactions are directed outwardly, toward others. Emotional outbursts, for example or being overly defensive.
Co-occurring issues
It is very common for those diagnosed with ADHD to have co-occurring conditions or what is referred to as comorbidities. Depression, anxiety, substance use disorders, addictions of various kinds including gambling are all higher than in the neurotypical population. One study found that the most common cognitive distortion for those with ADHD was perfectionism suggesting that may be a challenge as well. Often these comorbidities are more what catches attention and treatment sought. There is also a significant percentage (one study said 14%) of people with ADHD who also have autistic traits or autism spectrum disorder (ASD). The rate is much higher for those with ASD who also have ADHD (maybe as high as 90% suggested by some research).
On the upside:
Hyperfocus can mean you can get really good at what you are interested in and achieve a lot in that area. If the thing you are really interested in and can hyperfocus on is your work, you may be very successful at it. You can be adventurous and spontaneous and see things from a different point of view than the neurotypical population. You can be fun to be around. You may be quite creative. You may do well in physical/practical skills that require learning by doing rather than (boring to you) lectures. You may notice significant and important things that others don't because you have been "distracted" by them. You may get over things quickly (maybe because you moved on to something else) and so don't hold a grudge. And you may have abundant energy.
One of the main disadvantages and what makes ADH a Disorder is that we live in a world now that requires a high level of executive functioning with multiple demands and time split into small increments with dire consequences if missed. Hunter gatherers didn't have watches. It was night or day, Summer or Winter. Time was about natural cycles not tiny increments artificially constructed. Depending on what sort of life you live and how severe your attention deficit is, for example, you may not rate as having a disorder. Something is considered a disorder when it causes negative consequences and distress (to you but also others). Everyone experiences anxiety, for instance. Not everyone has an anxiety disorder.
Want to know more?
Watch this video: www.youtube.com/watch?v=ouZrZa5pLXk&t=53s
Want to get a quick gauge if this might apply to you? You can do this quick online test to see if it is worth pursuing further:
screening.mhanational.org/screening-tools/adhd/
Assessment, diagnosis and treatment.
You can get a preliminary assessment done by a psychologist but to get an official diagnosis you will also need a psychiatrist to make the diagnosis and to prescribe medication (if you choose) which is the first line treatment and highly effective for assisting with focus in 80% of those with ADHD. You may also need help to manage sleep problems. Melatonin is often used to help with falling asleep. Additionally coaching which involves strategies or hacks to manage some of the challenges that exist because your brain operates differently. Like setting pop-up reminders with “by this time” included, and that keep popping up until the task is complete. Or to have or pay someone do the things you find impossible to do well. Like paying an accountant or bookkeeper rather than struggling to do it yourself. There are also therapists who specialise in relationship counselling where one partner has ADHD.
If you have ADHD, you probably struggled to read this far, so well done! If this is about someone you know, maybe read sections to them or get them to watch videos as that keeps attention better than static words on a page. Short videos are better!
