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The Truth about ADHD

ADHD has been all over recently- social media, the news, etc. I've seen stories about people reporting symptoms of ADHD to a "doctor shop" and getting prescribed a stimulant. I've also seen many memes that lead any living human to believe they might meet the criteria for ADHD. Those negative stories aside, there are a lot of other informative podcasts, youtube videos, and articles that shed more light on the less talked about and complicated features of ADHD. You see, ADHD, like many mental health disorders, has the misfortune of becoming a caricature in popular culture. I will talk about adult ADHD primarily here, but many of these symptoms and traits also apply to children. I wanted to write about adult ADHD because I've found it's historically talked about less than ADHD in children. While researching ADHD further for this article, I found that many of the websites for leading organizations focused on ADHD are focused on ADHD in children. While there is overlap, ADHD tends to look different in adults in some ways. Adults with ADHD often don't "look" like they have ADHD, or at least it might not be as easily recognized by others (or folks struggling with it) because most adults have figured out various ways to cope with or hide the symptoms. The reason- they have to function.

I was recently on Reddit and saw a post about ADHD that talked about "less talked about symptoms of ADHD." Reddit is not my research source, but that post sparked hours of deep diving into research articles. I'm a trained therapist, and I've also been diagnosed with ADHD for close to fifteen years now. That being said, I'm a little embarrassed that I didn't know many of the things mentioned. To be clear, I'm not saying that you have ADHD if you deal with any of the topics I talk about here. However, it's essential to speak to a professional to diagnose ADHD because, as anyone who has looked up symptoms on WebMD knows, it's easy to misdiagnose ourselves.

Folks need to know about more aspects of ADHD to understand better how their brain works so they can work with their brain and learn practical and effective coping skills for their brain rather than fighting their brain and setting unrealistic expectations. I believed many symptoms and characteristics related to ADHD were character defects, laziness, or personal failings. I know I'm a therapist and work with people on self-compassion and challenging negative beliefs about self. Being vulnerable and acknowledging the feeling of shame (let's call it what it is) I have felt my whole life is my effort to practice what I challenge others to do- stop hiding the things I feel shame about, as this only serves to feed shame (thanks, Brene Brown). I felt shame because I have always struggled with consistently adhering to routines, procrastinating, poor organization, effectively prioritizing tasks, and impulsivity.

adhd diagram

So, let's dive into some of these topics. Researchers have found that people with ADHD tend to have less dopamine (the neurotransmitter associated with reward and feelings of well-being) receptor sites (like maybe 40% less), which means that the brain produces less dopamine. This impact is that folks with ADHD tend not to get the slight releases of dopamine when they do routine, healthy behaviors (the struggle with routine and consistency I've noticed). When the dopamine reward isn't present after doing those routine, healthy behaviors, it's harder to continue engaging in those behaviors because the reward (even if it's small) isn't there that reinforces and motivate those healthy behaviors in the future. This is not to say that folks with ADHD cannot engage in routine, healthy behaviors, but it can mean that it can be much more challenging. The difficulty with routine and consistency also varies depending on how severe their ADHD is. The reason that stimulant medications are prescribed for folks with ADHD is that it provides dopamine in the prefrontal cortex where there is a deficiency. It corrects the excess dopamine in the basal ganglia (associated with hyperactivity).

ADHD experts suggest that those with ADHD struggle to pay sustained or consistent focus on things that are not novel, interesting, and new. This symptom connects to dopamine deficiency. The novel, engaging, and new experiences release dopamine for those with ADHD. When you are dopamine deficient, you are trying to balance that dopamine level to make your emotions more stable. Now, novel and interesting experiences release dopamine for those without ADHD as well, but those without ADHD have dopamine's stable, engaging, rewarding effects. The stable release of dopamine relates to repeating healthy, routine behaviors. They don't have the same need for life to feel novel, interesting, and different. In other words, this dopamine deficiency means that someone with ADHD might feel chronically under-excited and uninterested in daily life's basic routines and everyday activities.

This same concept relates to impulsivity which can be common in those with ADHD. Impulsivity correlates with avoiding waiting for something. An impulsive choice is typically designed to prevent a delay for a reward. When you have a dopamine deficiency, that reward is designed to regulate your system and make you feel engaged. Thus, people with ADHD can tend to be more impulsive. But, again, this can present in a variety of ways, and most adults with ADHD have learned ways to suppress some of this instinct or find acceptable outlets for it.

Procrastination is common with ADHD, but clearly, lots of people without ADHD deal with procrastination as well. I have been a chronic procrastinator my whole life. I felt shame about this and believed procrastination was bad. I started to shift my thinking in graduate school; my program director was talking to a woman in my cohort and me. We were talking about how my cohort peer typically had assignments done weeks ahead of things being due, and conversely, I tended to start the important papers the week before they were due (sometimes less than a week). My program director explained that the difference between myself and this peer was that her anxiety about the paper would spike weeks earlier than mine. Procrastination often differs from how our brains are wired, which is NOT bad! Often we think about anxiety in a black-and-white sense (anxiety is bad, and no anxiety is good). Most anxiety is good as it motivates us to do what we need to do. If I started a paper weeks before it was due and tried this at times, I was less efficient and struggled to focus and stay task oriented. I didn't have anxiety motivating me. I always did quite well in grad school, but I long held the belief that I would have done much better if I had started those projects and papers weeks earlier like my peers. Yet again, I had shame, but I've recently embraced my procrastination. I am much more efficient, focused, and effective when a deadline looms. As long as I make sure I am doing things at a manageable time and have backup time to complete something if needed, I've decided to accept how my brain works. I started this article about two weeks before I agreed it would be completed. Typically, I start writing three days before the due date (proof that ADHD is not a rule or impossible to change). I'm doing it ahead of time because I am finding researching ADHD interesting and novel right now, which creates a burst of energy and focus, another common trait of ADHD).

adhd notebook

The topic of procrastination naturally leads us to manage, organize, and the ability to prioritize. First, let's mention that organizing things could be more exciting for most of us (yes, I know some love it). Thus my ADHD brain struggles to engage in organization because it typically doesn't feel novel, new, and engaging. Researchers at the National Center for Biotechnology information explain that consistently engaging in organizational skills requires motivation and immediate stimuli to reinforce the behavior. Without that reinforcement, motivation decreases, and the brain looks for other stimuli in the surrounding environment. For someone with ADHD, organizing requires more effort to fight against some of these challenges brought on by ADHD.

The symptoms talked about in this article are by no means comprehensive. Also, the good news is that various strategies and interventions are available to help people deal with ADHD. If you are interested in learning about some of those strategies, I would love to explore them with you. You can find my info on the website and schedule a free consult to see if I would be a good fit for you.

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