ADHD Myth: Hyperactivity is not essential

“Have you got ants in your pants? Can you not sit still? Do you need the bathroom?” As a woman in my 40s, I reflect on my childhood and realize that even though I was a daydreamer with ADHD and autism, there were clear signs of hyperactivity. THEN I spoke with an ADHD coach and realised that my thoughts - my inner world - was still hyperactive. But can you have an ADHD diagnosis if you are not even slightly ‘hyper’? Why do we expect it from boys and not girls - and yes, I’m looking at you Mel Robbins - it’s not ‘boy ADHD’ if you’re hyperactive…

The Three Presentations of ADHD

It’s literally in the name - Attention Deficit Hyperactivity Disorder - so how can we have a diagnosis of ADHD without hyperactivity? I think most people agree - the name is terrible - and lots of people still use ‘ADD’ as the non-hyperactive alternative. We need more people to recognise that ADHD is not a ‘monolith’ or single way of behaving. There are  three primary ‘presentations’ described in the current  diagnostic manual: combined, inattentive, and hyperactive-impulsive. 

A study by Willcutt et al. (2012) emphasises  the importance of noticing the differences between these subtypes for an accurate diagnosis and treatment. Contrary to popular belief, hyperactivity is not a mandatory symptom for an ADHD diagnosis.

The Misconception: A Name That Misleads

The term "Attention-Deficit/Hyperactivity Disorder" can indeed be completely inaccurate. It's easy to see why many people, particularly those unfamiliar with ADHD, might assume that hyperactivity is a defining feature. However, this assumption is a far cry from the reality, as highlighted by a study by Barkley (2014).

Inattentive ADHD: A Valid Diagnosis

Inattentive ADHD, previously known as ADD, is a subtype of ADHD that doesn't include hyperactivity. Symptoms often encompass difficulty in sustaining attention, forgetfulness, and disorganization. A study by Nigg et al. (2005) confirms that this is just as real a form of ADHD as any other- and in my experience and observation, just as disabling if it is not spotted and supported.

Gender Myths: Debunking Stereotypes

Let's dispel another myth: the idea of "boy ADHD" and "girl ADHD" is a fallacy. There is no evidence to support the idea that boys outgrow ADHD more than girls. This notion also spreads harmful stereotypes - I’m looking at you, Mel Robbins, with that dangerous podcast. Sprinkling myths in between facts just means people get confused.

As Uncle Ben said in Spiderman -

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The Importance of Accurate Understanding: The Ripple Effect

It can be hard to diagnose hyperactivity, especially in adults and females who might experience it in their thoughts which obviously can’t be seen. A study by Biederman et al. (2004) underscores the importance of accurate diagnosis for effective treatment and support -

and it makes me really, really frustrated when I hear the popular press talking about the ‘trend’ for ADHD diagnosis. Recognising the generations of undiagnosed inattentive ADHDers - men AND women - is just about identifying why so many struggled for years - and giving us a name, an explanation and a way to understand and manage our experiences.

A Call for Nuanced Understanding

Hyperactivity is NOT essential for an ADHD diagnosis. During ADHD Awareness Month, let's aim to understand this complex condition based on evidence, without myths or stereotypes.

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Further Reading:

 Willcutt, E. G., Nigg, J. T., Pennington, B. F., Solanto, M. V., Rohde, L. A., Tannock, R., ... & Lahey, B. B. (2012). Validity of DSM-IV attention deficit/hyperactivity disorder symptom dimensions and subtypes. *Journal of Abnormal Psychology*, 121(4), 991-1010.

Barkley, R. A. (2014). Attention-deficit hyperactivity disorder: A handbook for diagnosis and treatment. *The Guilford Press*.

Nigg, J. T., Willcutt, E. G., Doyle, A. E., & Sonuga-Barke, E. J. (2005). Causal heterogeneity in attention-deficit/hyperactivity disorder: Do we need neuropsychologically impaired subtypes? *Biological Psychiatry*, 57(11), 1224-1230.

Quinn, P. O. (2005). Treating adolescent girls and women with ADHD: Gender-specific issues. *Journal of Clinical Psychology*, 61(5), 579-587

Biederman, J., Faraone, S. V., Monuteaux, M. C., Bober, M., & Cadogen, E. (2004). Gender effects on attention-deficit/hyperactivity disorder in adults, revisited. *Biological Psychiatry*, 55(7), 692-700