What you need to know about ADHD right now

& how ADHD in women looks 'different'

If you’ve got a mental picture of “ADHD” I’m going to guess it’s a young boy who gets into trouble in class and has ‘ants in his pants’ when he’s supposed to be sitting down, right?

Slide your mental gaze sideways. 

Do you see that girl at the table, unfocused on the work in front of her, hand poised to write? Twirling her hair, tapping her toe quietly, unable to remember what the teacher just asked them to do. The one who will never remember to pick up the evening paper on her way home from school, no matter how often her loving parents ask

She has ADHD.

The teacher at her desk, whose mind is whirring with work plans, thoughts about parents night, shopping lists, guilt about forgetting her own child’s class project requirements, oh wait, didn’t her husband mention a trip? Who keeps tripping up on her diet and has depression and guilt because she just can’t get it together?

She has ADHD too.

Even now many of us have a stereotypical view of ‘who’ ADHD affects - when I want you to know WHAT ADHD is.

ADHD symptoms in women? Do women and girls have ADHD? Surely not!

We know that it’s not a moral failing; it’s not bad behaviour; it’s not poor parenting; it’s not laziness or DEFINITELY not lack of care.

We know it’s highly heritable (so if your parent or child has it… maybe grandma’s quirks weren’t just being ‘scatter brained’) but the exact gene’s haven’t been identified yet. It’s likely a cluster of genes that get switched on if the circumstances are right. 

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• 8-10% of the population have ADHD

  and interviewing adults attending psychiatric clinics for other conditions found that 

• 15% had ADHD (more than the general population) and

  within that group

• 53% had never been diagnosed with ADHD

• 66% had never been treated for ADH

• 89% had another diagnosis (depression, obesity, sleep disorders etc).

What else do we know?

We know that it’s not caused by junk food or too much TV or smart phones or online games - but we do know why you or your ADHDer love them more than they maybe ought to.

We know it’s 100% possible to have a full, happy, exciting and fulfilled life with ADHD - and it’s common fellow traveller autism.

We now know that somewhere between 12 and 50% of people with diagnosable ADHD also meet the criteria for Autism (and oh yes, we will talk about diagnosis and traits and all of that).

We have safe, reliable drug treatments that can and do work, as well as evidence that therapy and coaching, often together with medication, provide the gold standard of supporting ADHD when the traits get in the way of our daily lives and goals, whether that’s because you can’t focus enough to study for an exam or because the oestrogen drop during perimenopause means that for the first time, you just can’t function - or your new family circumstances have thrown you absolutely for a loop.

What’s the point of a late diagnosis for ADHD adults?

The potential consequences of untreated ADHD have been shown in many recent studies, some examining the long-term outcome of childhood ADHD and others exclusively examining adult ADHD. They include:

• impaired quality of life

• impaired relationships;

• reduced employment;

• vulnerability to addiction;

• vulnerability to depression and anxiety;

• impaired driving safety;

• premature death from accidents;

• suicide.

ADHD (and Autism) can be present in anyone - the previous idea it was just men and boys has been absolutely discredited - and we know that it’s a neurological difference which means you do not grow out of it, NOR does going ‘keto’ or whatever the latest dietary craze is, cure you.

(If you feel better and maintain your health, hooray! But please don’t add to your guilt over not managing this).

WHAT EXACTLY IS ADHD? (TL/DR at bottom of page)

“ADHD is a unique brain wiring which requires engaged interest with a clear, purposeful intention in order to activate and access attention so an individual can manage the brain’s executive function.”

— ADDCA (ADD Coach Academy)

The name is a real problem: attention deficit hyperactivity disorder.

Most ADHDers have no difficulty AT ALL summoning attention - and lots of it - when we are interested in a subject. The difference is that we 

• Find establishing focus and attention difficult on demand

• We don’t always find important things interesting enough to start our attention

• We can lose attention and interest when things no longer sparkle/feel new

Many ADHDers have bursts of activity - but it’s maybe not the classic ‘driven by a motor’ mentioned in DSM-V - sometimes it’s our brains that never stop, and keep us going in different directions - or, as a client once told me, “like my wheels are churning and turning but they don’t go anywhere”.

It is so important that we start to talk about ADHD as a ‘brain wiring’ issue and remove the deficit/disorder based language. Whenever possible, I use positive, strengths focused language so that it can become as normal as saying ‘X person has straight hair, Y person has curly hair’. We would never judge or write off a person based on their eye colour or hair type, would we?

Neither is this an “ADHD is my superpower” cliche -

the shame, frustration, guilt and pain ADHDers experience must not be ignored.  The number of undiagnosed ADHDers in the prison population and in obesity clinics is far higher than the general population, so we know that without the knowledge, support and scaffolding our unique wiring requires, we will face additional challenges and barriers to the ‘PNT’ (predominant neurotype) population.

However, it is absolutely possible to create a positive environment and rewire our thoughts (to diminish the guilt, frustration etc) that allows the gifts and strengths of the ADHD brain to flourish. With the right support and self knowledge, everyone can flourish and grow - the old gardening adage of ‘right plant for the right place’ applies to humans too.

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Let’s have a look at how some scientists have explained their view of ADHD (for want of a better shorthand).

• Dr Thomas E Brown compares it to an orchestra without a conductor who knows what they’re doing - all the instruments are there, they all have the right music, but without someone to get the group started and tell them when to come in on time, it’s a bit of a mess. This is ADHD as an “Executive Function” problem.  Researchers describe Executive Function as how the brain prioritises, integrates and regulates other functions. If you’ve ever watched a human try to self-regulate their emotions and thoughts (in less than helpful ways), you can see why ADHD as an executive function difference makes sense.

• Dr Russell A Barkley has a more deficit based definition - “it’s a disabling condition that arises from neurological and genetic factors and causes problems in every area of life”, especially productivity. Leaving aside the negative suggestion of ‘disabling’, how does that sound for you? Most ADHDers find that it affects every part of their life - whether they want it to or not.

• Dr Nora Volkow has studied the dopamine levels and mechanism in ADHDers, especially in relation to drug abuse and obesity - she found that ADHD patients had lower levels of dopamine receptors and transporters in areas related to processing motivation and reward - so the reward activation being different means ADHDers have problems engaging in activities we don’t find rewarding or reinforcing. We need to value an activity or subject ourselves, not just be TOLD it’s important (does that sound familiar?)

• Dr Dodson came at things from a different perspective - in 2017 he presented at CHADD a functional, experience based definition of ADHD (which, lets face it, is more useful for those of us outside the laboratory):

“ADHD is a genetic, neurological/brain-based difficulty with engagement as the situation demands, in which not just performance, but also mood and energy level are solely determined by the momentary sense of interest, challenge or competitiveness, novelty (creativity), passion, or sometimes urgency (usually a deadline).”

— Dr William E Dodson

(DID SOMEONE MENTION DEADLINE?)

What is absolutely vital here is that he’s describing a difference - not a less than, not a broken system, just that our nervous system is different. It’s the psychological version of trying to shave a square peg until it fits into a round hole - when there’s a square hole right over there, ready for it.

He has gone on to explain that there are three crucial ADHD differences that DSM-V misses: our requirement for interest above importance; our emotional hyperarousal; our sensitivity to rejection (and recognition).

ADHD-ERS ARE NOT BROKEN, DEFICIENT OR NEED FIXING

- we just need the right environment, the right tools and skills, and the right tasks. 

The variability of our interest and energy makes so much sense when we look at it as a nervous system difference where environment and focus are taken into account - yes there will be some ADHDers who thrive in the energy of a classroom or office and need a background buzz of a coffee shop to allow them to get started on a task - but there will be others who need a quiet, organised environment and short, simple steps to get into their energy for work. And there will be times of the day - week - month - when no matter what, it just won’t happen. That’s situational variability and ‘stuckness’ - both classic markers for a neurodivergent brain that you’re not going to find on a DSM tick list for diagnosis.

ADHD Traits & DSM-V Diagnostic Criteria

In case you’re still interested in the ‘official list’ and want to compare it to the descriptions given briefly above, you can look here . Bear in mind that the ‘official’ definition has changed repeatedly - now it has to show up before age 12, not age 7, and it no longer has to cause “impairment” - changes that have raised eyebrows in the psychiatric professional community.

DSM-V Diagnostic list includes:

• Present before age 12

• Inattention

• Hyperactivity and Impulsivity

• Present in different settings

• Interfering with every day life or work

• Cannot be explained by another mental disorder

The symptoms of ADHD (and more likely to be recognised by ADHDers and those who love us) include but are absolutely not limited to:

• Incredible levels of focus in a subject that we are interested in

• Tendency to find those same things less interesting quickly

• Feeling things more intensely - rejection, recognition, physical sensations

• Discounting work/jobs/subjects that are important but not interesting 

• Sensory overload/hyperawareness - sounds, smells, touches, tastes can be too much - or not enough

• Trying to manage overwhelm by having strategies and coping mechanisms, some of which are not helpful or cause other problems (that square of chocolate to get started on laundry anyone?)

• Quickly diving deeply into passions and then… not following through

• ADHD paralysis - when we just have all the thoughts and ideas and feelings.

Is this sounding familiar? I hope that, as a woman with ADHD and autism, I can reassure you that you or your loved ones are different, not less. With the right knowledge, support and care, we can all thrive, not just survive

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Reading & references:

Geffen, J. and Forster, K. (2018) ‘Treatment of adult ADHD: a clinical perspective’, Therapeutic Advances in Psychopharmacology, pp. 25–32. doi: 10.1177/2045125317734977. Dr Thomas E Brown A New Understanding of ADHD in Children and Adults Dr Russell A. Barkley - http://www.russellbarkley.org/factsheets/WhatCausesADHD2017.pdf Nora D. Volkow, Gene-Jack Wang, Joanna S. Fowler, Dardo Tomasi, and Frank Telang Addiction: Beyond dopamine reward circuitry 2010 https://www.pnas.org/doi/epdf/10.1073/pnas.1010654108 Dr William Dodson - https://www.additudemag.com/symptoms-of-add-hyperarousal-rejection-sensitivity/ C. Vonvicini, SV Faraone and C Scassellati, Attention-deficit hyperactivity disorder in adults: A systematic review and meta-analysis of genetic, pharmacogenetic and biochemical studies. Molecular Psychiatry 2016. Sanders, S., Thomas, R., Glasziou, P. et al. A review of changes to the attention deficit/hyperactivity disorder age of onset criterion using the checklist for modifying disease definitions. BMC Psychiatry 19, 357 (2019). https://doi.org/10.1186/s12888-019-2337-7