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Post: Blog2_Post

ADHD Stigmas

Updated: Dec 14, 2023

As I was trying to figure out what topics to write about for ADHD Awareness Month, I Googled "Top questions asked about ADHD". It was no surprise to me that the first 5 links were advertisements and links to ADHD medication websites. This, of course, creates a stigma in and of itself about ADHD and its association with stimulant medications. This, I think, is the number one worst stigma towards ADHD as it not only causes people to hesitate to get a diagnosis, but it also prevents people from getting the medication part of the treatment they need because they are either afraid of being treated like a drug addict, or they don't want to be on medication for their whole lives. To the fear of being treated like a drug addict, my response to anybody that has ever treated me this way is "if I were addicted to this drug, I guarantee I would not be forgetting to take it as often as I do."

The reality of ADHD medication is that if you are taking the correct dosage, then you shouldn't even notice a difference other than life getting a bit easier for you. When I first started taking Adderall for my ADHD I found that I didn't even notice anything. It wasn't until I responded to something my wife said to me while I was reading something on the internet that she stopped me and said something along the lines of "do you realize that is the first time that you have ever heard me much less responded when you were focused on reading? The meds are working!" When I told this to my doctor, he responded by saying "Yep, that's how I know you have ADHD. The people who have ADHD won't usually notice anything, and it's usually the ones around you who noticed the most significant changes."

Another Stigma that crops up a lot is when people say something like "Everybody is a little ADHD sometimes." My response to this is, "Sure, but by that standard, everybody is a little diabetic sometimes as well." We all get a little low on blood sugar now and then. But for most of us, our pancreas is able to produce more insulin to quickly balance it out and tell us to eat more sugar. So our body has a natural way to bring us back to the baseline.

The same thing holds true for ADHD as well. Sure, people are more forgetful, or "random" at times, especially if they are mentally exhausted or sleep deprived. But most people's brains have the ability to get them back to a baseline where they are able to function normally. The same holds true for ADHD. Neurotypical brains have the ability to recognize when it is low on dopamine or norepinephrine and produce more to get back to the baseline. ADHD brains, however, do not have that ability.

Now, imagine feeling like you are perpetually operating with only 3 hours of sleep at all times, but then, in seemingly random intervals, you are able to operate as if you have had the most amazing sleep of your life, eaten a perfectly balanced breakfast, and your coffee has suddenly just kicked in and you suddenly get laser focused and in the zone. But the problem is that there is no predictability or control over this ability. And what is worse, after you come out the other end of this laser focus, you now feel like you haven't slept for 48 hours straight and you need a day or 2 to recover. This is what it is like to have ADHD. A life of zero consistency and a constant never-ending struggle to maintain a sliver of self-control.

I think that the next worst stigma about ADHD lies in the name itself. "Attention Deficit Hyperactivity Disorder". ADHD by far has the absolute worst name for a condition because not one of the words in the name actually describes what is actually going on. ADHD is a condition that causes poor executive function in the brain due to its inability to regulate both dopamine and norepinephrine levels. Dopamine is basically the reward chemical in the brain whereas norepinephrine is the fight, flight, or freeze chemical that assists in impulse control. Basically, because our brains have no idea how to regulate these two very important chemicals, our brain is constantly trying to seek out ways to reward ourselves while also not being able to prioritize day-to-day tasks. And because many ADHDers are highly intelligent, they tend to get bored easily and seek out other forms of stimulation. Ultimately though, it has nothing to do with a deficit of attention. If anything, ADHD causes a person to have too much attention. They just aren't able to prioritize what thing they should be paying attention to due to the fact that they will always focus on the thing that grabs the attention of their brain first. This could also come as an advantage, as people with ADHD are often some of the most creative, motivated, and caring people in the room, as long as that thing is something they are passionate about. So in that sense, can ADHD really be considered a disorder? This is one reason I stand behind calling it a type of Neurodivergence, than calling it a disorder. I couldn't believe it when I saw that the FAQ for parents and caregivers on the CHADD website was "My child was just diagnosed with ADHD. Is she eligible for Social Security Insurance (SSI)?" It staggers me that any parent would think about something like that before considering that their child might just be different and need some accommodations in place to help them out.

ADHD takes many forms though. All of them stem down to the brain's constant hunt for that sweet sweet dopamine. Sometimes, that sweet word takes literal form in the form of an insatiable sweet tooth. Sugar and chocolate have the unique ability to immediately cause dopamine release in the brain. It is because of this reason that another ADHD stigma has been created due to the many studies linking obesity to ADHD. Really though, in my humble opinion, this begins with parents instilling good eating habits in their children from an early age, so that their first go-to dopamine fix isn't from sweets.

Depending on the person, ADHD could take the form of having an overabundance of energy on the outside, which, combined with the inability to control impulses, could make someone look like an undisciplined child that likes to cause trouble. These are the children that are the most quickly identified as having ADHD, and unfortunately, have become the poster child for it. This is what is now known as ADHD Hyperactive Presentation, or ADHD-H For the more introverted people, boredom of the mind can be as bad as being physically tortured. So, many will overcome this by learning a new hobby, or reading an overabundance of books, or becoming a musician, etc...etc...etc. This second type of person is the least likely to get diagnosed with ADHD, especially as children. And unfortunately, as I've seen it, these are also the most common. This type of ADHD is called ADHD Inattentive Presentation, or ADHD-I. There is also a combined presentation of ADHD (ADHD-C) that has both an internal and external presentation. This is actually the most common form of ADHD. These people often end up going in one of two directions. Either they will have issues in school because they are able to do really well on tests, but because of their inability to prioritize tasks, skip their homework to do something that engages their mind more. Because of this, their grades slip, and they end up getting comments from their teachers like "He has so much potential if he'd only apply himself," or "She's a pleasure to have in class, she just needs to focus on finishing her assignments." These types of comments, of course, only serve to damage the kid's self-esteem even greater, because to them, it's not something they are just able to "choose" to do. If it was that easy, they would have done it from the very beginning.

The other direction that is sometimes taken, which often happens more with females, is the opposite approach. The kid is very acutely aware of their misgivings and develops anxiety about it over time. This anxiety leads to the child overcompensating to try and overcome their shortcomings and being overly critical of themselves for not meeting perfection. They will then begin to believe that they are going to get in trouble even if they won't if they don't meet these unsustainable standards. These people are often seen as overachievers, and unfortunately, when they eventually burn out, they crash hard and often fall into a deep depression. It is this type of ADHD presentation that is the most misdiagnosed as something else. And because many people will never actually get it diagnosed as ADHD, they will spend their whole lives trying to treat the symptoms and not the cause of the problem.

Unfortunately, this most often happens to girls because they have grown up in a world where, because girls aren't fully treated as equals with their male counterparts, they have to work that much harder just to be recognized at the baseline. And because they become so used to having to work towards this higher standard, it's only natural for them to push themselves even harder if they have any other disadvantages stacked against them.

It is because of these stigmas around ADHD that a large majority of people who should probably seek a diagnosis, never do. Some people believe the stigmas themselves and falsely think that they can just somehow will themselves to get past these obstacles. But the reality is that they can no more will themselves to make their brain function normally than a blind person can will themselves to see. Other people are simply afraid that others who believe the stigmas will judge them and deem them unworthy for whatever reason. It is to these people that I say this. Don't let ADHD be just a label on you. Look for tools to help you overcome the obstacles, but embrace the strengths that ADHD can bring, such as creativity, empathy, charisma, and open-mindedness. We are all unique in our own way and we should not let a label like ADHD define who we are.

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