ADHD: Myths and Misconceptions

Common myths and misconceptions (and the truths):

Only boys have ADHD

Both boys and can girls can have ADHD. It had previously been reported that males are much more likely to have ADHD, with population studies reporting male to female ratios of around 3:1, whilst clinical samples suggested ratios of between 5:1 and 9:1 [1,2]. However it is thought these findings may not be completely accurate, owing to factors such as referral bias, differences in symptom presentation and symptoms being attributed to other co-morbid conditions, such as anxiety or depression. This is already highlighted by the differences seen between clinical and population based studies, supporting that females are much less likely to be referred for clinical diagnosis. More recent reviews have suggested a much closer gender split, with ratios of around 1.6:1 in adults (Figure 1) [3]. However it is likely that split could potentially be even closer than that as ADHD still tends to be diagnosed much more often in boys. This is likely due to the fact that hyperactivity appears to be more prevalent in boys than girls, and girls tend to be less disruptive and are more likely to present as ‘daydreaming’ or being generally distracted, indicative of the inattentive form of ADHD [3]. Females are also more likely to be diagnosed later in life compared to their male counterparts as they are often misdiagnosed, with their symptoms often being attributed to other conditions, such as depression and/or anxiety [4]. Additionally, it is thought that females may be better at developing coping strategies that mask their symptoms [4].

Figure 1: Male:female ratio of adults with ADHD, developed using data from Willcutt EG. Neurotherapeutics 2012; 9: 490-499. Taken from “Gender in ADHD Epidemiology | ADHD Institute” (2020) [5].

People with ADHD are always hyperactive and full of energy

Hyperactivity is one symptom of ADHD, however not everyone with ADHD will experience it. As mentioned above, for example, hyperactivity tends to be less common in girls than boys.

There are actually 3 different types of ADHD; hyperactive-impulsive type, inattentive type, and combined type (see previous post on ‘What is ADHD?’).

People with ADHD are simply ‘lazy’, ‘unmotivated’ and ‘need to try harder’

A common experience for those with ADHD is being labelled as ‘lazy’ throughout school and their school reports being filled with phrases such as ‘needs to focus more’, ‘needs to stay on task’, ‘easily distracted’, ‘needs to apply his/herself more’, ‘not reaching his/her potential’, ‘must try harder’, ‘bad attitude’ etc. However, people with ADHD are not intentionally being lazy , in fact a lot of the time they are trying as hard (if not harder!!) than their neurotypical peers to pay attention. But they find this extremely difficult, not because of problems with their attitude, but rather due to how their brains work. ADHD brains tend to have lowers levels of the neurotransmitters dopamine and norepinephrine, which are associated with the pleasure and reward systems in the brain and with executive functions such as attention, planning and working memory[6]. This explains why ADHDers may have difficulties with tasks they find boring or repetitive, such as those common in classroom environments and office jobs.

ADHD is only present in children

Similar to the boys vs girls myth, many people don’t believe that adults can have ADHD. Whilst it is thought to be true that you can’t develop ADHD in adulthood, and DSM-5 guidelines state that symptoms must have been present before the age of 12, many people (again particularly women) do not get diagnosed until well into adulthood[7]. This can be due to managing to ‘mask’ symptoms well or succeeding at school despite their difficulties due to ‘natural talent’, however it is likely the symptoms were in fact present from childhood. Symptoms in childhood can also often be attributed to other causes and many girls in particular are diagnosed with anxiety and/or depression during their teens, when in fact these symptoms may be, at least in part, caused by difficulties linked to their undiagnosed ADHD and the struggles associated with this. For example constantly being told they are not trying hard enough or are underachieving, despite putting in a lot of effort, which can severely impact self-esteem and contribute to mental health problems (e.g. depression and anxiety).

I know I for one held some similar beliefs to these for many years. Often wondering if I may have ADHD due to my inability to stay focused and constantly being distracted, but also thinking I could not have ADHD as I so often felt completely exhausted and seemed to spend a large amount of time napping, including at school…, the apparent complete opposite to being hyperactive.

I have obviously experienced first hand the damage these stereotypes can cause in terms of preventing diagnosis and the detrimental and long lasting effects this can have on an individual’s self-esteem and mental health. As such, I am very eager to try and help raise awareness of and bust these myths and increase knowledge of the truth about ADHD and how it can present. Particularly the contribution of such myths to the low levels of diagnosis in young girls. More needs to be done to ensure schools and higher education institutes, as well as parents, are more aware of the potential signs of ADHD, particularly in girls, so that early identification and intervention can occur. This would allow more support to be put in place to help them at an earlier stage in their life, which would help minimise the detrimental impacts this can have on emotional wellbeing, academic achievement, relationships and employment prospects.

[1] Gaub, M., & Carlson, C. L. (1997). Gender differences in ADHD: a meta-analysis and critical review. Journal of the American Academy of Child & Adolescent Psychiatry36(8), 1036-1045.

[2] Skogli, E. W., Teicher, M. H., Andersen, P. N., Hovik, K. T., & Øie, M. (2013). ADHD in girls and boys–gender differences in co-existing symptoms and executive function measures. BMC psychiatry13(1), 298.

[3] Willcutt, E. G. (2012). The prevalence of DSM-IV attention-deficit/hyperactivity disorder: a meta-analytic review. Neurotherapeutics9(3), 490-499.

[4] Quinn, P. O., & Madhoo, M. (2014). A review of attention-deficit/hyperactivity disorder in women and girls: uncovering this hidden diagnosis. The primary care companion for CNS disorders16(3).

[5] Gender in ADHD Epidemiology | ADHD Institute. (2020). Retrieved 8 August 2020, from https://adhd-institute.com/burden-of-adhd/epidemiology/gender/#:~:text=ADHD%20is%20more%20commonly%20diagnosed,years%20and%20over%20(Figure).

[6] Logue, S. F., & Gould, T. J. (2014). The neural and genetic basis of executive function: attention, cognitive flexibility, and response inhibition. Pharmacology Biochemistry and Behavior123, 45-54.

[7] https://chadd.org/about-adhd/overview/

What is ADHD?

So what is ADHD? Most people have heard of it but much fewer have a good understanding of what it is. When the term ADHD is mentioned I’m sure many people’s minds immediately picture the classic stereotype of hyperactive, naughty little boys who are constantly full of energy and get distracted by anything and everything. Whilst it can sometimes present in this way, this does not describe the large majority of people with ADHD and someone does not need to be hyperactive to have ADHD. In fact ADHD can lead to many different symptoms and difficulties that differ greatly between individuals. In particular symptoms can present very differently between sexes and between adults and children. This post aims to outline the different forms of ADHD and highlight some common symptoms, beyond the typical ones that everyone has heard of.

There are 3 types of ADHD:

  • Hyperactive-impulsive type
  • Inattentive Type (formerly known as ADD/Attention Deficit Disorder)
  • Combined type
https://bestwoldofknowledge.blogspot.com/2015/03/adult-add-symptoms.html

Symptoms of inattentive type include (DSM-5 criteria)1:

  • becoming easily distracted
  • trouble holding attention on tasks or play activities (i.e. getting bored quickly)
  • poor attention to detail or making careless mistakes in schoolwork, at work, or with other activities.
  • avoids, dislikes, or is reluctant to do tasks that require mental effort over a long period of time (such as schoolwork or homework).
  • difficulty organising thoughts, tasks and activities
  • losing things, e.g. keys, phone, pen, homework etc
  • often appear not to be listening when directly spoken to
  • forgetful in daily activities
  • often does not follow through on instructions or fails to finish tasks

People who are impulsive or hyperactive often (DSM-5 criteria)1:

  • fidget, fiddle with things or feel restless
  • struggle to sit still or often leave seat when remaining seated is expected
  • talk too much and/or too quickly
  • have trouble engaging in quiet activities
  • are constantly “on the go”
  • are impatient and have difficulty waiting their turn
  • act impulsively without thinking about consequences of actions, e.g. doing something dangerous without thinking about potential for injury
  • blurt out answers and inappropriate comments
  • interrupt people when talking

May also (not included in DSM-5 guidelines):

  • struggle to process and remember new information or large amounts of information at once
  • have difficulty focusing on a single task, often switching between many different tasks
  • be overly sensitive and/or have exaggerated emotional responses
  • often appear to be ‘zoned out’ or daydreaming

People with combination type experience many symptoms from both lists.

To meet diagnostic criteria you must experience at least six of the nine key symptoms for a specific type of ADHD (or five or more if aged over 16 years)1. To be diagnosed with combination ADHD, you must show at least six (or five if 17+) symptoms from each group (inattention and hyperactive-impulsive behaviour). Additionally, symptoms should have been present before the age of 12, occur in more than one setting (e.g. home, school, work, or with friends), and significantly impact everyday functioning, e.g. work or school performance or socially. Finally, the symptoms cannot be better explained by another mental disorder.

Hopefully this post has helped deepen your understanding of ADHD slightly and highlighted that not everyone that has ADHD is hyperactive and that there are many other everyday difficulties associated with ADHD, such as memory, processing and organisational issues.

[1] American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub.

Why I started this blog…and how it relates to baths!?

Well…the first, and main, reason I decided to start writing this stuff was as a form of ‘therapy’ for myself. My mind was constantly racing with millions of thoughts quickly passing through, jumping from one thing to another, with no structure or coherence. This gave me minimal time to process and understand each thought and left little to no mental capacity for important tasks that I needed to do, such as writing coursework and revising for exams.

Over the last few months I have found writing to be a great outlet and release and has allowed me to organise my thoughts in a much more structured and coherent way than what I am able to do in my brain. Getting things out of my head and down on paper (or screen) has provided me with a sense of relief, somewhat relieving the pressure building up in my brain. My brain was like a bathtub with the tap stuck on, constantly overflowing (see image below), and pulling the plug out didn’t help as the water was still flowing in quicker than it was emptying. The water flowing out the bath represented all the important things I had to remember slipping from my memory, or my ideas escaping from my brain mid-sentence, making me lose my train of thought. I could not focus on tasks and kept forgetting things as everything was overflowing out of my mind, never to be seen again.

How to Handle a Bathroom Flood

By getting some of the thoughts down on paper/screen it almost felt like the tap had been turned down slightly, not completely off, but enough to stop the overflowing and allow the bath to gradually empty to a more acceptable level (see below image; a slightly more relaxing, less hectic experience than before…). Writing things down allowed my brain to finally start emptying slightly, freeing up space in my mind, allowing me to focus on things for a bit longer, without getting so distracted, without losing or forgetting key information part way through.

An oval bathtub filled with bubbles in a … – Buy image – 11396864 ...

Now I hadn’t originally planned on sharing any of this stuff I was writing, it was simply just a strategy I was using to vent and free up some space in my mind for more important things. (DISCLAIMER: This is definitely NOT a ‘feel sorry for me’ thing at all and I don’t want people thinking that!). I was hesitant to make this public for that exact reason. However, whilst talking about it with a mentor I’d been seeing, I thought maybe sharing what I’d written could be beneficial, both for myself and others. I thought perhaps if people read it, they would not only understand me more, but it could help raise awareness and understanding of neurodiversity and mental health conditions and encourage people to seek help. I hoped that maybe such increased awareness could also allow people to be more understanding and accommodating of friends, colleagues and acquaintances, in workplaces, social situations etc. If this could help even one person, it would make it worth it.

Finally, I hope that increasing awareness will aid in busting myths and misconceptions surrounding ADHD and associated mental health problems. For example, people being labelled lazy, rude, stupid, useless etc. I hope this will make people stop and think before labelling someone as such and consider whether there may be underlying issues or that the environment might just not be right for them (yes, I’m looking at you school classrooms and 2 hour long lectures!!) and adjustments may need to be made to accommodate for this.

Introduction

Hi I’m Alice, a 23 year old, recently diagnosed with (ADHD). I enjoy exercising, napping, complaining, making people laugh and impulsively doing reckless things…

Welcome to my blog “I need a nap”. Why is it called this you ask? Well, firstly, anyone who has lived with me or knows me well probably knows that this is one of my most commonly used phrases haha so I thought why not make it the title of this blog. But also because this blog is going to be centred a lot around my mental health struggles which, as anyone who has experienced MH struggles themselves will know, can be extremely mentally and physically draining and can leave you feeling constantly exhausted and in need of a nap.

Naps have always been an escape for me, no matter how I am feeling. Sometimes it’s physical exhaustion, others it’s mental, and sometimes I’m just bored, whilst at other times I just feel overwhelmed by everything and simply need to ‘switch off’ for a bit. Therefore “I need a nap” seemed a fitting title. The main focus of this blog will be ADHD and associated mental health comorbidities, such as anxiety and depression, which often go hand in hand with ADHD.