attention (!) deficit (!) hyperactivity (!) disorder (!)
Un cri de coeur
I’ve recently realized ADHD is much worse than the average person assumes. It’s worse than I assumed. I think treating a disclosure of ADHD with more gravity — not mythologization, simply weight — might make life better for those with ADHD and those without it.
I wholeheartedly support the reduction of stigma for those with mental illness, and believe that the mentally ill benefit from public awareness of their conditions. It is also fun when people who know what they’re talking about joke about it.
However.
My own experience inclines me to agree with Dr. Russell Barkley, who famously called ADHD “degenerative diabetes of the brain.” It is not Fidgeting in Your Seat Disorder. We are not indigo children; we are not Bart Simpson. The never-ending parade of famous people talking about their ADHD seems to imply that there is an equal chance for those with and without ADHD to succeed in most domains. Untreated, there is not.
In my perfect world, we would also treat ADHD-like symptoms as something to avoid causing in other people, and investigate the processes that cause them seriously. I’m concerned about the recent uptick in diagnoses. If we are all, as some have claimed, undergoing mass-ADHDification through TikTok or what have you, this is a terrible thing. If more people have ADHD, this is also bad.
I’m not a psychologist. Also, I have ADHD. By the way.
ADHD is implicated in hoarding, and a host of other bad outcomes that the average person doesn’t think about:
If you’ve got ADHD, you’re more likely to
develop Hoarding Disorder
get into car wrecks
develop problems with substance use
try to end your own life, and succeed
Among other things.
I’m not saying that the average ADHDer is driving their car off a bridge. But I’m saying that some of the really bad problems in life begin with something like ADHD. A lot of the behaviors we consider baseline respectable are made harder by it.
On a miniature scale: I was once part of a student production going to Vegas. The task of packing was so paralyzing that I stayed up all night — packing very little, worrying a lot, reading and re-reading the same articles. When my boyfriend at the time and his brother arrived, they had to help me finalize what I was taking. It was not the first time I had stayed up all night not-packing; it would not be the last. If they had not been there, I would not have arrived on time.
We all piled into the bus. I was wearing a very fetching coat (gift from a friend) and scarf (gift from mom). We were about to leave. There was only one problem. We were waiting for the lead.
The lead of this particular show had a problem with time. She had been late before; she always missed the call for places because she never budgeted half an hour to do her makeup. She was not well-liked.
On the bus, people joked that we should leave without her, and have the stage manager go on in her place.
There but for the grace of God—
Pills don’t always fix it, and managing them is something people with ADHD are also often bad at.
Yes, Emma, you say, but ADHD is one of the most treatable conditions. Studies show that meds help a lot.
Correct. And:
Not all medications work like putting on glasses. Most people with ADHD need to find the “right” meds at the “right” dosage. This means:
remembering to take them
remembering to take them consistently
managing interactions with sleep, appetite, menstrual cycle
and/or other medications
remembering your reactions to them
scheduling appointments
remembering to show up
Ayyyy Macarena!
Meds are life-changing. They rock. Due to the stuff I listed above, however, they don’t rock in the same ways for everyone all the time.
And for a substantial but quiet number of people, they do not rock at all.
ADHD is like having low conscientiousness; low conscientiousness leads to bad life outcomes.
I rely a lot on the five factor model because it’s well-known, it feels like Dungeons and Dragons, and it’s fun to talk about at parties. If you’re an enthusiast, you know all about how conscientiousness (self-discipline, organization, goal-orientedness) is linked to health and wealth and that kind of thing. It’s a bigger predictor of those outcomes than IQ. That nice Russian lady at the Atlantic put a whole chapter in her book on it.
You know what looks like not being self-disciplined or organized or goal-oriented from the outside? A lifelong disorder where you can’t regulate your attention.
A little interlude about emotional regulation and rejection sensitivity
ADHDers are known to be sensitive to criticism — “rejection sensitive dysphoria” was the pop-psych term that was being thrown around for a little while. Now, it’s referred to as “rejection sensitivity,” which I like.
Anecdotally, I think this is because people with ADHD are rejected constantly by their peers. Russell Barkley likes to mention that executive functioning is delayed up to 30% in ADHD kids. In How to ADHD, ethereal goddess Jessica McCabe points out that “the 18-year old you are sending off to college might have the executive function of someone who is 12.”
Every kid I know who had ADHD was a weird kid.
ADHD is very heritable. If your parents have it, you’re looking at an adult with an impaired frontal lobe having to be their kid’s frontal lobe too. Depending on how the parent’s ADHD traits were understood in their time/place/culture, you’re also looking at someone watching their kid learn to deal with the traits that might have made their childhood hell. (This is before we add other baggage.)
ADHDers need responsive systems — what Barkley calls a “prosthetic environment.” Responsive systems are occasionally Out to Get You.
Okay, you say. We get it. But there are other treatments.
I love video games, naturally. This is because the time between action and payoff (or punishment) is very short. The entire world operates in a series of quick loops. We affect things. Misquoting Sasha Chapin, I have come to call this quality responsiveness.
Russell Barkley recommends ADHDers build ourselves responsive worlds to function. Constitutionally, everything must be now or not-now; the far-off is not salient for us. ADHD coaches talk about “re-sparklifying” systems that have ceased to be interesting enough to work. We have to connect the outcome we want to the process itself.
The problem is that responsiveness is also a quality of some places that want your time, your money, your precious finite slack. Casinos. Social media. Sales. The performing arts, even.
Sidebar: AI chatbots are extremely responsive. I know I am going to need to set guardrails around my usage because social media worked on me in a similar way.
Hyperfocus is not the capitalist dream machine state everyone seems to think it is; it doesn’t always feel like creative flow either.
But surely you can leverage your incredible hyperfocus to create magnificent things.
Sure! Steve Jones, the guitarist for the Sex Pistols, took a bunch of black beauties and learned to play guitar in three months. He’s also frank about his extensive criminal history, but I digress.
Life is full of competing priorities. When I was undiagnosed in middle school, I had a math test and a French project on a regional food of my choice. I wound up picking Comté, a mellow-tasting cheese from the Jura Mountains. I don’t know if I even cracked the spine on my math book, but I do remember investigating the Appellation d’Origine Contrôlée so completely that I can still recall a specific travel blogger’s brother’s name. The project kicked ass. Down the line, I needed the algebra.
When you’re older, this is supposed to get better, because you have more choice over what you’re supposed to be doing. Right? WRONG, mostly. Sure, you can get really into pianos and have a career as a piano tuner. But it turns out when you’re an adult, it is even less socially acceptable to neglect what you need to do for what your brain needs to do. This brings me to my next point:
Involuntary hyperfocus is awful and I hate it
We don’t always hyperfocus on work, or even things that can be honestly described as “activities.” I’ve hyperfocused on listening to Olivia Rodrigo’s “so american” over and over while shredding a Goldfish bag to bits with my fingernails. I’ve hyperfocused on doodling during a midterm review because I could not make my brain write the date. Once, I hyperfocused on taxonomizing an ex-friend’s social media when I had a scene to perform in three hours in front of my entire grade. Those are just the examples off the top of my head.
Then there’s time blindness. Oh, God, the time blindness. I wake up. I sit on my bed. I put on a single sock. I look out the window for thirty seconds. I put on another sock. Someone is screaming at me — we’re late, hurry up, we’re the kind of late that pisses people off — I need to have shoes-dress-hair-makeup-bag done in two minutes. Someone else is honking their horn; the ride is a favor, they came from across town. I like these people. I want them to like me.
This, every morning for your entire childhood, tends to produce an antagonistic relationship with one’s own brain. Sometimes, it feels like in order to make any mark on the world at all, you have to voluntarily scrape your nails down a big long chalkboard.
Other people call this “writing,” and debate types of chalk.
Neurotypical standards are… pretty normal, actually
One piece of advice for people with ADHD is “not to hold yourself to neurotypical standards.” This feels relevant when you’re planning for future versions of yourself, but there is literally no way to live in the world without expecting the same things of yourself that neurotypical people do.
These “nefarious” norms include:
Show up to your obligations on time
Turn in work of decent quality, at the time you said it would be done
Control your emotions
Honor the social contract
Whatever your social role is, you’re going to need to follow through, and no matter what, when you have ADHD you’re going to fail more often. The question is whether or not you’re failing on a near-daily, weekly, or monthly basis; whether the conscientiousness skill check is game-changing or trivial.
ADHD is not something you should want to have.
Look, I know some people think ADHD is just a mismatch to the environment. One story I keep very close to my heart is that of Gillian Lynne, the eventual choreographer of CATS. She was taken to a doctor as a kid after teachers flagged her for inattention. The doctor took her mother into the other room and left the radio on. They watched little Gillian dancing through the window, and the doctor said she should be enrolled in dancing school.
To this I say: do you have any idea the amount of executive function it takes to choreograph a musical on the West End? The scheduling, the smooth running of rehearsal, managing your social presentation at every networking event, persevering, persevering, persevering….
I have an extremely complicated relationship with diagnosis, pathology, stigma, the push to de-stigmatize, the push to re-stigmatize, and people on the Internet hurling invective at each other about it. I have fought this battle for years and it has been fought in me and over me and about some of my closest friends. I have a substantial amount of skin in the game. At the risk of sounding melodramatic, it sometimes feels as totalizing as debates over nationality or gender. This makes knowing people think it’s a fun personality quirk feel very strange.
If you have attention problems and suspect they are ADHD, I would ask you to suspend judgment until (if, I know) you can see a professional. Whatever you do, hold other possibilities alive in your mind until that moment.
If technologies such as social media are making even a few people a little bit more ADHD, or inducing executive dysfunction in some people some of the time, I think this is probably worse than we think it is.
I am sympathetic to people who push back on the narrative that we are all trapped in a system that is systematically eroding our attention. It feels totalizing, erases agency, and reduces a complex number of things to a Big Ol’ Theory. I get it.
But the world is large, and getting increasingly more complex.
My ADHD has hurt people. Full stop. It has also inconvenienced people, annoyed people, and made it hard for me to live with myself. If I could immediately cure my ADHD, and all it would take was a pill that changed the fundamental profile of what I like, I would hesitate and agonize, sure.
But I would take the pill.
yeah man fuck ADHD!!