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Jul 14

What Most People Don’t Know about ADHD


By Margarita Tartakovsky, M.S.

Today, there are still many myths, misconceptions and misunderstandings about attention deficit hyperactivity disorder (ADHD). Everyone from the media to mental health professionals may perpetuate these erroneous beliefs. Below, experts shared what most people don’t know (or commonly misunderstand) about ADHD. You’ll find everything from what causes ADHD to what helps it.

1. ADHD is not caused by our super-busy, tech-consumed culture.

Today’s world is certainly busier and more distracting and more hectic than it’s ever been. Our attention spans are shorter. We have a harder time staying focused. We often can’t go an hour or 30 minutes without checking email or glancing at our phones.

However, those of us that don’t have ADHD still manage adequately, said Mark Bertin, MD, a board certified developmental behavioral pediatrician. ADHD is a complex neurological disorder that goes beyond being distracted.

“ADHD affects self-management skills called executive function that include not only attention and impulse control but organization, planning, time management and far more,” said Dr. Bertin. In this post he further explains how ADHD really functions:

ADHD is a poorly named condition. The stereotypical symptoms – lack of attention, hyperactivity and impulsiveness – merely scratch the surface. The parts of the brain implicated in ADHD also control executive function skills – abilities such as time management, judgment, organization, and emotional regulation. Executive function is kind of like the brain manager, responsible for supervising and coordinating our planning, our thoughts and our interactions with the world. The true issue with ADHD is one of executive function and as has been said by Dr. Russell Barkley and others, a more appropriate name for ADHD might be ‘executive function deficit disorder.’

Multitasking, social media, email and other distractions may exacerbate ADHD. But they don’t cause it.

2. ADHD affects all areas of a person’s life.

People often think that ADHD solely affects academic performance or possibly one’s productivity at work. Unfortunately, ADHD has far-reaching effects.

“ADHD can affect anything in your life that requires proper regulation, organization, planning, attention, impulse control and emotional grounding,” said Roberto Olivardia, Ph.D, a psychologist who treats ADHD and a clinical instructor in the department of psychiatry at Harvard Medical School.

This could be anything from sleeping to paying the bills to cleaning the house to interacting with your spouse.

For instance, as Bertin notes in this piece, kids with ADHD are at an increased risk for language delays. They also struggle with finding the right words and stringing thoughts together quickly. They have a hard time focusing on conversations in groups or noisy environments.

3. Up to two-thirds of people with ADHD have another disorder.

People with ADHD also may have depression, anxiety, obsessive-compulsive disorder or bipolar disorder. (This piece lays out comorbid disorders in kids with ADHD along with recommended resources.)

This is why it’s important to receive a comprehensive evaluation, which screens for other disorders. According to Bertin, “if treatment stalls, it’s worth looking again to see if something else is going on with ADHD.”

4. ADHD is highly genetic.

“If two tall people have children, and put them up for adoption, people expect the child to be tall regardless,” said Bertin, also author of The Family ADHD Solution. “The heritability of ADHD is similar.”

That is, if a family member has ADHD, the chances of another person in the family having ADHD increases three- to fivefold, he said. “For identical twins the risk may rise to 80 percent.” Bertin emphasized that ADHD is a medical disorder, which is “primarily programmed by genetics.”

Olivardia cited this 2012 review and this 2014 review for more on the genetics (and neurobiology) of ADHD.

5. Learning disabilities go underdiagnosed in ADHD.

This typically happens because the learning problem is believed to be part of ADHD, instead of something that’s exacerbated by ADHD, Olivardia said.

For instance, he noted that dyslexia is massively underdiagnosed. “It is assumed that the trouble reading is attention-related (ADHD) when there could be significant decoding, phonemic awareness, comprehension, or fluency issues that are completely independent of the ADHD.”

Anywhere from 40 to 60 percent of people with ADHD have a learning disability, Olivardia said. Almost half of children with ADHD might have a specific writing disability, Bertin added. (He cited this study as an example.)

This is why it’s essential for all students with ADHD to be properly evaluated for a learning disability.

6. Overcoming ADHD isn’t about working harder.

Often people assume that someone with ADHD just needs to work harder. They assume the person is lazy or lacks motivation or just doesn’t want to put in the work.

However, as Bertin points out, “You wouldn’t say to a child with asthma, ‘Just try harder, stop wheezing.’ Likewise, expecting a child with poor executive function skills to ‘pull it together’ right now is unfair and sets up challenging, often unrealistic expectations.”

Plus, people with ADHD are already working hard. “Studies show that an important mental control area of the brain — the dorsal anterior cingulate cortex — works much harder and less efficiently [in people with ADHD] than for those without ADHD,” said Terry Matlen, ACSW, a psychotherapist and ADHD coach, in this piece.

Instead of working harder, the key is to work differently. That means finding strategies that work with one’s ADHD brain. This can include everything from setting alarms as reminders to organizing with a specific paper system.

Again, ADHD is a complex neurological disorder. It’s also a highly treatable one. It’s important to get a comprehensive evaluation and seek treatment. This may or may not include medication.

“[P]eople sometimes avoid evaluation because they equate diagnosis and treatment of ADHD with deciding to use medication,” Bertin said. However, just knowing that you have ADHD can help you make positive changes.

“[P]eople often choose not to take medication, and still can take steps that help make ADHD easier to live with. Which isn’t to discredit what medication has been shown to do for ADHD, either.” Plus, if you’re not in crisis, starting with non-medical approaches to see how much they help is a great first step, he said.

Whether you’re taking medication or not, it’s important to use ADHD-friendly strategies, practice healthy habits and work with a therapist and/or ADHD coach.

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