An inside view of ADHD: What your doctor probably didn’t tell you
This started life as a more accessible version of my ADHD list for writers, and turned into a two-part series. That’s how ADHD works sometimes.
1. ADHD is an executive function disability.
Executive function is hard to define, even for researchers. However, all agree it’s a set of skills that let us control our behavior and respond flexibly to a changing environment. Executive function skills include:
Executive functions are like the conductor in an orchestra, while the different parts of our brains are the musicians.
Each musician in the orchestra plays beautifully alone. But to sound good when playing together, they need a conductor. The conductor keeps them playing with the same timing and the same style.
Similarly, each part of our brain functions pretty well independently. But when we need to do a new or complex task, we need multiple parts to work together with the right timing. To do that, we need executive functions.
2. We may have a distinctive way of thinking and talking.
People with ADHD might think in a web instead of a straight line. Here’s a blog post that illustrates the difference.
Each connection between ideas is logical, but because we zigzag through it, our train of thought looks disorganized to people without ADHD who do not share our “mental map” of the world.
We move through our mental web through associations.
A stray thought, another person’s words, or something we see or hear can remind us of something else. Because we’re easily distracted, we often go off on tangents. Because we have poor short term memory, we then forget what we were talking about previously.
We also talk fast, trying to pack all the necessary background information in our web into the shortest amount of time, before people get impatient.
As a result, when we talk to people without ADHD, both people often get frustrated.
But before you blame yourself and apologize for the communication problem, know that nothing is smoother and more energizing than a conversation between people with ADHD who think this way!
It feels exhilarating, and the energy builds increasingly as we talk. Everything the other person says makes perfect sense. We can go on for hours and never run out of things to say (or return to the topic we started with). We can finally be ourselves and talk comfortably, without worrying about irritating or confusing the other person.
Another positive to our thinking style: it’s ideal for “divergent thinking,” for making creative associations that wouldn’t occur to most people.
Priti Shah’s research team finds that ADHD adults excel at certain types of divergent thinking, which can help them outperform neurotypicals on both creativity tests and real-world creative achievement.
3. ADHD is a production disability, not a learning disability.
Because we think in a non-linear fashion, it’s harder and more time-consuming to explain our thoughts to other people. You first have to figure out what to say (and what not to), and put it in an order other people will understand, before you can speak or write.
If the inside of your head looked like this, you’d have trouble communicating your thoughts, too!
That means that deadlines are a lot harder for us to meet, even if we can remember them (a big if!).
ADHD is often categorized as a learning disability in education systems, but that’s a mistake. Many of us have no difficulty getting information into our brains. Our difficulty is with production: expressing what we know by a deadline, in the correct format.
Some consequences of this:
1) A person with ADHD may well be brilliant in class discussions and in-class quizzes, but perform poorly on long-term papers and presentations. It’s because of how our brain works, not because of the amount of effort we put in!
2) For a person with ADHD, the content of schoolwork is easy, and if we turn it in on time we’ll get an A. But turning it in is harder than the homework itself.
3) As a result, we have an all or nothing pattern of achievement. We either ace or fail assignments depending on whether we manage to turn them in on time and format them correctly.
4) We also have all or nothing effort. There’s no way to gradate effort because if we put less effort in, we won’t finish and turn in the assignment at all. People often say “just do the minimum,” but that doesn’t work for us.
4. What other people think is “hard” is often easy for us, and what they think is “easy” is often hard.
Homework isn’t the only case where the “hard” part is easy for us, and the “easy part” is hard.
I have difficulty with some of the boring paper shuffling tasks but am really good at creating websites, brainstorming, creating presentations and new systems. Does anyone out there feel that people treat you as less intelligent because we have difficulty with simple tasks?
I wrote a post discussing “the complex is simple, the simple is complex” phenomenon here.
5. Boredom is torture, and we get bored REALLY easily.
Boredom feels like Chinese water torture. Every second is a drop of water.
Boredom feels like being in a sensory deprivation tank. You feel like you’re going crazy.
All of us find boredom more painful than the average person. But we vary in how often we experience boredom, and how we deal with it.
Some are constantly bored, and highly aware of their search for stimulation. Others, like me, think they’re never bored, because they always keep themselves occupied.
In my youth, I always carried a book to read and a sketchbook to write in, and I’d read even while crossing the street. At the breakfast table, if conversation was impossible, I would read the cereal box.
Only when I started learning to cook did I realize that I can get bored and desperate to wander off within less than 30 seconds.
6. We often have bad memory.
I’m not sure why, but people with ADHD often have a bad memory.
In particular, our memories aren’t useful or deliberate. That is, we can remember random details from our childhood or trivia about our interests. But we have trouble remembering what we did on a particular day, when someone’s birthday is, or even our own phone number.
Poor working memory is common, and linked to lower brain activity than neurotypicals in the frontal lobe.
Having a bad memory affects more than academics:
We might be constantly writing things down.
We might worry about how to organize this record of our lives, and what would happen if it were destroyed in a natural disaster.
We might worry about whether anything we experience is “real” or meaningful if we’re almost guaranteed to forget it.
7. We have especially bad prospective memory, which is remembering to remember.
One of my most frustrating ADHD difficulties is my failure to “remember to remember.”
Without extensive strategies to remind myself, I remember errands I need to run at times I can’t do them, and forget about them when I can.
When I was a kid, my mom tried to teach me the strategy of “when you’re angry, count to 10 before you do anything.” I couldn’t use the strategy because when I was actually angry, I wouldn’t remember the strategy existed.
Thus, we ironically forget to take stimulant medication for the very reasons we need it in the first place!
8. A double bind: We need habits to function, but have trouble making them.
Because we can’t “remember to remember,” we have trouble making new habits. We can’t consistently remember the habit at the time we’re supposed to do it.
That’s a problem because habits make everything easier for us.
When tasks are automatic, we don’t have to make decisions and use executive functions--the things people with ADHD struggle with most.
9. We can’t process visual clutter well.
In everyday terms, “visual clutter” is when there’s so many objects with so many colors, textures, and shapes that all your brain stops seeing any of the things. All it sees is an undifferentiated mass of “stuff.”
Researchers have a slightly different definition of clutter, measuring small decreases in response time and accuracy rather than the experience of “objects turning into a mass of stuff.” But they find that neurotypicals have trouble processing visual clutter, too.
People with ADHD just have more difficulty processing clutter in everyday life, produce more of it, and have more difficulty cleaning it up.
10. It’s hard to remind ourselves to do things without creating visual clutter.
Some people mistakenly think putting post-its everywhere will solve our “remembering to remember” problems--even people with ADHD.
But too many post-its become visual clutter.
We might stop looking at them to protect ourselves from being overwhelmed.
Or, we might be so overloaded by clutter that we look right at them and don’t register their existence.
Visual clutter paradoxes apply to more than just post-it notes.
If objects in my home aren’t visible, I forget that they exist. They don’t even need to be in the back of a closet; they can be in an opaque drawer or even a shelf I don’t use all the time. I even forget about food in the back of the refrigerator sometimes.
So, you would think I need to make all my things visible. But then I still can’t see them, because they just look like clutter.
(You would think the solution would be to get rid of most of my stuff. But the decisions involved would take hours and leave me exhausted. Remember, clutter is just un-made decisions).
11. Organizing our lives is harder for us than for most people because we keep running into double binds.
We’ve just discussed some double binds people with ADHD run into when they try to organize themselves:
We need habits, but have trouble making them.
We need visual reminders, but too many of them just turns into clutter we can’t process.
We only remember what we own if it’s visible, but we can’t process any of our things if too many are visible.
We need to own few objects so as to avoid clutter, but it takes a difficult, exhausting amount of executive function to get rid of extra stuff.
We often put huge amounts of effort into making our time and space organized, and still fail.
Most ADHD adults research, invent, and tinker with organizational systems our whole lives. Most don’t work because of these double binds, and we keep changing or replacing them. This can look, or be, inefficient.
Well-meaning advice from well-meaning friends, family, and coworkers doesn’t work and leaves everyone frustrated.
Even advice from professional organizers and life coaches might not work well if they aren’t trained in dealing with the double binds created by ADHD.
12. Look at both extremes.
Some of us can multitask well, but are terrible at focusing on one thing. Some, like me, are the opposite.
Some of us feel stifled by structure, while others, like me, try to plan everything in advance. The first type of person fits many people’s stereotypes of ADHD people as “spontaneous” and “disorganized.” But because of ADHD, I rely on routines and schedules to function.
Some of us have IQ in the “gifted range” (top 2% or so), while others have low IQ and severe developmental delays (children who are born prematurely, get lead poisoning, or have fetal alcohol syndrome often have ADHD).
Some of us can see the big picture brilliantly, but miss many important details. Others focus intensely on the details but lose the big picture. Others, like me, can do either, but not both at once.
Some of us are artists, some are scientists, some are both.
We can be the best students or the worst.
We can be social butterflies or socially awkward penguins.
13. We’re consistently inconsistent.
Our functioning is inconsistent from day to day and even moment to moment. Not surprisingly, we fear that others will fire us or reject us because we’re unreliable.
But also, we may feel that we can’t rely on ourselves. This diminishes our confidence, motivation, and self-esteem.
If we feel unable to rely on ourselves, we might feel that we have to rely on other people. We might resent our dependence, and fear that if we mess up one too many times, they will leave us.
Research calls our inconsistency “intra-individual variability.” Ironically, they find that inconsistency ranks among the most consistently observed ADHD traits.
14. When life gets hard, we can stop being able to do things we “know how” to do.
When our lives are going well and the people in our lives support us, we often function well in school, at work, and in our relationships. Some of us do so well that our ADHD is invisible.
But when difficult life transitions happen, some of us seem to suddenly fall apart. I call this “hitting the wall,” and Laurie Dupar calls it a “tipping point.”
Basically, we can no longer compensate for our disabilities, because we no longer have the time or energy to use the strategies that worked for us in the past. In fact, our old strategies might even be counterproductive. Our ADHD traits become more obvious, and we stop being able to do things we could before.
Common tipping points include:
ADHD can turn even the joyous milestones of life into a struggle.
15. Many of us develop anxiety.
More than half of us develop anxiety.
We’re prone to overthinking, and may have trouble controlling our thoughts.
We have to worry about others misunderstanding us and calling us lazy, stupid, flaky, or rude.
We are inconsistent, and worry about the effects on ourselves and others.
Some of us develop an exhausting habit of “constant vigilance” to avoid making ADHD mistakes like losing things, forgetting belongings, running late, math/writing errors, etc.
16. We usually have other conditions along with ADHD.
People with ADHD are more likely to...
Have other developmental disabilities, such as autism.
Have learning disabilities, such as dyslexia, dyscaluclia, or nonverbal learning disability.
Have difficulties with sensory and motor processing, such as sensory processing disorder and dyspraxia.
Develop mental illnesses, including depression, anxiety, obsessive compulsive disorder, and bipolar disorder.
Have certain physical and neurological disorders, such as tics/Tourette’s syndrome or night-time bedwetting ( “enuresis”) into late childhood or adolescence.
As children, exhibit behavioral problems, which may be diagnosed as so-called “oppositional defiant disorder.”
Self-medicate to the point of developing substance abuse, such as alcohol or nicotine dependence.
Personally, I believe that our difficulties with self-regulation go way beyond high-level abilities like executive function.
We have difficulty regulating even the most primitive brain functions (such as maintaining alertness). Some of us even have difficulty maintaining homeostasis of bodily functions.
For example, I overreact to small changes in light, atmospheric pressure, temperature, blood sugar, hunger, thirst, or sleep, with migraines, pain, fatigue, irritability, and difficulty thinking and moving quickly.
Difficulties regulating sleep, including falling asleep, staying asleep, and waking up well-rested, correlate with and probably explain some ADHD symptoms.
(For this reason, anyone evaluating someone for ADHD should always inquire about sleep, because some people may look like they have ADHD when they don’t purely because of chronic lack of sleep! But people with ADHD also often have sleep difficulties).
In other words, if someone has ADHD, they probably also have disabilities or difficulties with self-regulation that affect other areas of life.
17. Our family members are likely to have ADHD or autism, diagnosed or otherwise.
Many people report being diagnosed with ADHD after their own children were diagnosed.
ADHD is highly heritable, meaning that it’s highly likely that someone with ADHD traits will have children, and parents, with similar traits.
The same genes can also predispose someone to both ADHD and autism. So families that contain autistic people often contain people with ADHD, and vice versa. My own family is one of these.
18. Not everyone with ADHD views their condition the same way.
Some of us see ADHD as uniformly disabling. They believe it prevents us from using our talents and passions.
Others see ADHD as a gift that must be managed.
People with each of these viewpoints sometimes see the opposite as harmful to people with ADHD.
Still others view ADHD as a trait like any other, which can have positive or negative effects depending on how one chooses to use it and whether it fits the environment.
Personally, I see ADHD, in general, as a set of traits. However, I see my own as mostly negative. I like my creativity and ability to hyperfocus. However, I believe my ADHD traits interfere with using my talents, and would be impairing in any environment. (What benefit could inconsistency and self-regulation difficulties possibly have, in any environment?) But there are environments where my ADHD traits would be less disabling, and I’m trying to find and create them.
19. ADHD can be a serious disability.
On the surface, ADHD looks like something “everyone deals with.” But as this list suggests, it can cause serious problems in school, work, and relationships.
The large-scale MTA study followed hundreds of girls and boys with ADHD into adulthood, and found the following outcomes:
Higher rates of self-injury and mental illness
More adolescent substance use
Poorer relationships with peers in adolescence
Poorer relationships with parents and partners in young adulthood
ADHD has also been linked to:
Poorer education and work performance
Greater risk of accidents
Researchers and the media tend to describe these problems as the result of ADHD traits themselves, especially impulsivity.
But I believe the way we treat people with ADHD has a lot to do with the bad outcomes.
Many of us, especially those diagnosed late in life, develop crippling shame and self-hatred. This alone can lead to poor school performance, mental illness, substance abuse, relationship difficulties, and underachievement at work.
20. But people with ADHD are awesome!
People with ADHD can be creative, energetic, passionate, thoughtful, smart, academically skilled, empathetic, spontaneous, entrepreneurial, and more.
Famous people in every walk of life have diagnosed ADHD, and many past geniuses had traits.
Like other disabilities, ADHD colors how we experience and act in the world, and it adds unique struggles to our lives. But ADHD does not diminish us or make us less human.
Thank you for reading. If this post helped you understand ADHD better, please share it. Let me know if I’ve missed important ways ADHD has affected your life.
