ADHD Part 1 – Medical Definition

ADHD (Attention Deficit Hyperactivity Disorder) is the most commonly diagnosed “disorder” applied to children. It affects children, teens and adults. It has high prevalence (5 to 8 of 100) and is a condition that is poorly understood. It can be difficult to manage, especially if the condition is misunderstood and mistreated.

Part 2 – Experiencing ADHD [Link]

Part 3 – Managing ADHD [Link]

Luis from the Marvel movie Ant-Man shows many classic examples of ADHD – odd conversation style, low ability to stay focused, easily distractible

Defining ADHD

ADHD describes a condition of low attentiveness (thus the Attention Deficit part of the name) caused by hyperactive brain activity that sometimes also affects the motor section. Common side issues of ADHD is doing behaviours with low regard to consequences and emotional dysregulation (mood varies chaotically and can be hard to control).

People diagnosed with ADHD often describe it as trying to work out what is the important thing to do, when that thing over there is more shiny, and now that, oh and look over there… Prioritising, concentrating and sticking to a chosen task is hard, while being distracted and becoming engrossed (hyper-focused) on an unimportant task is common.

The average adult has a 20 minute window of concentration, the average university student has evolved a 40 minute window of concentration. The average adult diagnosed with ADHD is about 5 and can train up to 10 minutes. If you can’t fit a task that isn’t shiny into 5 minutes, it won’t get done. Shiny is a personal definition – what is shiny for me won’t necessarily be shiny for you.

Working with someone with ADHD can be frustrating as they don’t stick to a task for as long as you want them to, get easily distracted by something else and seem to have a very different idea about what is important. Often we take out our frustration on the other, forgetting this this is frustrating for them too. Imagine knowing you need to do a thing, it is vitally important, but your brain just won’t let you. It’s like “I need to do this thing – I roll my two 6 sided dice to see if I do it, if I roll twin 6’s, I get to do it… and I guess I’m doing some other random thing instead”.

Steve Irwin – amazingly full of energy

Richard Giles [CC BY-SA 3.0 (http://creativecommons.org/licenses/by-sa/3.0/)]

ADHD vs ADD

Originally there were two conditions – ADD was used to describe people who seemed to fade out, or would easily get distracted, while ADHD was used to describe people who fidgeted, couldn’t sit still and were full of energy. While both of these were noted for attention deficit, it was considered to be two separate conditions.

In modern times it is recognised that these both have the same root cause (mostly) with different presentations. As such, ADHD has three subtypes – inattentive (classic ADD, now called ADHDi), hyperactive-impulsive (classic ADHD, now called ADHDh or ADHDhi or ADHDk) and combined (ADHDc). Many practitioners still use the old terminology to distinguish the subtypes – with hyperactive (ADHD) or without (ADD).

Prevalence and causes

In children under 18 years of age, 7.2% of people fit the criteria for ADHD. This will vary a little based on country and screening tools. This statistic is pulled from a meta analysis of 175 reliable studies.

Unfortunately adults with ADHD have not been as well studied. Studies in Europe, the Middle East and the United States of America indicate a likely 3.4% of people
fit the criteria for ADHD.

(General Prevalence of ADHD – CHADD [Link])

Some of this variance from childhood may be the end of puberty defiance, or it may be that the adults have learned how to temper themselves better and camouflage their experience. More study into this is needed.

Another confounding factor is that children are often screened by asking the parents questions. Parents who come from a stricter background are likely to over-report difficult behaviour, not necessarily because the child has a disorder, but because the parent’s definition of reasonable is variable.

While a specific gene has not been located for ADHD, it is well known that ADHD tends to run in families. It can also spontaneously appear, especially in the presence of certain pollutants, premature or underweight birth and brain damage. While ADHD is unlikely to be a learned behaviour, some environments promote ADHD symptoms over others.

(About ADHD – Symptoms, Causes, and Treatments – CHADD [Link])

What this amounts to is that in any group of 20 people, you are likely to have between 1 and 2 people who are likely to fit the criteria for ADHD. For most classrooms of 30 kids, you are statistically likely to have have two people who fit the criteria. Many schools will note these youth and put them into a specialty class that doesn’t actually address the ADHD issues well, but mostly aim to contain the disruption these youth bring to from the rest of the class. This does not help people with ADHD symptoms to learn to manage themselves, it promotes self blame and lowered self esteem.

Co-occurring conditions

As many as 65% of people who fit the criteria for ADHD also have a co-occuring (comorbid) presentation with at least one other condition, around 25% of people have two, and some have three or more. It can be difficult to determine if these other conditions are parallel (happen to be in the same person at the same time) or secondary (one promotes diagnosis of another).

Most common co-occuring conditions in children:

  • Oppositional Defiant Disorder (ODD) and Conduct Disorders (CD)
  • Specific learning disorders (language, learning and motor skills)
  • Autism Spectrum Disorder (ASD)
  • Intellectual disorder

Most common co-occurring conditions in adults:

  • Anxiety (General Anxiety Disorder, Social Anxiety, specific phobia)
  • Depression
  • Substance Abuse
  • Intermittent Explosive disorder(impulsive anger)

( Psychiatric Comorbidities in Patients with ADHD|ADHD Institute [Link] and ADHD And Co-occurring Conditions – CHADD [Link])

What this amounts to is the fact that people trying to manage ADHD symptoms are often also trying to manage other things as well, each of which often requires specific methods to manage, some of which contradict.

Relationship tips

Relationships can be hard, especially when you are not used to them, scared of being hurt, or there is some messy baggage with you. Here are some tips to cut through some of the more common problems.

Relationship Building

1. Work on the principle of Charity

When an ambiguous statement is made, such as “interesting hair”, assume the other person means the best version of that. Doing the opposite of this is looking for malice.

This also means that if you aren’t sure – that is, struggling to interpret with charity – you should ask for clarity. The other person needs to hear your request for clarity in the best light too. “What do you mean by that” should be a genuine request to explain, rather than “I think you mean me harm”.

2. Assume Trust

If you do not trust the relationship, it is time to call it what it is – over. If it isn’t over, then it is time to rely on that trust… even if you are struggling to feel it.

If the other person transgresses trust, then you have a discussion to have. Is the transgression major (cheating) or minor (didn’t call back when they said they would). Is a major transgression worthy of ending the relationship? Is it likely to ever happen again? How many transgressions do you allow before you end it? How many minor transgressions become a major transgression? These are all personal questions that you must figure out.

If it isn’t over, demonstrate trust, assume trust. Have conversations that build trust.

But when it is over, it is over.

3. Take things at face value

Frequently we try to read too much into what the other person means, just in case there is more. This is often fed by our own fears, or the other person being abusive.

When we take things at face value, we slow down the over processing that we are prone to when we try to work out tricky meanings. Instead assume that “it is” what “it appears to be”. For the majority of the time this is true. Sometimes things are different to how they appear and we can then adjust to that as needed. The overthinking comes in when you try to preempt the times things aren’t what they seem because we don’t trust our ability to adjust to that greater complexity.

If the other person is being abusive, there are some signs and symptoms of that (see Red Flags below). If the face value of a thing the other person said is not accurate to the situation, this may be a warning of deeper problems.

Often it is just poor communication.

4. Communication is key

We are not mind readers. We may make some excellent guesses, but that is both hard work and fraught with errors. What is better than assuming is discussing. Communication relies on trust, expectation that you are all working together for the greater good of the relationship and each other, and that there are no hidden agendas.

It is also very important that everyone actually have a say about how they feel, what they think and what they want without it turning into a tool to use against the other.

A temptation is for one person to do more of the communicating than the other, which unfairly gives them either greater responsibility for when things go wrong, or greater power for defining how things are going to be.

Safe and balanced conversation is tricky, but worth it.

5. Own your own stuff

Own when you make a mistake. It seems simple, but it can be really hard. Often we refuse to take responsibility for our mistakes, or we take far too much responsibility and own someone else’s mistakes.

It is time to get honest with ourselves. Did we do the thing? If so, own it. Own your part in it – it is rare that you are solely to blame, but don’t blame someone else for what you chose to do – don’t excuse it.

Also be real when you didn’t do the thing. If it wasn’t you, then don’t take the blame.

Most human interactions involve multiple people who are all partially responsible for what has happened. It can be tempting to start creating a false equivalence – you did this, I did that, so we are all to blame… but if you did 5% of the damage and I did 95% of the damage… then actually this is my thing to fix and I should accept my part in this. They are not equivalent parts.

Red Flags

Red flags are warnings that the relationship may be abusive. Just because one of these flags is true doesn’t mean that the relationship definitely is abusive – it may just be immature, poorly communicated, or full of various people’s baggage. Red flags indicate that there is a part of the relationship to be wary about and that work needs to be done to fix it.

Remember that it takes all parties to fix a problem.

  1. Shifting blame

A person who shifts blame is someone who does a thing wrong, but never accept responsibility for their actions. They will always blame someone else as the cause of the wrongdoing – for example: “I’m under a lot of stress at work”, “it isn’t me, it is you”, “look what you made me do”, or “I wouldn’t have had to do this if you hadn’t…”. Even when presented with evidence that they are directly responsible for what happened they try to shift the blame elsewhere.

While it is awful when other things are creating stress for an individual and a short temper can be understood, it is not a valid excuse to hurt another, nor can the blame for one’s actions be placed at the feet of another.

2. Movinggoalposts

If you feel that you can never win because the rules keep changing, or the measure of success keeps being redefined, then you may have a problem with moving goalposts.

It is important to have mutually accepted rules that are fair and understood. What is good for the goose should be good for the gander. There are limits on this, such as “I have an alcohol problem so won’t drink alcohol, but you are free to as you don’t” is fine, but “I can see my friends when I want, but you can’t” is not.

3. Walking on eggshells

This is where you are walking on eggshells, that is: waiting for the problem to crop up, or to be in trouble, or trying to avoid feeling guilty. There is an underlying fear to your interaction where you are very worried about how things will go because you will feel awful or be hurt in some way as a result of the outcome.

If you find that these red flags are dominant in your relationship and the other person in your relationship isn’t interested in addressing them, you might be in a domestically violent relationship [link]. If you are all interested in addressing these red flags, then following the first section will help to minimise the problems.

Outrage

In the early days of psychotherapy the legal process influenced how people saw sanity and insanity. One of the laws that were very influential in many countries was the illegality of homosexuality, specifically male to male. As a reflection of this, it was medically defined that homosexuality was a mental illness.

Many men were defined as insane because they desired love from another man
and or were attracted to men. The legal aspect attacked the body, the psychological aspect attacked the mind, the combined effect added to societies message which attacked the heart and soul of a large proportion of people.

Some men hid who they were, pretending to be straight, denying the aspect of themselves that was homosexual. Some men hid from society instead. Some men pushed back. Many men died.

Those who denied themselves often sought help to “be straight”. Gay conversion therapy in the USA was created by a psychologist who was trying to use the best tools of the time to address the distress of his clients who came in “wanting to love their wives properly” as society demanded, or “not to feel attracted to men”, which was defined at the time as wrong.

We now look back at this and are generally revolted. Gay conversion is banned in a number of countries. It does not “work” and misleads people into thinking that being homeosexaul is wrong and an illness to be cured. We now know that homosexuality is an aspect of being human. Not all people have it, but it is normal.

Homosexuality is like having blue eyes. Imagine if blue eyes were defined as a weakness, a failure to be part of the brown eyed majority, something to hide behind shaded glasses or contact lenses. Eye colour is a thing about you that is part of you. You cannot will your eyes to change colour, you can’t talk your way to changing the nature of your eyes and you shouldn’t have to hide it. Not all people have it, but it is normal.

Not all of society has caught up to the latest science and social attitudes.

People who have grown up in the transition phase from where homosexuality was defined as illegal and a mental illness to now where it is embraced by enough of society that people can be very open about their sexuality have a natural anger and outrage that who they are was once defined as wrong, as deviant, as insane.

We once thought that slavery was normal and fine. Well, those who weren’t slaves thought so. Now we know better.

I work with many clients over various representations of the human norm. The section that is filling my mind of late is the neruodivergent section. The diversity of mind that doesn’t really fit the current societal model and expectations. Sometimes this divergence comes with a handful of considerations, and sometimes people with a divergence happen to also have other things going on that are actual problems.

An example of a consideration is white skin at the equator. There is nothing wrong with having a low melanin count in your skin. If you do, it is important to note that you have a higher sensitivity to ultraviolet radiation, increasing your risk of sun damage in the forms of temporary burns and long term exposure can increase your risk of skin cancer. Sunburn and skin cancer are secondary to over exposure to ultraviolet radiation while at the same time having pale skin. People who have a high melanin count are less likely to get sunburn and skin cancer, but with a high enough exposure will also do so. They are just less sensitive to it. The flip side is, people who have a lot of melanin in their skin away from the equator are more prone to vitamin D deficiency, which can lead to a secondary problem of brittle bones. There is no “right” skin colour, because that implies a “wrong” skin colour.

A common secondary problem that comes with being divergent to the defined normal is anxiety and depression. Being told that who you are is an error enough times will make anyone terrified of being caught and exposed, lost in who you are and where you fit and your sense of self can be very damaged. Often you will spend a large amount of your early childhood resources trying to “fit in”, that is, camouflage yourself. This takes away from the resource you may use for learning and other things.

Imagine if we stopped this. Instead of telling kids “be like Johnny and Sue”, we said “be you” and embraced them. There goes the secondary anxiety and depression.

It is important to note that secondary anxiety and or depression are often mistaken for primary anxiety and or depression. Primary anxiety is a condition all on its own, which often has a neurological component to it. Secondary anxiety is a reaction to things you have experienced.

Look back at the example of homosexuality being defined as “wrong”. Many men spent a lot of personal resource not being found out, denying their own nature and feeling generally horrible about themselves on the assumption that society was right to define “them” as wrong. The suicide rate amongst homosexual people was very high (it still is, but it has dropped compared to 50 years ago).

Homosexual men often came to therapy anxious and depressed. Only once trust was made (rapport), would they also talk about their feelings of alienation and self loathing, their confusion about sexual identity and finally revealing, often reluctantly and with mixed denial, their homosexuality. In those early days, the next question would be “can you fix me?”

The answer to that, now, is “there is nothing to fix”. Instead of trying to fix homosexuality, the focus is to embracing who you are, finding like minded people and letting go of those who judge you, as they are backwards members of society.

There is understandable outrage at being judged by society as wrong when there is nothing wrong.

Experiments have been done with random “in group” and “out group” assignments with many school kids. It doesn’t matter what the arbitrary grouping is – eye colour, the flip of a coin, male vs female, the hidden witch etc – the results are the same. People form inclusion and exclusion for no good reason.

This is happening right now, and like the early days of society reform around sexuality, there is a burgeoning outrage by the divergent populations who are being currently defined as “wrong” for being a normal variance of “human”. We now understand that this idea of “wrong” is, in fact, wrong.

I work with people who use suicidal ideation,self harm and intoxication to manage their experience. A large proportion of them have no medical condition – such as gross perceptual hallucinations; psychosis; various neurological conditions; terminal illness; chronic pain – to explain their experience.

They have a social condition to explain their experience.

They are currently rejected by society because who they are is defined as “wrong”.

You are currently reading this, or listening to someone/thing else reading this. I wrote this on a computer, stored in the “cloud” on a website, displayed on a screen connected to “the net”, or printed on a page by a device – none of which was conceived or developed by “normal” people. Our entire technological “advancement” was made by people society defines as abnormal. The irony is that while we applaud the result, we deplore the people.

The outrage is good.

The outrage is normal.

The outrage is the first stage of standing up and fighting the false assumptions of wrongness.

It will drive us to become loud and normalise being us. I encourage those who have the strength to follow the example given to us by the homosexual community, the slaves, the women, the people of colour, all of the oppressed peoples – to have divergent pride and stop allowing people to condemning those who are different.

Get outraged.