Understanding ADHD Essentials is a condensed version of the 3 ADHD Primer articles, but in video format. I try to quickly answer what is ADHD, what is the medical side of ADHD including about Dopamine, Noradrenaline and Neurodivergence, what is the prevalence of ADHD, the dangers around ADHD, ADHD and diet, ADHD identity, and ADHD loneliness.

Introduction

ADHD is not just boys being boys, just a naughty boys disease, or simply a problem with not letting kids play. ADHD is often mistaken for a mental illness or some kind of brain damage rather than a fundamental difference in Neurology. The ADHD initialism, literally means Attention Deficit Hyperactivity Disorder, was originally a description of what a diagnostician would look for in a patient. Unfortunately, ADHD taken as a literal description, only describes a small percentage of the people who are actually have ADHD.

This is going to be a fairly brief overview of ADHD.

For more in-depth information check out the links below.

ADHD in a Nutshell

Humans have more than one neurotype, where the biggest group, a little over half the population we think, are called Neurotypical. ADHD is the next biggest neurotype.

Being different from the typical is considered neurodivergent.

ADHD is old, being first medically recorded by Melchior Adam Weicard, in “Der Philosophice Arts“, Volume 4, 1779, a German medical text from over 250 years ago. The description of who fits the “lost attention” diagnosis disorders is very similar to modern diagnostic manuals such as the DSM 5 TR. ADHD has also been called Hyperactive Syndrome, Hyperkinetic Syndrome, Maladjusted Children, Minimal Brain Dysfunction and ADD, all obsolete names. ADHD has been the medical name for the last 35 years.

Unfortunately most of the methods of diagnosis is still based on the old stigmatised ‘poorly behaved child‘ model, leading to struggles to be recognised if you aren’t misbehaving, suffering enough, or happen to be female.

ADHD has a few diagnostic subtypes. To understand that we first have to recognise that the modern ADHD initialism is describing what your brain is doing more than what your body is doing. The ‘attention deficit‘ refers to how your brain isn’t paying attention to what you ‘should‘ be paying attention to. Of course the definition of should is a bit contentious.

Hyperactivity is more about how your brain is overly active trying to compensate for not enough neurotransmitters in your Frontal Lobes – the Prefrontal Cortex – and Amygdala.

ADHD is called a disorder because it interferes with capitalism and or the neurotypical status quo.

It was only from around 1944 that the newly synthesised methylphenidate was found to help people diagnosed with what we now call ADHD.

You may know this chemical by the pet name the chemist who made it (Leandro Panizone), called it ‘Ritalin‘ after his wife Margarita (Rita, his pet name for her).

Amphetamines were the next major success in helping people with ADHD in the early 1960s. It is from these medications that we finally understand what is behind ADHD. Modern studies have shown us that methylphenidate and amphetamines improve dopamine and noradrenaline in the frontal lobes (Prefrontal Cortex) and central brain (Amygdala) regions. From here we were able to recognise that a number of similar conditions were all the same thing – that is, ADHD is considered to be a spectrum condition where the appearance and experience of ADHD is varied but the fundamental cause is quite similar. This is why the medical subtypes of ADHD exist.

• Inattentive for people that tune out,
• Hyperactive for physical movements, and
• Combined for those traits most of the time.

ADHD Diagnosis & Misdiagnosis

ADHD is often under diagnosed as it requires a specialist trained and qualified in ADHD to recognise its root cause.

Prevalence & Aetiology

ADHD is very common. It is estimated to be between 2-5% of the general population – with as many as 40% of some subpopulations having been diagnosed.

Any condition that is more than 1% of the population is considered to be a part of being human.

Often, the high diagnosis percentages in subpopulations are correlated strongly with those who have survived a crisis such as refugee populations, adding to the mistake of thinking that ADHD is a trauma response.

ADHD is not a former response.

The self-management of ADHD can be adversely affected by trauma.

My opinion of why ADHD is found in higher proportions in people who have survived strong adversities such as refugees is because ADHD is a strong survival trait. The other members of that population didn’t make it.

ADHD is congenital. That is, you are born with ADHD.

You don’t develop it through an experience like trauma or mimicking someone who is ADHD

There is a definition in some countries of ‘Acquired ADHD‘ where some forms of brain damage can seem similar to ADHD and are also positively treated by the same medications as ADHD, so some similarities in diagnostic behaviours. however this is not actual ADHD, which is congenital.

ADHD is strongly inherited. That is, ADHD is genetically passed on from the parent to the child with around about 80% confidence, possibly more, and that’s only from one parent who matches the criteria for ADHD (whether they’ve been diagnosed or not).

Often, if an ADHDer is in relationships that has lasted for more than six months, then they are dating another ADHDer. If you have one person in a family with a diagnosis of ADHD, it’s smart to check for everyone else too.

Neurology & Medication

Most people with ADHD neurology benefit from medications. Many lay people misunderstand what the medication does, leading to the mistaken view that taking ADHD medication is the same as taking recreational drugs or taking ‘smart pills’.

What the medication is doing is, at the least, helping to make the neurotransmitters Dopamine, Noradrenaline & Adrenaline more efficiently used in the Prefrontal Cortex and the Amygdala (central brain).

ADHD behaviour is mostly around trying to make a small amount of neurotransmitter last the longest and not get wasted on things that your base survival biology (survival brain) doesn’t think are important … like study. If the brain fuel is more biologically efficiently used, then this avoidance of non-biologically important aspects is reduced.

The other effect that some of the ADHD medications have is helping your brain generate just a bit more dopamine than usual in those same locations, effectively increasing the size of your tank.

ADHD Bio

Exercise & Diet Can Help

Most ADHDers benefit from regular exercise, ideally daily.

This has been strongly correlated to a reduction of the amount of medication needed or an increase in how long an ADHDer can get benefit from those same medications.

Not all ADHDers benefit from this.

Many ADHDers struggle with diet.

The ratio of food high in fat, sugar, carbohydrates, protein and salt is much higher in the general daily food intake for an ADHDer in comparison to a non-ADHDer. And often, ADHDers will hunt for these foods when feeling brain fog needing to concentrate or feeling mood dysregulated.

These are considered to be the dopamine-chasing foods, as eating them triggers a biological Dopamine release reward.

Protein is the only item on that list that actually helps your body synthesise Dopamine and Noradrenaline. An excess of Dopamine-chasing foods, aka junk food, frequently leads to obesity and malnutrition and a high risk of Diabetes Type 2.

Another major dietary problem that ADHDers struggle with is allergies and food intolerances.

• Allergies are often easy to spot due to the obvious signs of hives, welts and hospitalisation.
• Intolerances are subtle and hard to spot and are generally more experienced as various gastrointestinal difficulties such as IBS or malabsorption of nutrients and the cognitive and mood destabilisation that those foods trigger.

That is, you get brain fog or your mood goes out of kilter just after you’ve eaten the thing.

Sometimes, though, we get a mood boost followed by a long mood deficit.

Dopaminergic Neurotransmitters

Let’s talk briefly about Dopamine and Noradrenaline.

Dopamine can be considered to be the fuel that runs the part of your brain collectively called the executive function. This helps you to keep track of recent events, plan into the future, hold on to a temporary bit of information whilst doing a thing, understanding what things actually mean beyond the service level and solve problems in creative ways.

Low Dopamine leads to losing track of things, not understanding new ones and break down in creativity and problem solving.

Noradrenaline can be considered to be the Threat Detection System, much like Dopamine is Thinking and Understanding, and is directly connected to your mood being accurate to the circumstance.

Part of detecting threats is sensory perception and this is tuned by the brain to be useful. Noradrenaline also allows you to initiate and complete tasks.

Low Noradrenaline leads to mood dysregulation, sensory sensitivity, hyper-reactivity and the inability to initiate tasks without being stressed.

Sometimes, we have too much Noradrenaline and this can lead to feeling paranoid or connecting the wrong ideas behind things.

Some of these difficulties can be overcome by behavioural strategies but you need to have enough executive function capacity to follow the strategies and enough mood stability to be able to focus on those.

So if you have insufficient executive function or mood regulation, you need medication to help.

While most ADHDs do benefit from medication and non-medical help, such as therapy and coaching, it is very important to recognise that with different neurology comes a strong difference in what it is to be human and what kind of culture we form.

ADHD Beyond the Body – Identity

So far, we have only focused on ADHD as a medical condition. There is more to having an ADHD brain than medical problems.

• ADHD is an identity.
  • ADHD Identity is not the best name, but it’s what we have.
• ADHDers are very creative, can handle stressful situations very well and are better than average survivors.
• ADHDers are not very good at peace or boredom.

Which is ironic as many ADHDs are unhappy trying to be neurotypical and with the ongoing struggle to get access to your own brain’s resources, we see a very high death rate in undiagnosed ADHDers, primarily from suicide, estimated to be around 20%.

While ADHDs may be very good in times of external adversity and stress, they are not very good at managing boredom or societal stigma.

Watching television, films, reading books, listening to music, visiting art galleries and going to shows fills me with pride that the creative side of humanity is so vital to who we are as a people. The vast majority of the people who create these are ADHDs. ADHD is also found commonly in science.

A common trait of ADHD is being cool and functional in highly stressful situations. And the ADHDs with these traits are often our emergency workers. Loneliness can be a common trait of the ADHD that doesn’t know that they have ADHD.

ADHD, Social and Autism

ADHDers often find that having compatible ADHD friends is more fulfilling than trying to fit into the Neurotypical friendship groups where you may feel like an imposter or hollow, not welcome, in a crowd but not of the crowd.

It can be incredibly lonely.

It doesn’t have to be.

Late Diagnosis

I have many clients come to see me in adulthood for help with their struggles. I ask them if they know they are ADHDs and frequently they don’t.

Once we have done the checks to ensure that we are on the right track, a common part of the diagnosis is to gather evidence from childhood, which often means talking to parents.

Around half the people I see had parents that were told their child was likely ADHD in childhood, but they did nothing about it to avoid drugging their child or labelling them. This not only led to a life of misery, but to them being labelled lazy, difficult, stupid or worse.

Diagnosis and medication is shown to significantly decrease the risk of drug addiction and death from suicide.

Stigma

Parents. Yes, you parents. Your kid is going to get labelled regardless. Do you want the label to be useful or hindering?

ADHD is only a stigma if you perpetuate that stigma.

Hobbies

Many ADHDs have multiple hobbies, many areas of special interest and become good at many things.

• ADHDs like to stay active and often don’t need to relax.
• Having to take time to recover from injuries or illness can be very tedious.
• ADHDs like novelty over repetition.

ADHDs are often accused of being very extroverted, while most will identify as introverts.

Conclusion

The stigma against ADHD is very strong, while the reality is that ADHDs are often lovely people who are just trying to get along in a world that no longer really values the neurology that helped humans survive, innovate and become the dominant macro species.

More ADHD Links