ADHD: The Mental Health Toll of Constantly Adapting
Have you been hearing more about ADHD lately? Have you come across someone saying, "I keep getting distracted, I think I have ADHD!"? With more talk about ADHD lately, one might wonder: What does it mean when someone has ADHD? What is it like?
Attention deficit hyperactivity disorder, or ADHD, is a condition of neurodiversity. In recognition of Neurodiversity celebration week in March, we thought to offer a glimpse of what living with ADHD could look like, informed by studies on the condition and experience of persons diagnosed with this condition.
What does ADHD look like?
Perhaps to answer this question literally, the brain of someone with ADHD is structurally different from the brain of someone without ADHD. Research suggests that a brain with ADHD may experience delays in neural development and different levels of activity in certain brain regions. The frontal lobe of the brain, associated with executive functioning, is proposed to be wired differently for a person with ADHD, which can impact a cluster of executive functions for the individual in varying degrees.
Executive functioning encompasses the following:
- Planning
- Staying focused
- Sustaining effort (i.e. follow-through with actions)
- Emotion regulation
- Memory retention and retrieval as needed (i.e. ‘working memory’)
- Inhibition control
You may have heard of someone with ADHD describe difficulties with sustaining their attention. Doing a series of tasks to achieve a goal may entail multiple thought interruptions in the process. As such, living with this neurodevelopmental condition means it can be challenging to persist in actions with consistent effort and focus for prolonged periods of time.
When we see people with ADHD putting themselves through school, doing well academically, and being able to secure good jobs, we may think they appear to not differ much from people who do not have ADHD. Perhaps, this condition is a reminder that not all impairment is visible, and high functioning may not mean an absence of dysfunction. Underneath the surface, individuals living with ADHD may still be faced with daily challenges presented by their neurodevelopmental condition and are constantly needing to rise above the challenge to fit into society and adapt to the world in ways that others cannot see on the outside.
Another ‘symptom’ persons with ADHD may face is being criticised for being late, being absent-minded, being irresponsible, and other adjectives that may be issued from an assumption that the person is not trying hard enough when there is something fundamentally different in how their brains are structured from the average person. We are no stranger to some ADHD presentations, in fact, some of us may identify with them, such as getting sidetracked in the middle of tasks, procrastinating, making decisions on impulse… The difference is that while persons who do not have ADHD experience these from time to time, all the above can be a constant experience for someone living with a neurodevelopmental syndrome.
ADHD and Psychological Well-Being
When the above is daily life for someone, we can imagine how these situations may affect their engagement with life and the person’s sense of self. People with ADHD have advised thinking they are ‘always letting people down’, reinforced by reactions from others telling them they are not working hard enough. They described seeming unable to fulfil their potential despite knowing they have the abilities, and express feeling frustrated, helpless, or disappointed in themselves for being unable to attain desired outcomes repeatedly, and not for a lack of trying. We can see how an accumulation of these moments can affect the relationship they have with themselves and their external world, which can take a toll on their psychological well-being.
Some thoughts that a person with ADHD might have:
‘I can never trust myself to finish what I need to, or what others ask of me’
‘I am going to fail’
‘What others seem to do easily, I will always struggle with’
The way we think can vastly shape the way we behave. If we lack the confidence to execute tasks effectively, there might not be much motivation, knowing the hoops we have to jump through and possibly still not achieve our desired outcome. Someone faced with these beliefs may engage in avoidance or detach from the task, which can lead to more experiences of failure, frustration and disappointment received from others and self, and more enhanced alienation and social withdrawal. Having limited support and understanding from family, friends, and the community (school, work, shared spaces with others) and feeling entrapped in these difficulties without being equipped to manage the symptoms of ADHD can be overwhelming and pose a risk of developing other mental health conditions, such as depression or anxiety.
ADHD and Society
There has been an ongoing debate: Is having ADHD a disability, or are we living in a world that has been set up in a way that may not be aligning so well with the ADHD mind, simply as persons with ADHD form a minority of the population?
With how differently the brain of someone with ADHD is wired, individuals living with this condition may offer unique strengths and qualities in what they bring into this world. If you know someone who has ADHD, you may be able to recognise these strengths too. However, individuals with ADHD may not always feel safe or comfortable to open up about the kinds of hurdles they have to overcome to catch up with societal expectations, due to a worry of not being understood or accepted. This can be a weight that they continue to carry in society and interpersonal relationships, for as long as the systems and societal expectations remain.
While a part of managing ADHD resides in the individual’s effort to develop their own strategies to adapt and cope, broader support on a societal level can help bolster a sense of acceptance and fit for persons with ADHD. Perhaps, as more awareness spreads through the community, we may be closer to re-evaluating systems in society that can prompt a systemic shift, such that people living with ADHD, or people who are experiencing aspects of neurological difference as a minority, may feel similarly valued in the different ways that their minds work.
In the meantime, perhaps a step we can take to building a better world for those around us who are different can start from being willing to understand what this difference means for them. It may take a while for systems to develop and change in support of persons with neurodiversity. At the same time, your curiosity (that led you here!) and openness to learning how you can offer support as an individual can make a difference for someone living with ADHD.
Is there treatment for ADHD?
Yes, there are multiple options for managing symptoms of ADHD. In terms of pharmacology, doctors can prescribe medication for ADHD. People have reported some effectiveness from taking medication, such as an easing of the impact from impaired executive function to facilitate more sustained focus, planning, and organisation, and improved working memory functioning and emotion regulation. Some have advised that medication has helped them regain control of their life by alleviating the impairment temporarily such that they can use their minds better and meet the demands required of them. At the same time, some have also reported limited benefit from medication. Studies have found that medication coupled with training to develop adaptive behaviours through therapy can lead to more lasting management of ADHD symptoms.
Is it suitable for someone with ADHD to engage in psychological therapy?
Yes, there is increasing research that highlights the need to adapt therapy models to account for ADHD for therapy to be effective. This would mean the practitioner's consideration of ADHD on the client’s engagement in therapy, and creating a supportive environment for therapeutic change. In honouring the client’s hopes for therapy, the therapy plan for clients with ADHD may still vary depending on their desired outcomes and areas they would like to address. However, the process of therapy can similarly be ADHD-informed, in the ways that the practitioner develops an understanding of the client and in how sessions are facilitated.
As practitioners, we build our understanding of the client based on the context that their difficulties are embedded in, and value every piece of the client’s world that contributes to their being, including living with a condition like ADHD. Our approaches for supporting adults with this condition are substantiated by studies on interventions appropriate for ADHD, and are therefore evidence-based. For therapy tailored to managing ADHD symptoms, we invite collaboration with clients to design behavioural plans that overcome the hurdles presented by the client's experience of ADHD. Therapy also comprises of approaches that foster self-understanding and confidence in the ability to self-regulate across cognitive, emotional, and behavioural domains, paving the way to leading a more fulfilling and empowered life.
References
American Academy of Child and Adolescent Psychiatry. (n.d.). ADHD medication guide. https://www.aacap.org/App_Themes/AACAP/docs/resource_centers/resources/med_guides/ADHD_Medication_Guide-web.pdf
Beaton, D. M., Sirois, F., Milne, E. (2022). Experiences of criticism in adults with ADHD: A qualitative study. PLoS ONE 17(2): e0263366. https://doi.org/10.1371/journal.pone.0263366
Brown, T. E. (2013). A new understanding of ADHD in children and adults: Executive function impairments. Routledge.
Clerkin, S. M., Schulz, K. P., Berwid, O. G., Fan, J., Newcorn, J. H., Tang, C. Y., & Halperin, J. M. (2013). Thalamo-cortical activation and connectivity during response preparation in adults with persistent and remitted ADHD. American Journal of Psychiatry, 170(9), 1011–1019. https://doi.org/10.1176/appi.ajp.2013.12070880
Gehricke, J.-G., Kruggel, F., Thampipop, T., Alejo, S. D., Tatos, E., Fallon, J., & Muftuler, L. T. (2017). The brain anatomy of attention-deficit/hyperactivity disorder in young adults: A magnetic resonance imaging study. PLOS ONE, 12(4), e0175433. https://doi.org/10.1371/journal.pone.0175433
National Institute for Health and Care Excellence. (2018). Attention deficit hyperactivity disorder: Diagnosis and management (NICE Guideline NG87). https://www.nice.org.uk/guidance/ng87/resources/attention-deficit-hyperactivity-disorder-diagnosis-and-management-pdf-1837699732933
Ramsay, J. R. (2021). Adult Attention Deficit/Hyperactivity Disorder. In Wenzel A. (Ed.), Handbook of Cognitive Behavioral Therapy: Vol. 2. Applications. American Psychological Association. https://doi.org/10.1037/0000219-012
