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“It Looks Like a Duck and Talks Like a Duck, but is it Really ADHD?”

The following statements are not meant to be used in place of specific, professional care or diagnostic processes, and is for informative purposes only.

There has long been great debate about whether ADHD (Attention-Deficit / Hyperactivity Disorder) is over-diagnosed, or even, according to some naysayers, a figment of our therapeutic imaginations. With diagnoses in the United States greatly outnumbering those of children in the UK, some medical professionals assert opinions that ADHD is more of a metaphorical replica of the American culture at large, instead of an actual diagnosis [5]. While this particular discreditation has been disproven due to studies across several different cultural environments, there continues to be a vein of disbelief concerning the validity of the ADHD diagnosis throughout some communities of thought.

Whatever the reason for these cultural discrepancies among medical professionals, it cannot be ignored that children and adults who suffer from ADHD recognize its very real and sometimes debilitating effects on daily life. ADHD interferes with executive function, school and work performance, and relationships [1, 6, 11]. It also often presents alongside other mental, emotional, or behavioral disorders, which complicates the process of receiving accurate diagnosis and treatment for many individuals. Specialists who study and treat ADHD are persistent in their desires to help individuals with this often wildly misunderstood disorder.

What is ADHD Anyway?

According to CHADD (Children and Adults with Attention-Deficit/ Hyperactivity Disorder), an organization dedicated to “improving the lives of people affected by ADHD” through education, research, and support [1], ADHD is a “brain-based disorder” that affects approximately 1 in 10 children ages 5-18. More than half of these children are expected to have symptoms that carry into adulthood, though the presentations of symptoms may vary at different stages of life. These symptoms include “higher levels of inattention, impulsivity, and/or hyperactivity than their peers” [1].

Executive function, or basic mental processes, is impaired in individuals with ADHD, making it difficult to effectively participate in tasks involving organization, planning, and remembering.

One adult with ADHD describes it as feeling like so:

“I’m almost sleepwalking. Hours can pass in this unfocused state…I can combat it consciously for a few minutes, but the moment I get into anything, the moment I stop monitoring what I’m doing and get into the flow of the work, then I’m at the mercy of my whims. If I could stay focused for just one hour, I could probably get my whole day’s work done” [6, p. 191].

Simply put, ADHD is exhausting.

Subtypes and Comorbidities:

The DSM-5* lists diagnostic criteria for 2 types of ADHD [2]:

1. Inattention and 2. Hyperactivity/ Impulsivity

While the DSM page for ADHD could appear to be a simple list of criteria for the disorder, it is actually incredibly difficult to appropriately diagnose ADHD without consulting a professional who specializes in the disorder using a series of interviews and testing.

Further, there is a wide range of presentations of ADHD—many more than just the stereotypical image of an energetic, school-aged little boy that tends to come to mind when most of us think of ADHD.

One of the most helpful therapeutic resources on the presentations of ADHD is the book Driven to Distraction [6], which breaks down these two diagnostic subsets into 10 different presentations, which the authors title, “Parts of the Elephant.”

It is not lost on me that for a book about inattentiveness, Driven to Distraction is a particularly lengthy one. If you or someone you love struggles with what you believe to be ADHD but you are not ready to commit to reading an entire 355 pages, I would highly suggest a commitment to reading just this one chapter: “Parts of the Elephant.”

One of the reasons this chapter is so important in the understanding of ADHD (or ADD, as the book calls it, which is a previous name for the disorder), is because many people might recognize an accompanying mood disorder prior to recognizing their struggles with inattention.

An adult or child may be entering counseling with obvious depression, anxiety, or other concern, without obvious recognition to the relationship this disorder has with their ADHD. For therapists, it is vital that we recognize these dynamics at play in a person’s presenting symptoms. For parents, being aware of the potential comorbidities that children can exhibit is especially helpful as well.

According to the updated CDC information on ADHD from September 2021, 64% of children with ADHD also qualify for another mental, emotional, or behavioral disorder [4]. It has been reported that more than 80% of adults with ADHD have at least one other disorder [4].

Some of these disorders, most specifically anxiety, can actually present very similarly to ADHD in many children and adults, which is why as professionals we stress the importance of seeking specific consultation when considering an ADHD diagnosis for your child or self. While ADHD and anxiety may present similarly, the treatments are vastly different, and misdiagnosis can exacerbate symptoms for someone suffering with either disorder.

The difference between ADHD and anxiety ultimately comes down to whether or not the individual is not focused because of fearful, apprehensive thoughts, or is not focused because of being easily distracted even though their mind is calm” [8].

Simply observing someone’s inattentiveness does not answer important questions regarding why a person is inattentive.

Another reason that chapter 6 of Driven to Distraction is important is because ADHD looks so much differently across these subtypes. Historically, females can often go undiagnosed because they may not be “bouncing off the walls” like their male counterparts [6,1,3,11]. Or, adults who have learned to cope with ADHD with substance use or maladaptive relationship patterns may not realize the origin of these issues in their lives that seem all-encompassing and overwhelming. Working with a professional who is trained to recognize and walk through self-exploration with a client is vital.

Seeking diagnosis:

There are several benefits to having a formal diagnosis for ADHD. For children and college students, a diagnosis can help a student receive much-needed accommodations and support from school staff and teachers. Further, medication management can be more appropriately determined.

The problem with obtaining an ADHD diagnosis, however, is that the “boundaries” are “fuzzy,” often resulting in misdiagnoses from well-meaning family doctors or primary physicians [3]. Karen Barrow, writer for ADDitude magazine, reminds parents to avoid “pressuring” doctors for a diagnosis, but instead seek a formal diagnosis from an ADHD professional who will administer a battery of tests (normed rating scales), and complete interviews with you, your child, and your child’s teachers, to provide a full overview and determination of the presenting diagnosis [3].

As mentioned previously, the reason this is so imperative is to make sure that the correct thing Is being treated. Simply answering a questionnaire about symptoms is not an appropriate avenue for diagnosis.

Families who pressure doctors for diagnoses may seem like they are seeking a quick way to receive school accommodations on the front end, but can actually lead to a series of harmful interventions for the child in the long run.

For parents unsure where to begin in finding an ADHD professional, a good place to start is with the school psychologist or other school professional that can either administer testing or refer families out to a community resource.

An accurate ADHD diagnosis is incredibly beneficial for the success of an individual who is struggling, but a misdiagnosis can lead to detrimental treatment for years to come.

Pseudo-ADHD

While ADHD is in fact a legitimate, formidable disorder for the individuals who suffer, over-diagnosis and misdiagnosis is still a concern due to generalization and stereotyping of the disorder. As well, we have the make-up of our ever-evolving, constantly-preoccupied and fast-service culture to thank for blurring the lines between normal presentations of inattention versus diagnosable ADHD.

It becomes increasingly difficult to recognize what symptoms are deviant to the norm of typical American distractedness. All of us could report struggles to concentrate at some point,

especially with the onset of technology that makes information, communication, and notifications a constant aspect of our lives.

However, this does not mean that ADHD is simply a normal marker of American society. Driven to Distraction states that,

“While pseudo-AD[H]D may be interesting as a kind of metaphor for American culture, the true syndrome is no metaphor. It is a real, and sometimes crippling, biologically based condition that requires careful diagnosis and equally careful treatment”

[6, p. 240]

Please hear me out on this. If you or your child might struggle with ADHD, do your due diligence. Seek professional help outside of your primary care doctor, and know that there are therapists, psychiatrists, and psychologists alike that care about helping you determine your specific needs for treatment. And most importantly, know that you are not alone.

5 Quick Resources for adults and parents of children with ADHD

  • Understand the history of the ADHD diagnosis:

https://daily.jstor.org/adhd-the-history-of-a-diagnosis/

https://www.healthline.com/health/adhd/history

  • Subscribe to the ADDItude email newsletter

https://www.additudemag.com/adhd-newsletters/

  • Learn about CHADD; contact your local chapter for support groups, information, and up-and-coming-research

https://chadd.org/

  • Familiarize yourself with the educational rights in your state for those with ADHD

https://chadd.org/for-parents/overview/

  • Identify your (or your child’s strengths) and cultivate those with pride

**At the writing of this article, the DSM-V-TR was being released, which is an updated version of the 2013 DSM-V and could have slightly different information and page numbers than discussed here

References:

  1. ADHD quick facts about ADHD – chadd. (2020). Retrieved May 11, 2022, from https://chadd.org/wp-content/uploads/2020/04/About-ADHD-ADHD_QF.pdf
  2. American Psychiatric Association. (2017). In Diagnostic and statistical manual of mental disorders: DSM-5 (pp. 59–66). essay.
  3. Barrow, K. (2022, February 9). Why ADHD is a “fuzzy diagnosis”. ADDitude. Retrieved May 11, 2022, from https://www.additudemag.com/adhd-diagnosis-problems-adult/?utm_source=eletter&utm_medium=email&utm_campaign=treatment_may_2022&utm_content=050522&goal=0_d9446392d6-ad03536a37-310204358
  4. Centers for Disease Control and Prevention. (2021, September 23). Data and statistics about ADHD. Centers for Disease Control and Prevention. Retrieved May 11, 2022, from https://www.cdc.gov/ncbddd/adhd/data.html
  5. Faraone, S. V., Sergeant, J., Gillberg, C., & Biederman, J. (2003, June). The worldwide prevalence of ADHD: Is it an American condition? World psychiatry: official journal of the World Psychiatric Association (WPA). Retrieved May 12, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525089/
  6. Hallowell, E. M., & Ratey, J. J. (2011). Parts of the Elephant. In Driven to distraction: Recognizing and coping with attention deficit disorder from childhood through adulthood (pp. 187–240). essay, Anchor Books.
  7. Holland, K. (2021, October 28). The history of ADHD. Healthline. Retrieved May 9, 2022, from https://www.healthline.com/health/adhd/history
  8. Is it ADHD or anxiety? ADHD vs. Anxiety – What’s the Difference Between ADHD & Anxiety? | Drake Institute. (n.d.). Retrieved May 11, 2022, from https://www.drakeinstitute.com/adhd-vs-anxiety-whats-the-difference
  9. Parenting a child with ADHD. CHADD. (2021, June 24). Retrieved May 11, 2022, from https://chadd.org/for-parents/overview/
  10. Romeo, J. (2021, July 20). ADHD: The history of a diagnosis – JSTOR DAILY. JSTOR Daily. Retrieved May 9, 2022, from https://daily.jstor.org/adhd-the-history-of-a-diagnosis/
  11. Sharon Saline, P. D. (2022, March 23). 5 overlooked signs of ADHD – the inattentive type. ADDitude. Retrieved May 11, 2022, from https://www.additudemag.com/adhd-inattentive-type-5-signs/?utm_source=eletter&utm_medium=email&utm_campaign=adult_april_2022&utm_content=041922&goal=0_d9446392d6-e61481cbad-310204358
 Allison Hurst, MS, NCC, LPC

Author Allison Hurst, MS, NCC, LPC

More posts by Allison Hurst, MS, NCC, LPC

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