ADHD boy in classThe Great Value of Children, Adolescents, and Adults with ADHD

People with ADHD deserve a better reputation, whether they are children, adolescents, or adults. With a correct diagnosis and appropriate treatment they become creative, energetic contributors for themselves and to the world around them. Too often, they’re not shown in a good light, probably due to a missed diagnosis or no treatment. A missed diagnosis or no treatment is caused by the adults around them. Children, after all, cannot on their own seek a diagnosis and pursue treatment. People with ADHD can be a great asset to most situations. Typically they’re bright, easy to work with, and prefer to be problem solvers, not problem creators. That said, some individuals with ADHD can be more complicated. More on that below.

Surprise – Many People with ADHD Are Not Overly Active

A cute little girl with long brown hair in a pink dress sits with a book in her hands looking vague as a daydreaming bubble and arrows in many directions float around her.
Photo by khamkhor

What! Now, wait a minute here. Doesn’t ADHD stand for Attention Deficit Hyperactivity Disorder? Well, yes, it does, and that can cause a lot of confusion. Because, it does seem to make sense that a person with ADHD should be overly active. But it’s not always true. It is true that many children and adults with ADHD really are over active. But it’s also true that many are not very active at all. In fact, some don’t move around much. Individuals with ADHD who appear calmer and less active still find it hard to focus their thinking on one thought for very long. In that way, all people with ADHD struggle with focus whether they’re hyperactive or not.

One of our readers in Boulder. Colorado commented:

It’s upsetting to me that the ADD diagnosis was not recognized in girls 37 years ago. It turns out I had it, that is, I have it, the inattentive type. School was hard. I didn’t do well. Dropped out halfway through college and got married. My daughter was recently diagnosed. Daydreaming, scattered, poor in school. Then it was realized that I’ve had it since I was a kid. Now we’re both taking medicine and life is different. I mean, for me, now I have a life for the first time.

Your situation is certainly a good news / bad news story. It’s true that, while we don’t know all the causes of ADHD, it does run in families. There appears to be some genetic basis for ADHD. And, just as you describe, while the ADHD is there in childhood, often people with inattentive ADHD don’t get a good diagnosis until they are adults. As a result, school years are tough. These kids get reprimanded a lot at home and in school for poor attention. As you describe with your daughter, they’re daydreamers. Assignments don’t get finished. Without the hyperactivity no one thinks of ADHD. Your history is also typical in that this is an especial problem for girls who might be more quiet and passive than hyperactive boys. In the classroom the ADHD diagnosis does not jump out at people. Another usual part of your description is that adult women too often are not recognized as having ADHD until one of their children is diagnosed and Mom sees the similarities in her history situation and their child’s situation.

The “Attention Deficit” Part of ADHD

It gets less public discussion than the hyperactive part, but there is this “attention deficit” part. Attention deficit means that the person has trouble focusing their attention for very long. Since they’re not all-over-the-map with activity, these individuals sit quietly, daydreaming, their mind wandering from one thing to another. And that daydreaming is the dilemma. Girls and women are more likely than boys and men to have this calmer type. Remember, we’re trying to get more girls into STEM studies. Clearly this daydreaming rather than focusing creates problems in school in younger years and at work as careers move forward. Because they’re sitting quietly and not disruptive, they don’t come to anyone’s notice. But because they’re daydreaming and not focused, it’s much harder to learn. They can be really smart but not get anything done. That can put STEM (Science, Technology, Engineering, and Math) down the drain.

The Diagnosis of ADHD – It’s How the Brain Is Wired

ADHD is a brain-based condition. It’s not imaginary and not changeable with stern parenting or strict education. It’s how a person’s brain is wired, hard-wired, often for life. Some people with ADHD have the “inattentive” type while others have the “hyperactive/impulsive” type. Inattention means that your mind drifts and allows you to wander off the task in front of you. It’s difficult to pay attention over time to the narrow, limited focus of a job or task.

The Hyperactive Part of ADHD

The “hyperactive/impulsive” type is the ADHD type that most people think of when they think of ADHD. The overly active, or “hyperactive”, means full of energy and continuously on the move, not staying still. Or at least this is the way that the person with ADHD might appear to parents, friends, spouses, and relatives who do not have ADHD. The social situations in which this individual finds himself are mainly a problem if he is restricted and cannot freely move around. If stopped, he/she becomes really uncomfortable. Maybe uncomfortable to the point of being upset and disruptive. In the classroom or in a business meeting these individuals talk out of turn. Children “fidget” even when they’re asked to sit still. If he cannot move much he might start tapping his fingers or the toes of his shoes. Anything that helps “get the wiggles out.” They’re restless. Continuously.

Young boy about six years old perched on a Speedee brand bright green all-terrain quad bike with a blank background, perhaps in a studio. He's looking excited and confident, hands on the handlebars and making motor revving sounds while a friend that's his age looks on. On his knitted cap it says, "Be Cool".
Photo by White77

The Impulsive Part of ADHD

The impulsive part of ADHD might be funny if it didn’t so often lead to dilemmas. The quick action of people with ADHD means that at times these individuals’ bodies move and act before the executive circuits of their brain have even thought about it. The problem with this situation can be shown using the old military target practice firing sequence of shooting a weapon at a target: ready, aim, fire. The impulsive person with ADHD might shoot the weapon before any thought takes place, then he thinks about it and gets ready and aims. One can see the risk. The front yard summersault can start and complete before the child thinks about the mud puddle just ahead. Another aspect of this is interrupting others when they are talking. Or bursting into a social group uninvited. And making snap decisions, even important ones with long-term consequences, without much thought.

A little boy in blue jeans, athletic shoes, and a red sweatshirt is at a fork in the path in a tall hedge maze.
Photo by Arek Socha

As These 3 Parts of ADHD Sort Out Among Individuals…

As we sort these 3 parts of ADHD among the people who have ADHD, it gives us 3 types:

  • A combined inattentive and hyperactivity-impulsivity type
  • A mostly inattentive type
  • A mostly hyperactive-impulsive type

ADHD Remains a Medical Puzzle

Though all the doctors doing research on ADHD think they’re moving closer to what it really is and what causes it, for now it remains a puzzle. And because no one has nailed down the true cause, everyone thinking about it comes up with a “laundry list” of causes. Some are experts and some are not. Those who believe in one or another cause come up with the reasons why they think their view is the correct one.

Here are a few examples

  • maybe a family history and inherited genes cause ADHD
  • or, a mother’s cigarette smoking, alcohol use, or drug use during pregnancy
  • maybe a mother’s exposure to harmful environmental toxins during pregnancy
  • perhaps direct toxic exposure of the person with ADHD, like high lead levels at a young age
  • or low birth weight
  • maybe brain injury during birth or while growing up

Then Reality Steps In… Complex ADHD Situations

The ADHD described at the start of this page is just typical, garden-variety, uncomplicated ADHD. And those who have usual ADHD are lucky. In the larger real world the medical condition of ADHD can get complicated. Along with ADHD children can have learning disabilities, anxiety disorders, conduct problems, depressed mood states, and the poor judgement to use harmful drugs and/or alcohol. Mix any one, or two, or three of these situations with ADHD and the result is a person who really struggles in life. A good doctor who believes in the person with a complicated ADHD situation can be a powerful support to assist the child, adolescent, or adult to work through everything and come out more of a winner.

ADHD Treatment

There’s more complete information on treating ADHD on our main page on ADHD Treatment.

Here’s A Brief Overview of Treating ADHD

To put it right out in front, a person with moderate-to-severe ADHD needs a medication. There’s no way around it. Many people hope to avoid using medications, which is sort of understandable. Then there is a set of people against medication for ADHD who do their best to make it sound bad. In a negative tone of voice they refer to ADHD medications as drugs or pills. If these people felt the same about insulin for type-1 diabetes many people with type-1 diabetes would be dead. Parents often try to avoid using a medication for their children, which is, again, understandable. But skipping a needed medication makes things worse, both in the short term and life-long. It might be that a person with mild ADHD could work it out, make it through life and not use a medication, and still win. But even so, why? Why, on purpose, spend a life working hard to get to 80% when one can work much less hard and make it to 95%?

Here’s Why People Need Medication for ADHD

In the old days of black-and-white television shows of the 1950s there was a popular series, The Adventures of Robin Hood. A guy in Robin Hood’s gang was Little John, a large, strong, muscle-man. In one episode, Little John (played by Archie Duncan) is carrying a big wooden box. As they walk through Nottingham Forest, he struggles more and more to carry it. Finally, he can’t keep going. He can’t understand why he has this “weakness” because the box is not that big and he can carry just about anything of any weight. He’s the “Lou Ferrigno”, the “Arnold Schwarzenegger”, of Robin Hood’s band of thieves.

Why Little John Feels Weak; Mystery Solved

Little John decides that there must be some wicked black magic, a curse on the box, that’s making him weak. But when they open the box, he finds that it holds a stone block used for minting the King’s gold coins. That’s why he couldn’t keep carrying it. It was one huge piece of solid rock. The point of the story is this. Anyone can put a 10-pound backpack on their back and hike all day. But put on a 150-pound backpack and most of us would collapse in a few steps. Without medication, you’re asking a person with ADHD to carry around a 75-pound backpack all the time, for life. They are going to struggle and at times fall. With medication, that backpack shrinks to 10-pounds like the rest of us can carry.

Here’s What Medication Does for ADHD

The medications are supposed to lessen the over activity, lessen the impulsive actions, increase the individual’s ability to focus, and improve how long the person can stay focused. If all this works they do better in school, earn more money and get more promotions at work, and are more fun and happier at home with family.

Choosing Which Medication for ADHD

The Stimulants

Methylphenidate, the amphetamines, and other “stimulant” medications work best for most people with ADHD. While they are stimulants for people who don’t have ADHD they’re calming if you do have ADHD. It’s the way the ADHD brain works. At the right dose, these medications help the brain’s executive circuits. The person can think more clearly and keep everything under better control. These medications also turn down the volume knob on the brain circuits that push for endless on-the-go activity and change the brain’s circuit activity so the person is less impulsive. With a good physician following along, for most people these medications are safe to use.

A Reader In New Zealand Wrote…  No Amphetamines There!

A reader in New Zealand wrote to say that they are not allowed to use any amphetamine medications, not even to treat ADHD. They can get methylphenidate medications, like Ritalin, Ritalin LA, and Concerta for ADHD. But they can’t get amphetamines like Dexedrine, Adderall, Adderall XR, or Vyvanse. This isn’t good for some people with ADHD. While most people with ADHD do well with methylphenidate, some children, adolescents, and adults instead need one of the amphetamines.

Non-Stimulant Medications

There are other medications that sometimes work when the stimulants don’t work or when they cause problem side effects. These medications are not stimulants. These non-stimulants take a few weeks to start working. The stimulants start working right away, within a day or two.  See the page on ADHD Treatment for more information about the non-stimulants.

A Person with ADHD Needs More Than Just a Tablet or Capsule

Let Us Show What We Mean by Talking About Diabetes

Take Type I diabetes, for example, the type that requires insulin injections. If a teenager gets Type I diabetes, how well would he do if you gave him one of the little bottles of insulin and a syringe with a needle and said, “There you are,” and sent him home. No instructions. No explanations. We can say for sure, he would not do well. He wouldn’t know how to do it. That’s why there are so many huge medical clinics set up everywhere for diabetes education.

Young blond girl about 10 years old looking studious and sitting at a kitchen table with bananas and peaches in a tray in the foreground. She's looking at a laptop computer and has books beside her on the table.
Photo by Markus Trier (Follow Muscat_Coach on Facebook)

Educating Someone About Their ADHD

Like the diabetes example above, just tossing a medication at a person who needs it for ADHD doesn’t help. Someone with ADHD needs to learn all about this brain-based medical condition. The education and support might come in the form of “therapy”. The combination of the right medication and best-fit therapy is the most powerful way to lessen ADHD. There are many types of therapy. There’s behavior therapy and interpersonal therapy. Family therapy or marital therapy (for parents or for adults) might be helpful. Training on specific skills or situations (stress management, test taking in school, dating relationships) might make success in life more likely. Another helpful set of skills one can learn is parenting skills training. Raising a child with ADHD, while rewarding in the long run, is a fast-moving challenge day-to-day. There’s more information about therapies for ADHD on the ADHD Treatment page.

Did You Know That…  Astronaut Scott Kelly has ADHD?

Astronaut Kelly has been on the lecture circuit. As part of his talk he says that he has ADHD. He described it at the Marin Speaker Series in February 2018 (San Rafael, Marin County, California). He said that he was a child before ADHD was considered as a diagnosis for problems in school, but he feels certain that if he were a child today he would be diagnosed as having ADHD.

Scott Kelly’s Santa Barbara Independent Interview

Astronaut Kelly also discussed his ADHD in an interview with the Santa Barbara Independent, a news, arts, and alternative newspaper published every Thursday in Santa Barbara (California). He said that, as a child, every year he promised himself that he would pay attention in class and finish his homework. It never happened. He could not get it done. Then he was inspired by the book about astronauts, The Right Stuff, and used this as his motivation to learn new habits of study, school, and work to become an astronaut. He succeeded, of course, and, among other achievements, spent a year on the International Space Station.

Helpful links:

Attention Deficit/Hyperactivity Disorder – National Institute of Mental Health

Attention Deficit/Hyperactivity Disorder – Center for Disease Control and Prevention (CDC)

Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD)

Attention Deficit/Hyperactivity Disorder in Children – The Mayo Clinic

What is ADHD? – American Psychiatric Association

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