I have seen a lot of things change in the almost 35 years since I was diagnosed with ADHD. Almost all of them have been for the better. There was a lot of, “I don’t believe in that, that’s not a real thing.” When I was younger. Seriously, people would have no problem telling me that to my face when I was like 13 years old. I think this is one of the reasons that I so strongly identify with lgbtq+ folks. Despite growing up white, suburban, and reasonably privileged, I was pretty consistently and fundamentally told, “No, you’re wrong. You’re not actually right about what your experiencing. I know better than you. As a matter of fact, in fourth grade, one of the two teachers had a master’s in special Ed. So they gave her all the kids with adhd. The first week of school in an IEP meeting she told my parents she didn’t believe in it. That was one of the worst years of my life.
I still get a lot of, “I think we all have a little bit of that.” And this is progress. But it’s kind of sinister in its own way. It’s really a way of unpathologizing a legitimate medical issue to a matter of severity of something normal that everybody deals with. That would be like if you told someone you were clinically depressed and their response was, I know everybody gets depressed sometimes. No. Everybody doesn’t get clinically depressed sometimes. Everybody gets sad sometimes. Everybody gets anxious sometimes. Everybody has a hard time being in charge of their attention sometimes. But that doesn’t mean they have clinical depression, generalized anxiety disorder, or adhd. There are clinical standards for these particular psychopathologies. When we don’t distinguish them from everyday feelings we do everyone a disservice.
the irony is, we’re much better at noticing things on a grander scale. Most people don’t have hallucinations or delusions. As a result, I’ve never heard anyone say, I think we’re all a little schizophrenic. Even with autism spectrum disorder, particularly as it manifests in men and boys, the symptomology is usually a typical enough that it’s easy to say it’s not a variation within the normal range. This is particularly true with less mild occurrences. I don’t think anybody thought rain Man was just really good at math.
so fundamentally how do we get people to understand what it’s like to grow up, develop, live, and try to function in this world without having control of your attention from moment to moment? Furthermore, I have been arguing for years, that we really need to expand our idea of what attention is. It’s not just sitting through a lecture in high school. It’s being able to do the tedious, repetitive, boring thing. It’s the ability to initiate. It’s the ability to do the non-preferred activity. It’s the ability to follow through. It’s the ability to manage complex tasks. There’s some disagreement as to whether or not executive dysfunction is an inherent component of ADHD, a sometimes symptom, or should be a separate diagnosable comorbidity. But most people with ADHD I know have some level of executive dysfunction, whether or not they compensate for it well or not. So add that on top of the attention stuff.
oh, and while we’re at it, at least 80% of ADHD people have one comorbidity. The two most common are depression and anxiety. The symptom sets overlap a lot with ADHD and can be difficult to tease apart. Depressed, anxious, inattentive? That’s the trifecta!
but, you’ve only been inside you. How do you know you’re not normal? How do you know your neurodivergent? This is especially a good question if you’re not so super ADHD like me that you hit your functional wall in second grade. But society is just getting faster and more overwhelming. And there’s more of an emphasis on taking care of our mental health. So I think diagnosis of ADHD is going to increase consistently for a while longer before it levels out. Not to mention it’s genetic and highly heritable. So there is a possibility that it’s actually increasing in our population. I think it’ll be quite some time before we have the statistical models to even begin to figure that out.
so over the last 35 years we’ve made progress in how we talk about adhd. We’ve made a little progress in how we think about adhd. We’ve made a lot of progress in how we treat adhd. But we need to do more. As with every medical condition, we need to try to help everybody who needs help. One of my favorite things that my late doctor, Dr biederman ever said to me was, “Matt, in medicine, we don’t only treat the worst cases.” This is very much a battle for the quality of life for tens of millions of Americans and their families. We can do better and we have to do better.