Attention Deficit Hyperactivity Disorder (ADHD)

Amanda Richardson, DNP, PMHNP-BC

ADHD is a brain-based disorder that is NOT caused by bad parenting, too much sugar, or too much screen time. ADHD is a confusing, frustrating, inconsistent, and at times contradictory condition. Below are some of the ways that these brains work that is different from a neurotypical brain.

• Pay too much attention to everything, unable to focus consistently on ONE thing, but usually have 4+ things on their mind.

• Smart and clever but you never know when the “zone” of no executive function deficit will show up. Sometimes you can trigger the zone with triggering interest, challenges, competition, novelty, and urgency.

• Symptoms can come and go throughout the day and are impacted by stress, anxiety, depression, sleep, and amount of stimulation (to name a few)

• Neurotypical people can use the concepts of importance and reward to start and stick with a task, but this does not work for an ADHD brain. We don’t know what motivates and ADHD brain yet.

• Ability to “hyperfocus” or “zone in” on one specific thing for long periods of time to the point of forgetting to take breaks, eat, use the bathroom, and sometimes sleep.

• Experience the word in a more intense and passionate way than a neurotypical brain. It has no way to “turn down” the outside sensory input and life frequently becomes overwhelming due to the high intensity of the outside world.

• Their nervous system is rarely at rest. Instead, it wants to be always engaged in something (internal and/or external), usually it is engaged in 4 or 5 things so nothing gets sustained or done well.

• It also doesn’t understand how to filter out the “unimportant” information that neurotypical brains do. Their worlds are constantly interrupted and disrupted by external stimuli that a neurotypical person is not even aware of.

  • Hyperacusis (amplified hearing) is common.

• Mood and energy levels are impacted by their level of interest or feeling challenged

  • When bored they will look and feel unengaged, lethargic, argumentative, easily irritated, dissatisfied, trapped in the task, and unfocused

  • When engaged they will look and feel happy, engaged, full of energy, and it may be hard to get them to put energy or attention into something other than the task they are engaged in.

• Memory works differently. Information and memories that are “out of sight” are literally “out of mind” for them. They have no reliable way to access information stored in their brain and every ADHD brain stores information differently.

  • "I don’t know” is not always an excuse, they usually have completely forgotten why they have/are/supposed to do something.

  • They struggle with putting things into long term memory and when it has been put in long term memory, they struggle to access it.

  • Their mind is full of the little day to day parts of a task that a neurotypical brain does automatically.

  • The ADHD brain is literally structured differently, and we don’t fully know how it works

• The brain cannot see what is happening “in the moment” which leads to those with ADHD having little self-awareness. This impacts:

  • Social interactions are seen differently. A word mid conversation or sentence can spark a thought for an ADHD person who then interrupts with their thought of what was triggered. This can be seen as not listening or not caring, but it is actually the opposite of what is going on in their brain.

    • They also see sharing stories of what they perceive to be similar experiences as a way of showing how they understand and relate to what the person is saying but many neurotypical people see it as them centering themselves which leads to being perceived as self-centered and not caring.

  • Feedback can be hard because what the person is experiencing does not match up with the feedback they are being given. This leads them to mistrusting their own experiences.

The ADHD brain is confusing to the person who has it, they also don’t know how to work or why it does what it does. It isn’t that they don’t want to get things done, that they don’t want to please you, or that they are lazy. They are just never certain when they are going to be able to engage in activities, which causes them to doubt themselves, not trust their abilities, and have a lot of shame around being unreliable or a “bad” person.

Biggest takeaway: You can’t make a neurodivergent brain into a neurotypical brain. It doesn’t matter how hard or long they try, how many medications they take, or how many skills they use. It is not possible.

References

“Secrets of Your ADHD brain” by William Dodson on Additude link: https://www.additudemag.com/secrets-of-the-adhd-brain/ 

“Face it – People with ADHD are wired Differently” by Oren Mason and Tamara Roiser on Additude website link: https://www.additudemag.com/current-research-on-adhd-breakdown-of-the-adhd-brain/ 

“How adults with ADHD think: Uncomfortable truths about ADHD Nervous System” by William Dodson on Additude website. Link: https://www.additudemag.com/adhd-in-adults-nervous-system/