Beneath the Surface of ADHD, Part 2: A Closer Look at ADHD in Daily Life

Finish this sentence: ADHD is _____. I bet there are a lot of words you may have thought of inputting there. The word we’ll continue to explore throughout this blog is “complex.” In this part of the series, we're taking a closer look at both "typical" and “atypical” ADHD presentations, the latter of which you may soon realize is far more typical than people realize. This includes looking at the basic or “classic” symptoms, and diving into the lesser discussed ways in which ADHD appears in daily life. If you read the first post to this series, we introduced a variety of subtopics that we’ll discuss in depth over the blog series. We hope that one of the clear takeaways was that there is more nuance regarding how ADHD can impact a person than we may typically think. Again, complex.

When you look at the diagnostic criteria for ADHD, it’s a TON to digest. If you believe you may have ADHD (despite Google’s vast resources) it is not a place for self-diagnosis, and we recommend working with a mental health clinician to learn more. To share insight about what a mental health clinician is looking for in comparing ADHD diagnoses versus other possibilities, here are some notes:

· Diagnostic criteria are essential to warrant a diagnosis, and this must be done through using a clinical provider and/or an assessment.

· The three types of ADHD are “predominantly inattentive,” “predominantly hyperactive-impulsive,” and “combined.”

When we think of inattention, we think of everyday things like: Missing punctuation in emails or running a red light; forgetting an umbrella on a rainy day unless it’s leaning up against the door; instead of looking at your computer screen, looking out the window behind your screen at squirrels running through a tree; remembering at 3:10 you have a 3:00 meeting; unloading the dishwasher to load dirty dishes, but instead of loading the dirty dishes going to fold laundry instead. A person might have a running loop of tasks in their mind that doesn’t get finished on time or finished at all unless they have successful ways to create structure.

Next, let's lean into the overactive behavior that goes alongside the running treadmill of your mind. When we think of hyperactivity or impulsivity, we think of everyday things like: Being asked to stop tapping our pen in a meeting when we don’t even realize it’s happening; talking out of turn; cutting the line; being so engrossed in something you’re passionate about that you completely lose track of time; getting up and walking out in the middle of a conversation while the other person is still speaking because you’re interested in something else. As you’re reading this notice if you’re thinking about times you may have done that. Maybe your mind went to your child, partner, co-worker, or best friend? We can all think of someone who may do these things, and now hopefully we can pause, take a breath, and have better awareness that some things are not intentionally happening to frustrate others.

Lastly, we have combined type which means, well, a combination of both. Trying to “pay attention” while it feels impossible to sit still. Imagine a dog having the zoomies, running around trying to figure out which surface it wants to jump on next, to then trip and fall as it gets distracted by a toy it’s running by, to then get up and run into the next room. The brain is overworking, our bodies try to keep up, and often we lose sight of the task at hand. This can be mentally and emotionally exhausting.

I imagine we all can relate to one – or many – of those things happening to us, or being done by us, in daily life. And maybe we can relate to those examples evolving over the course of our life - forgetting that umbrella on a rainy day used to be forgetting our backpack on the way to school as a kid.

So, while we can all probably relate, there is one more caveat to explore:

· Symptoms must begin before age 12, be impactful over time (i.e. 6+ months) and pervasive in life (i.e. across multiple settings in daily life). And these symptoms can’t be better explained by another mental health issue.

These are important factors to consider. If you remember from the introductory post in this series roughly 60% of all children have a co-occurring mental health disorder along with ADHD and many adults suffer from co-occurring disorders as well.

In some cases, it’s like considering what began occurring first, the chicken or the egg.

These comorbidities are mental health struggles that make ADHD even harder to diagnose.

In working with individuals seeking to learn if they have ADHD, it’s very common to hear “I looked on the internet and found all these symptoms that explain many of the difficulties I have in daily life. I have ADHD.” Look at this table (Houghton University, n.d.):

Attention	Hyperactivity	Managing Emotions	Daily Life	"Risky" Behavior
Trouble getting started	Simultaneous projects	Mood swings and/or very strong emotions	Difficulty balancing check book	Greater than average number of driving violations
Procrastination	Intolerance of boredom	Worry needlessly	Creative, intelligent	Impulsive (e.g. spending, life choices/decisions)
Trouble with follow through	Frequent search for high stimulation	Problems with self-esteem	Sense of insecurity	Addictive behavior
Impatient	Speaking your mind	Sense of underachievement	Inaccurate self-observation	Trouble following procedure or rules

What do you notice?

While there are a few items on this list that closely track with some of the examples listed earlier in this post, many have a different flair to them; they may be consequences of or related to symptoms on the list, and more specifically describe how people tangibly experience having ADHD. We see a spectrum of traits – not necessarily black and white – that people experience. This list does not mention some of the advantageous qualities often seen in individuals with ADHD such as warmth, generosity, passion, sense of humor, or unique perspectives or approaches taken to solve problems.

Dr. Ned Hallowell and Dr. John Ratey are psychiatrists who have focused their careers on researching and working with individuals that have ADHD and they created an ADD Screening Scale – the chart above was adapted from their scale – which they use when considering the “other” symptoms that occur with ADHD in adulthood. In relation to the many individuals who search the internet and based on anecdotes closely connected with having ADHD; these doctors are describing what their clients are truly experiencing. Throw in the fact that ADD/ADHD is an extremely heritable trait and family history matters, it can be difficult to determine the origin of these behaviors when someone so strongly resonates with these symptoms. Again, the chicken or the egg.

For those searching for a diagnosis and explanation for their behaviors, in many cases it’s very possible what they experience is either due to a different mental health difficulty or that they may be sub clinical. This means the symptoms exist, but do not fully meet those initial criteria needed to make a formal ADHD diagnosis. This can often be frustrating and feel invalidating because, in short, it’s not to say what they are experiencing isn’t true, it’s to say it can be complex in figuring out why. For example, one thing I experience a lot when working with clients is a sense of relief when I can help them break down how they think and make meaning of what they are doing, which supports learning how to do things differently and more effectively. Sometimes it is not necessarily the diagnosis that relieves the stress but knowing that there’s not something “wrong” with them. In addition, learning that an ADHD brain works uniquely can be freeing.

Here at TOPPS we take an individual approach to assist in understanding our client's needs, helping build structure and an environment so one can excel. We hope that from this post the foundation for understanding the nuances of ADHD is a bit clearer. With this foundation we can go forward and explore more about how to manage these nuances and difficulties, as well as utilizing the strengths, in supporting ourselves and loved ones. If you want to learn more about ADHD assessment, treatment, or learn how to perform your best, please contact us. We are curious to know what you may want us to write about, so reach out! TOPPS is here to serve the greater community of Austin.

References:

American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 5th edition. Arlington, VA., American Psychiatric Association, 2013.