A friend of mine was recently diagnosed with adhd and I’m having a hard time understanding how it works, being a child of the 80s/90s it was always just explained in a very simplified manner and as just kind of an auxiliary problem. Thank you in advance.
In: Biology
The easiest way to think of it is the inability to focus on tasks. In children, it often comes across as hyperactivity (not being able to sit in one place). But in adults, its more just being unable to work on stuff that needs to get done. ADHD adults struggle with things like work, school, chores etc which require focus with little to no immediate reward. In contrast adult ADHD sufferers prefer quick, easy tasks that give them that instant gratification dopamine hit. Its also very common for them to have extreme sensitivity to rejection. They think everyone hates them, which leads to low self esteem and depression.
Have some friends who have ADHD as adults and long story short the only thing that helped them in the end was medication. It doesn’t seem to be something that can be tackled long term with just cognitive therapy.
Imagine two college students: Student A and Student B.
Student A is currently working their way through school. A lot of their time is spent at their minimum wage job since rent and tuition are expensive.
Student B on the other has a trust fund from a grandparent which pays out based on how many units they’re taking. They still work a part time job a few hours each weekend, but it’s at their family friends business where they’re getting paid under the table above minimum wage.
Student A has to work in order to go to school. And at minimum wage they have to work a lot of days and a lot of hours just to be able to attend class. Maybe they don’t even take a full load each semester because they just don’t have the time or money. Maybe some weeks they just have to skip a class all together.
Student B doesn’t have to worry about that. They get paid when they attend school. When they *do* work, they make well above minimum wage, so even if something happens with the trust fund payout during enrollment they’re set; they have money saved up. Also, if they have midterms or finals coming up they can just take time off from work.
In this analogy Student A would be the brain of a person with ADHD and Student B would be a neurotypical brain.
The “money” in this analogy would be neurotransmitters like dopamine, norepinephrine, serotonin. “Work” would be some fun or interesting activity/task, and “school” would be some task you *have* to do.
Now, as to the why. Basically those neurotransmitters play a part in making sure animals do things they’re supposed to do in order to survive like eat, sleep, and have sex.
Since humans are still animals the neurotransmitters do that for us too. But they also play a part in making us do things that, while not necessary for our survival, play a part in making us more successful humans. Things like finishing homework, doing a project for work, or even doing the dishes or taking out the trash.
People with ADHD usually will get less of these neurotransmitters for performing a task, or will get none of them at all for some tasks. So often, in order to complete these neurotransmitter-negative tasks they will have to complete neurotransmitter-positive tasks either prior to or simultaneously.
That’s where the attention deficit and hyperactivity come into play. The task that’s not holding their attention is not providing any dopamine and/or the surplus from their previous task has run out. So they have to (sometimes constantly) search for a new task to provide that dopamine/neurotransmitter.
Taking medicine makes the brain create more of these neurotransmitters so our brain is okay with us doing tasks that aren’t immediately or inherently gratifying.
Taking Ritalin or Adderal for Student A in this analogy would be the equivalent of getting a full ride scholarship. Now, Student A doesn’t have to work and make money anymore in order to go to school. They have all the money they need so they can just focus on school.
Now, that ELI5 takes a lot of liberties and has a lot of inaccuracies for a number of reasons, but it’s the general gist.
The best way I’ve heard it explained is “A chronic inability to maintain intention over time.”
When explaining it to people I tell them that I have no follow-through. Which is the worst problem to have because how do you fix that? Make a plan? Then what? It always gets a laugh when I say it, but the laugh belies the fact that I feel like I’m trapped inside my own life watching as it just *does* things (some good things, some bad things) with no real ability to do anything about it.
You ever watch Star Trek? And sometimes the computer would have an issue and Picard would say “Run a self-diagnostic”? When I was a kid I used to think, “But what if the part of the computer that runs the diagnostic is the part that’s broken?” That’s me. The part of my brain that I need to solve the problem is the part of my brain that HAS the problem. If I was capable of enacting a plan to solve the problem, I wouldn’t need the plan in the first place.
It’s like telling a paralyzed person that the solution to their problem is to walk more.
It doesn’t help that as an adult you have a lot more responsibilities and many times a schedule you have to adhere to. Staying on task and finishing basic chores can really be difficult. The biggest takeaway I learned with ADHD is that *edit: due to a lack of neurotransmitters* your brain is always looking for stimulus, that’s why ADHD people are prescribed stimulants *edit: because they affect neurotransmitter function*. (Edit: For a more in depth explanation of medication see the edit below my example.)
Example:
I need to empty the dishwasher. Puts away a stack of bowls and silverware. Notices the kid’s tablets aren’t plugged in. Plugs them in. Speaking of the kids, they are going to want a snack in a few. Grabs 2 plates from the dishwasher and starts prepping snack. Wait, I need to finish the dishes, the kids aren’t asking for food yet so that can wait. Starts putting away cups. I need to use the bathroom. Replaces TP with last roll from pack. Goes out to garage to grab a new pack. Notice I forgot to put away a few tools from yesterday. Puts tools away. Why did I come out here? I know there was a reason before I saw the tools. Shrug. It’ll come to me later. Go back inside. See half made kid snack. Finish making snack. “Kids! Snack is ready!” Sit down with kids. Chit chat, eat a snack. Puts dirty dishes in sink. Oh yeah, I need to finish the dishes. Finishes emptying dishwasher. Oh that’s right! I went into the garage to grab a new pack of TP. Grabs new pack and puts in bathroom. What should’ve taken 10 minutes to both empty and fill the dishwasher has taken an hour and the sink is still full of dirty dishes.
Edit: some of you have pointed out my over simplification of medication above. Here is a more in-depth look.
Generally, it’s a 2-fold problem. The reason your brain seeks the extra stimulation and is easily distractable is because of the lack of neurotransmitters in your synaptic pathways, specifically dopamine and to a lesser extent norepinephrine. Certain functions, including attention, are affected by the lack of binding neurotransmitters. Your brain may be “seeking out” stimulation in order to stimulate the release of more neurotransmitters but is also easily distracted due to the impacts of low neurotransmitter binding. This may be because you are either not producing enough dopamine and/or the neurons are reuptaking it before it is able to bind to the receptors. (This is an example of why many ADHD people can play video games for hours, they’re stimulating the extra release which in turn allows them to focus.) Stimulant medication either floods your brain with neurotransmitters or slows down the reabsorption. Either way this allows for the dopamine to remain in the synapse longer to allow for receptor binding. This helps people with ADHD in 2 ways: your brain now seeks less stimulation to release said neurotransmitters and it is now able to function more “normally” (what is “normal” anyway…) as influenced by neurotransmitter function in the brain. ADHD medication simply helps to regulate how neurotransmitters are absorbed in the brain which can mitigate certain symptoms. They do not restore missing executive functions but rather increase the effectiveness of messaging pathways affected by these neurotransmitters. You can still be distracted and unfocused even with medication. All that being said, medication is not for everyone.
This is great to hear everyone talk about it. It’s nice to see that it’s not “just me” and I’m not a total failure because of this.
My business partner had to take some time to learn about adhd to understand how to work with me, and stop being on my case all the time about me switching between projects
Edit: spelling
I’ve noticed when I don’t take my meds I’m extremely unmotivated, will take naps, and I have a lot of trouble following conversations. I’d say the biggest impact is on work ethic and communication, which is huge.
It’s a constant state of want. Those with ADHD lack stimulation, so the brain puts a priority on finding it.
It’s like hunger. When the body lacks nutritian, it _demands_ that you find food and eat it. All you can think about is finding and eating food.
With ADHD, it’s stimulation you’re lacking, so the brain switches gears and demands that you find it. That’s where the concentration problems come into play – a lot of tasks don’t offer stimulation, so the brain forces you to look for it elsewhere.
It’s basically clinical boredom.
I’m currently trying to get an ADHD diagnosis as an adult, which is tough. I’m 36.
For me, everything in life is like that puzzle where you have a chicken and a fox and a bag of corn, and you have to cross a river but you can only fit one of them in the rowboat at a time. You can’t leave the fox with the chicken or the chicken with the corn.
So let’s say it’s my day off and I want to get up, work out, have some breakfast, shower. I have to go to the store for breakfast. But I don’t want to go to the store without having showered, so I should work out first. Then shower. Except studies show that you should get protein in right after a workout, so I need to go to the store to buy food. But I’ll need to shower. And there’s no point showering BEFORE I work out. But I’ll need food. I read it in a magazine. Which magazine was it? I need to find that magazine, it had some good workouts…
Three hours later and I’m in the attic reading old X-Men comics I found whilst initially looking for the magazine. I have not exercised or showered and I am hungry, but I also need to Google this “Count Dante” guy who used to advertise in comics.
So I have to put the chicken in the row boat first. Then the fox. Then, wait, why did we even bring a fox? And couldn’t we buy corn on the other side of the river? I should shower…
I work at a high school in a position that is more or less a combination of teacher and counselor roles. I have ADHD, 27, and have a lot of students that I work closely with on executive functioning and academic coaching. Diagnosed in 1st grade, medicated 1st- 8th then from college to now. Pretty much researching my whole life on it, and am involved in a lot of intense intervention work with ADHD students. This is going to be long, but I promise it’s worth your while.
Positive factors that affect myself and adults with ADHD:
It would help to know your friends age and background, but if he’s generally successful despite being undiagnosed his whole life, he’s developed behaviors to cope that have helped him succeed despite some of the difficulties. ADHD has given me a lot of positive things that actually have given me my success. These are the general positives, but they’re a double edged sword to the negatives. It’s all in how it’s approached by the person and their support systems.
– Hyperfocus: people with ADHD can put an incredible amount of concentration and effort into things that interest them. When used correctly, it’s an insanely powerful tool. I owe my job today to writing a rap song about metaphors and similes in my college teaching course due to hyperfocus on the task.
– Empathy: ADHD individuals tend to feel emotions stronger and are more empathetic than others. People with ADHD can make very strong leaders in fields where genuine empathy is valued as an important skill
– Creativity
– ADHD people tend to be big picture and not detail oriented
Negative factors:
– [Rejection Sensitive Dysphoria[Rejection Sensitive Dysphoria](https://www.google.com/amp/s/www.additudemag.com/rejection-sensitive-dysphoria-and-adhd/amp/)] I’m putting this first because this is the one you don’t hear about, and it’s perhaps the most important for you supporting your friend. TLDR, ADHD peeps take criticism especially hard, and can often break down because of rejection. I haven’t read into it in a while, I believe the figure was 90% of people with ADHD say it’s a factor, and 30% say it’s the most difficult part of having it. Simply knowing this was a part of it and putting a name to it CHANGED MY LIFE, and has made it so much easier to cope with. This is the flip side to the empathy piece. This is a piece that therapy helps with a lot.
– Distraction in general: This is the flip side to the hyperfocus. People with ADHD need stimulus that interests them, or it is much more difficult to maintain attention than an average person. Of course there’s a lot more to it, but perhaps the biggest aspect procrastination is a case of hyperfocus on the wrong thing for a long time, leading to poor time management. Medication helps this aspect most. The most successful people with ADHD will have the intention and plan to regularly evaluate and take concrete steps to change these habits. Therapy or some kind of other mentor can assist with this, while the medication can bolster that process to make it successful.
Success factors:
– while medication is absolutely the most effective treatment, I disagree with the sentiment that it is necessary for everyone to be successful. My dad went undiagnosed until I did, had a masters degree, and was a high up manager with a team of people under him at Coca Cola. That being said he is currently medicated as I am, and finds it much easier to function properly. Like I said before, if your friend is satisfied with the way he is handling life in terms of work, friends, and family, he probably Hs the coping mechanisms from years of building it up. Ultimately it’s his decision on whether or not it’s the best path for him.
– therapy: while on the topic of coping mechanisms, a lot of times going undiagnosed can lead to bad habits that need to be unlearned. For the HS kids that I’ve seen go undiagnosed until around sophomore year, most common bad habits i see revolve around making excuses for not getting work done to avoid embarrassment and general work avoidance due to lack of confidence in ability. Therapy can do wonders with identifying these things and making the changes you’d need to reach your full potential
– growth mindset: have your friend read into this. If he can commit to and believe in the philosophy of it, it can work wonders. Changed my life.
– support system: finally, like any person, everyone gives support plays a huge factor on whether or not a person is successful. Seems like he’s got you, which is a great sign.
Thanks for reading my novel and hope this was helpful. I skimmed on a lot of the important things, though there is much more I could write on. Please, please, please do not hesitate to ask for question or clarification, anyone! I do this for a living and would love to have something to hyperfocus on while I’m bored at home on summer, and am happy to help 🙂
Edit: this info is a combination of years of personal research, my own experiences with ADHD, experiences working with a decent sample size of ADHD students, some conferences I’ve been to for school on ADHD, and weekly meetings with learning specialists who have SPED degrees (mine is English Ed). As I say to my students, I am sometimes wrong. Feel free to correct me (gently, don’t wanna set off that RSD, haha) if something looks incorrect. I will look into it.
At a technical level, it takes a lot more stimulation to maintain psychological arousal.
You know how velociraptor vision is based on movement, and if you keep still, they can’t see you?
ADHD brains are a bit like that. If it’s not ‘popping’, if it’s not reactive, if it’s not clamouring for attention or scurrying away or generally on fire… then it fades into our mental background and becomes incredibly hard to stay aware of – like having a big blurry floater that inevitably moves in to blot out whatever you look at for more than a few seconds.
Think of the number 3 for five minutes. Not things there are three of, not triangular things, not multiples of three, not that song about three being the perfect number, not how you’re trying to think about 3, not *anything else*, just 3. Keep thinking 3, and don’t let your mind wander or slip off it.
You won’t last one minute, let alone five. The longer you go, the less traction you have – and the harder you scrabble to keep your position, the worse it gets. It takes increasing effort for decreasing results, and after a while all you’re thinking about is the effort you’re making to think about 3, instead of thinking about 3.
Okay: now imagine that *everything is like that*. Every single damn thing that isn’t actively jumping up and down or that doesn’t yelp when you poke it.
Your mind gets fatigued to hell staying on-task, if that task takes active concentration but is not reactive.
A task you can autopilot, like tidying up, cooking, sorting stuff, etc is fine because you don’t need to be mentally present for it. You just start going and you can be miles away down some weird-ass chain of thought, but your hands keep doing the work. And even for the bits you do need to concentrate for, there’s some interactivity that keeps it changed up.
But a job that needs your ongoing mental involvement, without giving anything back – like, say, copying numbers into a spreadsheet – is absolute hell. You can’t park your attention elsewhere, because you need to think about the numbers, look over here, remember the number, click on the box, type the number, cursor down, rinse and repeat. After a few minutes, you *just can’t make yourself* keep thinking the same thing; it simply doesn’t work. Try as hard as you want, your effort has no effect.
And of course *literally any distraction*, either internal or external, becomes infinitely louder, clearer and easier to follow. Any stray thoughts or sensations get sucked into the mental vacuum, and just take over.
This means that our short-term working memory is constantly getting overwritten, so our task management is *utterly fucking nonexistent*. It’s not that we don’t want to do the thing, it’s that it’s been *completely wiped from our awareness* until something reminds us of it. It’s not a matter of effort, or of wanting to – there’s just nothing there for volition to act upon.
Imagine being in a 24/7 Skype call with a bunch of 7yos who are being paid in sugar to loudly comment on and argue about everything they see or hear, and you can *never ever shut them up even for a minute*. And imagine that you’re trying to do your taxes in the middle of this, or keep track of a list of verbal instructions from your boss, or ensure that you pick up the shopping on your way home, or pay the phone bill on time.
We rely *heavily* on autopilot and routine. Once we can make something a background habit, we can do it without having to remember it – unless someone kicks us out of our routine, and then everything goes to hell.
I’ve been successfully distracted out of taking my lunch to work by my wife reminding me to take my lunch to work. I’ve walked into and out of a supermarket chanting ‘must buy milk, must buy milk’ to myself, only to walk out without buying milk, because I was so focused on reminding myself that I forgot to actually do it.
One time my wife called and asked me to take her notes to her at uni. I agreed, picked up her notes… then she called me again and asked me to bring her jacket as well. So I grab it, take it to uni, hand it to her…
“My notes?”
“… Fuck.”
That incident was hilarious, but a lifetime of shame and disappointment and being called inconsiderate and selfish and lazy… can really add up.
Other less-fun stuff is that we can be prone to sensory overload, a bit like the ASD folks. We have to work a whole lot harder at filtering out irrelevant stuff, and it’s pretty much a conscious process for us, so it’s easy for us to get overwhelmed in noisy or crowded places, if a bunch of people are talking to us at once, if we’re in too many people’s eyeline… it can all get way too much, very quickly. You’ll notice that if we go to parties, we’re the ones that stay at the edge of the crowd, and probably spend a lot of time helping in the kitchen.
And similarly we can just spontaneously get into this unpleasant state that’s not quite anxiety, not quite excitement – it’s just wound up and jittery and pacing, without anything to pin it on.
The meds do help. They’re mild stimulants that lower the threshold for that psychological arousal, so things don’t have to be quite so on-fire for our brains to track them. The blind spot takes longer to settle in, we’re a little harder to distract, we can keep at least a couple of items in working memory without getting crowded out by irrelevant shit.
From the outside they *look* like we’ve been sedated because we’re able to calm down – but that’s not the case. We’re calmer and steadier *because* we’ve been powered up, so we’re no longer flailing for context, we’re no longer running to catch up all the time, we’re no longer losing track of our thoughts, so we’re able to think in straight lines instead of zigzagging all over the place and teleporting around like we’re lagged to hell.
They aren’t a magic wand, and they take discipline to make use of – but they let us carve out a little tiny place to stand, instead of getting blown around like leaves on the wind.
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