“That which you believe, becomes your world”
John is a 27 year old Caucasian male of European descent. He has a Master’s degree and is working towards his doctorate. He works very hard in all areas of his life, and is particularly proud of his academic and career accomplishments. He loves learning new things by watching documentaries and reading books. John has a very classic style, often consisting of all black – his favourite ‘colour’.
To some, John seems like a very professional, serious, and ‘go get ’em’ kind of guy. Those who know him well, though, see him a bit differently. Of course, he is still super professional and ambitious. But he’s also very down to earth and very into reality TV (guilty pleasure!). He has watched Pulp Fiction at least 10 times and loves pasta. Like many others, John often finds himself in awkward conversational situations, such as saying “You too!” after the cinema cashier says “Enjoy your movie”, and saying “Welcome!” when introduced to colleagues who have been in their role for years.
John enjoys travelling, especially anywhere “with rugged terrain, forest, mountains, valleys, and nature”. He tries not to sweat the small stuff and makes his way through each day with a wise personal mantra: “That which you believe, becomes your world”.
He is successful, intelligent, determined, patient, respectful, and extremely well-spoken. So much so, in fact, that most people don’t know or believe that he has Attention-Deficit Hyperactivity Disorder (ADHD).
What do you think of when you hear the word “ADHD”?
There’s a good chance that your initial thoughts regarding ADHD have to do with young, out of control boys, running around and being disruptive. You may also think of kids with short attention spans who don’t listen, don’t pay attention, and don’t concentrate. Maybe you think that ADHD is just a bunch of letters put together as an excuse for poor parenting or misbehaving children. Or maybe you think of medication like Ritalin and Adderall and the problems surrounding it.
For many, ADHD carries with it a negative connotation. Yet for others, ADHD has a different feel. Parents of kids with ADHD may worry about their children’s social, emotional, and academic functioning. Adolescents and adults with ADHD may feel ‘different’ and worry about what all this means for their future careers and relationships.
We mostly hear about young children, particularly boys, being diagnosed with ADHD. However, ADHD is a life-persistent disorder meaning that those boys will eventually become teen guys with ADHD…who then become men with ADHD. And since, contrary to what some believe, ADHD also occurs in girls we then have women with ADHD. So to sum up: males, females, children, teens, and adults can all have ADHD.
There are also a few different types (psych term: specifiers) of ADHD. Although there are common themes, how one person experiences ADHD can be very different from how another person experiences ADHD. So, as was the case for addictions, the best way to understand how someone experiences and copes with their mental health challenges is to ask them. This is how I had a really awesome conversation with John.
ADHD is a neurodevelopmental disorder. What does this mean?
neuro = brain + developmental = during childhood
So, neurodevelopmental disorders are a group of disorders that typically begin in childhood and involve developmental deficits leading to impairments in personal, social, academic, and/or occupational life. These deficits are typically neurological in nature (have to do with the brain). The deficits associated with ADHD include impairing levels of inattention and/or hyperactivity-impulsivity.
Since ADHD is a neurodevelopmental disorder, symptoms have to be present in childhood. However, ADHD is not limited to children. Adolescents and adults can also be diagnosed with ADHD. The only thing? Symptoms have to have been present before the age of 12. As a perfect example, John was 13 when he started feeling something was “different” with him. He was able to be diagnosed with ADHD in his teens because he had been experiencing the diagnostic symptoms all his life.
To be considered a disorder, difficulties with inattention and/or hyperactivity-impulsivity have to be persistent and interfere with functioning or development. The impairment or interference is measured based on a variety of cognitive, behavioural, and physical symptoms. The symptoms for ADHD are organized into two categories: symptoms for inattention and symptoms for hyperactivity-impulsivity.
- Inattention refers to wandering off task, having difficulty focusing, lacking persistence and being disorganized. Despite what some people think, inattention in ADHD is not because of defiance or a lack of understanding. Symptoms of inattention include: forgetting what homework to do, losing things, not following through on instructions, and seeming to not be listening.
- Many people think of children running around uncontrollably when they think of hyperactivity. In addition to this ‘inappropriate excessive motor activity’ (psych term), hyperactivity also involves excessive fidgeting, tapping, and talking. Hyperactivity may look slightly different for adults than it does for children. Adults may be extremely restless or drain others with their constant activity. Other symptoms of hyperactivity include an inability to play quietly or a need to be on the go.
- Impulsivity refers to rash actions that happen with little forethought. Impulsive actions may also injure or negatively impact the individual (e.g., running into the street, declining a job offer). Often, impulsivity comes from a desire to be rewarded immediately or, said differently, from the inability to delay gratification.
To receive a diagnosis of ADHD, an individual has to have 6 or more symptoms of either inattention or hyperactivity-impulsivity, or a combination of both. Symptoms have to be present for at least 6 months and occur in at least 2 situations (e.g., home and school/work). As previously mentioned, there are different “types” or specifiers of ADHD. These specifiers depend on the kinds of symptoms an individual experiences. If someone’s symptoms come mostly from the inattentive list, that person is diagnosed with ADHD-predominantly inattentive presentation. If symptoms are mostly from the hyperactivity-impulsivity list, then ADHD-predominantly hyperactive-impulsive presentation is diagnosed. Finally, if the symptoms are a mixture from both lists then ADHD-combined presentation is specified.
As we saw last month with Katie, mental disorders often co-occur with each other. It was a bummer for addictions, and it continues to be a bummer for ADHD. ADHD commonly co-occurs with learning disabilities, anxiety, depression, and oppositional or defiant behaviour, to name a few. Basically, difficulties with inattention and/or hyperactivity-impulsivity can be present regardless of any other mental or physical difficulties. This means that individuals with ADHD can experience a lot of different symptoms. For example, John told me he experiences worrying, irritability, mood swings, guilt and fatigue. He often loses his focus and concentration, has slow thought processing and a foggy brain, and experiences obsessive and intrusive thoughts. Sometimes he eats too much, sometimes he doesn’t eat enough. Sometimes he sleeps too much, sometimes he doesn’t sleep at all.
ADHD can also vary in severity. Basically speaking, the more symptoms there are, the more severe the ADHD is. Symptoms wax and wane though, so severity can change over time. Individuals may initially have much more than the 6 symptoms necessary for a diagnosis, or the symptoms may be particularly impairing (severe diagnosis). Over time, the same individual may barely have enough symptoms for diagnosis (mild diagnosis). The opposite is also true – a few symptoms may end up being many symptoms with time. It is even possible for someone with ADHD to no longer have enough symptoms to meet diagnostic criteria. In this case, the individual would be considered in partial remission.
John’s experiences with ADHD are a perfect example of how a mental disorder can totally consume an individual or go mostly unnoticed, depending on the day. On a typically day John says he is only affected by his ADHD a little bit. On a good day, John isn’t affected at all (yay, good days!). But, bad days suck. ADHD is quite difficult for John on those days.
ADHD does not discriminate and occurs in most cultures. It is estimated that ADHD affects approximately 5% of children and 2.5% of adults. Generally, ADHD is more common among males than females with ratios of 2:1 for children and 1.6:1 in adults. Girls can definitely experience ADHD though, and so it should not be considered a “boy’s disorder”. Girls are more likely to present with predominantly inattentive symptoms. This does not mean that all girls with ADHD are inattentive (or that all boys with ADHD are hyperactive-impulsive). Take John. John is a male diagnosed with ADHD predominantly inattentive presentation.
Take that stereotypes!
As we saw last month, many people do not seek help for their mental health concerns. Some people don’t know where to go or who to talk to, others are worried they’ll seem weak if they reach out, and some feel they should be able to handle their problems themselves. Fortunately, John knew there was no need to suffer alone.
John was able to reach out to his family practitioner, a psychologist, and a psychiatrist. He says he also received support from his family, friends, and pets. He says it was easy for him to access psychological services and that having insurance, financial security, and supportive family members was helpful.
Another hurdle to reaching out for psychological services has to do with medication. Some people are all for medication and some people, like John, feel that we may rely too heavily on medication to fix all our problems. John takes medication for ADHD. He says that this medication helps with his cognitive performance. However, he wisely cautions against using medication as a crutch. He suggests that medication be used in the short term while individuals gather strategies to support continued growth – for example, cognitive-behavioural techniques taught by a counsellor or psychologist.
Of course, it is important to note that what works for one individual may not work for another. For some people, medication may be necessary whereas cognitive, behavioural, and emotional strategies may be enough for some others. Others may benefit from both medical and non-medical strategies. The important thing is to understand that everyone experiences their own mental health in a unique way. As John puts it “no one understands what its like to live in my shoes, so let’s be compassionate and not jump to conclusions”.
Stigma continues to be a huge hurdle for many individuals with mental health difficulties. John says, “I do not discuss my mental health issues with people I do not trust to show respect and compassion”. He admits to hiding his mental health struggles from people for fear of ridicule, criticism, or labeling. Unfortunately, John has reason to fear being stigmatized. He mentioned that sometimes, even the people he does trust, tell him to simply get over his problems. According to John, people also sometimes tell him he ‘looks fine’.
A quick note: how a person ‘looks’ or ‘seems’ often doesn’t match up with how they feel. (Case in point: someone with epilepsy often ‘looks fine’. They definitely still have a chronic neurological disorder though.)
Just like Katie, John believes that there is not as much recognition for mental disorders as there is for physical disorders. He does feel that things are getting better, but we’re not fully there yet. John says he can’t expect to get recognition if he doesn’t talk about his struggles. But talking about his struggles is something his experience with stigma stops him from doing (#DoubleEdgedSword).
John’s Final Thoughts
His biggest challenge is…
“Cognitive performance, paying attention, not feeling overwhelmed from the stimuli in my environment, not burning myself out from over working, organizing my thoughts and putting them into words, thinking quickly and responding appropriately and intelligently in a timely manner, sustaining a high level of performance, perfectionism and putting pressure on myself, being my own worst critic.”
His mental health challenge is…
“…not overthinking, dwelling on, or magnifying my mental health challenges.”
A myth surrounding his ADHD is…
“…that I am weird, lazy, stupid, don’t work hard enough, making excuses.”
His advice to others struggling is:
“Shift your perspective, do things that make you happy, go out into nature, take up a hobby, read a book, surround yourself with kind people who you respect and admire and who support you, always learn and grow, remain humble, do not give in to what others deem is right or what society is doing or thinks you should be doing, be authentic to yourself, use your own words and thoughts, do everything you can to have a healthy mind and body, participate in mindfulness, eat healthy, take vitamins and nutrient supplements, drink lots of water, keep drugs and alcohol to a minimum, exercise, turn off your phone and other devices, learn to love yourself and spend time with yourself, constantly reflect on positive things, how you can improve, be perceptive of the beauty that surrounds us at all times and absorb that energy while also releasing it back in a cyclical process.”
He wants others to know…
“…that I struggle despite seeming like I have it all together. And that I should not be judged or criticized because of the things that I do or how I come across sometimes, because they may actually be the result of my mental health struggles. No one understands what its like to live in my shoes, so lets be compassionate and not jump to conclusions, and in turn, I will do my best to show you that same respect.”
He would like to thank…
“…my mother for remaining strong during my struggles, despite having so many of her own. I would like to thank myself for never throwing in the towel and always striving to live a better life and have a happier existence, through whatever means. I was just trying to survive and thrive.”
A big theme that we saw from John’s experiences with ADHD is that things are not always as they seem. The best we can do is gain awareness of mental health issues. It is unnecessary for people to feel like they have no one to talk to, no where to go, no support. But this is the way many people feel. We can change that. We can be open and tolerant and invite conversation. We have been given a powerful gift – communication. As a society we communicate far and wide every day in a variety of ways. The best way to understand someone is to talk to them!
Let’s start talking now. Have something to say? Want more information? Drop me a line in the comments section below!
Thank you so much for taking the time to learn about attention-deficit hyperactivity disorder. And a huge thank you to John for sharing his story! I am very happy to share that this blog has now reached beyond Canada and has been read in the United States, the United Kingdom, Israel, Italy, Australia, Greece, the Philippines, the Netherlands, and Iceland! This means that we have the potential to be heard around the world! Thanks so much for your support – keep sharing and talking and spreading the love. Don’t forget to subscribe to get the next 10 blog posts in this series!