I meant to do this earlier, but in true ADHD fashion, I put it off until now. What follows is part bastardizing science, part personal experience, and entirely because I feel it’s something I needed to write out. Skip it, or read it, but either way, it’s on you now.

October is ADHD awareness month, and I wanted to take some time to help educate people about this misunderstood, and quite frankly, poorly named disease, so that others might begin to understand what life is like when you have it, but don’t know it.

ADHD would be better described as a Neurological Deficit Disease, in which the brains ability to not only regulate it’s executive function (the part of your brain that controls your ability to regulate emotions, priorities, and response to stimuli), but also it’s ability to produce and use the neurotransmitters involved in task management, is either stunted, or, as in my case, near non-existent. It is compounded by the fact that with ADHD comes a very wide array of comorbidities, many well known, such as anxiety, depression, and bipolar disorder, as well as a slew of lesser known conditions, such as Rejection Sensitive Dysphoria (which was just wonderful figuring out was one of the things I had as well; sorry to all my ex’s 😅😅), imposter syndrome, and other sensory disorders. Which means that not only does it get missed in lieu of more common causes, such as depression, but those misdiagnosed can have other issues that get misdiagnosed as well, causing a never-ending rabbit hole that can lead to poor treatment plans, and ultimately a lower quality of life.

ADHD is over diagnosed incorrectly (I’m looking at you, overworked college students who are taking 3 semesters worth of credits at once), poorly understood, misnamed, and undertreated when it is actually diagnosed correctly. It is currently seen as a label of a disease, when it should be a spectrum, with varying degrees, such as Autism. In fact, ADHD and Autism have so much overlap in it’s presentation, comorbidities, and physiology, that I could go on for hours on that subject alone; it’s nifty info.

What this actually means, for those of you who don’t read doctor, is that for many people with severe ADHD, like myself, we tend to not know about the symptoms or their extent, misunderstand the reason why their lives may seem more difficult than others, not be able to find up to date clinicians to willingly diagnose and treat them, not receive medication that helps treat the main cause, and are discriminated against due to not only the general public’s misunderstanding of the disease, but the stigma that ADHD is just a term for laziness. And all of this is done to a person who is already having trouble motivating themselves to even eat or make a phone call; sounds like a compounding problem if I’ve ever heard of one…

So let’s start with the big one. Medications. People with ADHD tend to either poorly utilize, or not produce at all, the neurotransmitters Dopamine and Norepinephrine. This is well known as a cause for things like anxiety and depression, but in our case, it goes one step further. When you go to do a task as a Neurotypical individual, your brain preloads you with dopamine, the ‘feel good’ chemical, before you even do the task, and then follows it with a second dump after you complete the task, as a “good job” for your brain, as training for motivation to do it again the next time you need to. For ADHD people, that just doesn’t happen. The cause is still debated, but basically our brains forgot, or misread those instructions, so we don’t get either the preemptive jolt, OR the feels good dump, when we go to do the thing. So, in order to do the thing, we have to work past the fact that we just, physiologically speaking, have literally no reason to do it, and anyone in medicine can tell you, if the body doesn’t have a reason to do something, it tends to just not.

Medications like Ritalin and Adderall are stimulants, and we know that one of the things they do well, is increase the affinity, and production, of Dopamine and Norepinephrine in the brain, and more specifically, in this executive function portion. While for Neurotypical people, these medications are basically like meth, for people like myself, what they do is raise our neurotransmitter production and usage to a ‘normal’ level; What makes some people able to write 4 essays, paint their room, reorganize their book collection, and study French over the course of 5 hours, allows me to wake up and decide to make an omelet for breakfast, instead of just eating a spoonful of peanut butter from the jar, or remember to change my laundry over without having to rewash it 4 times due to forgetting it. In a simple way of thinking about it, stimulant medications alter the way our brains function, to bring it more in line with how other brains work, and does it in a very specific way; Stimulants are the closest thing to gene therapy that you can get without writing new DNA strings. Much like how a diabetic needs insulin for controlling their sugar, we need stimulants to control our brain.

Another misunderstood aspect of all of this is the ‘Attention Deficit” portion of the name. I hate that, because it’s simply not true. The downside of the brain issue is that we have trouble self motivating, but the blessing of the curse is that we actually pay attention to literally everything; without the motivation control allowing us to filter what’s important and what’s not, our brain decides to focus on everything at once, which is why if you ever talk to someone with ADHD, you can see them get side tracked often. This isn’t a lack of attention, it’s a lack of the ability to focus the attention towards what they need to focus on.

As a side note, one of the things this causes is an issue with our ‘Object Permanence’. Anyone who’s taken a child psychology class will know what that means, but for those who haven’t, it can be boiled down to this: ‘If we don’t see it, or are not actively thinking about it, it DOES NOT EXIST in our mind’. This is why I need to make 3 trips upstairs when I leave for work many days: one because I forgot my phone upstairs, another because I left my keys in a different pair of pants, and again because I forgot to grab my bookbag the first two times. It’s just as frustrating for us, as it is for everyone else. We just are thinking about so much, we fail to remember what we know we shouldn’t.

Which leads to the “Hyperactivity” part of the name. Because we cannot motivate with dopamine, we end up having to find other, nifty ways of finding motivation. “Follow the Dopamine” is a newer meme for those with ADHD, but it is very true to the point; when you need something you can’t buy, you make your own. This is why we tend to hyperfocus on things; if we find something we CAN focus on, we will do it until we don’t have anything left to give; we don’t have issues CONTINUING to do tasks, only difficulty in STARTING tasks. So how do we start doing the things? Great question.

Generally, in order to get someone with severe ADHD to do a thing, it has to fall into one of 4 categories. It needs to either be Enjoyable, New, Difficult, or Immediate. Enjoyable meaning something we like to do; you don’t need to self motivate when the action IS the reward. Same thing when something’s new; if we’re learning about something, or how to do a thing, those neurotransmitter pathways work great, which is why we tend to jump from hobby to hobby; we’re following the dopamine used in the part of the brain that regulates learning! Same thing when something is difficult, or challenging; if we think it’s going to be hard, we know afterwards we will get that dump of “Did the thing” energy, even if we don’t normally get it from common tasks, simply because the brain uses other parts to give us those transmitters.

Which only leaves immediate. Darwin was right, and if we didn’t have this last one, most of the people with ADHD probably would have died out 50,000 years ago. If something is critical, or time sensitive, than we have no problem doing it, in fact, we are probably better at it due to repeated events done at the last minute. Practiced Procrastination leads to better Procrastination. But therein lies the rub; we won’t do it until we have no other choice. This is the part that develops into a stigma of laziness, because on the outside it looks like we’re pushing things off until the last minute, but internally, we’ve been dreading it for days, weeks, months even, before we were able to start. And that’s the thing I feel a lot of people don’t realize, is that the person with ADHD is fully aware that the room they’re in is a mess, or that their boss is waiting for a report. We probably are more anxious about that than you could imagine, but we literally are incapable of trying to start it until we have no choice. That’s why deadlines are important for people like myself; without them, I wouldn’t do anything.

There is so much more I want to type out, but if you’ve read this far, I am always open to talking more about it. I got diagnosed as a child, but didn’t start medications until only last year, and I’ve spent much of that time (while not actively trying to fix the 10 years of nothing I did), trying to figure out more and more about this condition, and it’s effect on me and my life. Without being open about these issues, we risk continuing on the same ignorant path that we’ve been on for 30 years, and if me typing this out helps, then I have no shame in writing this.

So, please, all those suffering ask for is a little bit of understanding, and a slightly larger bit of patience. I promise, we tend to be aware of our faults more than we may let on, and we will definitely get to our point in a second, once our brain has finished buffering.