Research debunks some common assumptions about this complex form of neurodivergence
Some popular assumptions about ADHD (attention deficit hyperactivity disorder) are simplistic and even wrong.
For years, ADHD was often described as a condition involving distractibility, inattention, or sometimes, excessive motor activity. The wild little boy racing around a classroom is almost a meme.
But recent research has viewed ADHD with more complexity.
In my psychotherapy practice, teens and adult clients with ADHD typically proclaim (and sadly, often apologize for) their problems with attention. At least, that’s what they’ve been told for years!
You never listen.
You can’t pay attention in class.
You are unreliable.
It’s no surprise that their self-esteem takes a hit.
The cumulative impact of this chatter about “deficits” takes its toll. Labeled by loved ones, teachers, and even peers as deficient, they internalize those comments and are left with feelings of inadequacy and shame.
What’s wrong with me?
Why can’t I just focus and pay attention?
Am I always going to be a problem to my family?
‘Attention Deficit’ may be a misnomer
Here’s the thing: attentional deficits are not necessarily pervasive.
Those teens and adults diagnosed (or self-diagnosed) with ADHD can readily focus on a beloved or engaging task. This is not just hyperfocus — many report a sense of creative flow and joy when immersed in a task they love.
Those same teens and adults can also remember dates and times that are meaningful to them — a concert, a friend’s upcoming party, a college application deadline if they truly care about attending said college.
It’s a “square peg — round hole” dilemma. Traditional schools, routine jobs, and living in a neurotypical world make life more complicated for folks with ADHD.
Inattention may not be the problem
In fact, ADHD may not be a disorder of attention at all, wrote psychiatrist Awais Aftab in a recent New York Times article:
“The classic features of ADHD include things like not staying on task, losing the thread of a conversation and forgetting instructions. They are failures of ‘sustained engagement.’ Doing so may be less a matter of filtering out distractions and more a matter of whether the task registers in the brain as worth doing in the first place.”
Any difficulty with inattention and focus may be related, instead, to prioritizing commitments, responsibilities, and outside demands that seem less compelling.
Yes, that video game is fun. But noticing when it interferes with more pressing demands (such as finishing a take-home exam) and how to offset such interference is essential.
Struggling to complete tasks on time, enduring boredom or waiting, and juggling multiple responsibilities are experienced by just about everyone.
What is different with ADHD is the frequency, extent, and qualitative impact of the struggle.
Arriving five minutes late for dinner with friends is not a big deal. But forgetting the time of a job interview carries much greater consequences.
So, if it’s not a problem with attention, then what is it?
It may be executive functioning, after all
ADHD is now considered a neurodivergent expression of brain differences. It can be understood as a condition involving executive functioning difficulties rather than attention, according to neuropsychologist Russell Barkley, a pivotal voice in the field of ADHD research.
Planning, impulse control, and time management are hallmark features.
Years ago, Barkley coined the term “time blindness” as a component of ADHD and linked it to basic neurological differences that affect executive functioning… not just the ubiquitous experience of boredom or occasional forgetfulness.
Later in his career, Barkley also identified challenges with emotional self-regulation as a central feature of ADHD, often expressed as emotional impulsiveness, low frustration tolerance, and motivational struggles.
“People with ADHD can live in a shrunken present moment,” wrote Aftab, “in which future consequences carry little significance and weight.”
Grappling with the long-term consequences of one’s actions and learning to inhibit impulses are common examples of executive functioning challenges.
Managing an active mind (and body)
When there are so many interesting, competing distractions, mundane compliance with class assignments or work deadlines or catching a train on time seem much less important.
Difficulties arise when juggling an overload of tasks. Or avoiding those deemed unimportant. Or struggling with delayed gratification.
Many folks with ADHD feel that their minds are too active and cluttered. When overloaded, they lose their internal compass for what is most important. There is just too much to keep track of and remember! Staying focused on what is best for their long-term well-being gets lost amidst the brain clutter.
They may eventually lose jobs and friendships — not just their car keys.
And when ADHD is expressed as high levels of activity (the ‘H’ in ADHD), sitting still in class or a sedentary job can feel like torture.
Then why does stimulant medication seem to improve attention?
Stimulant medication has been used for decades to presumably improve focus and subdue hyperactivity (see this overview for a helpful description).
If executive functioning struggles are more of a challenge than inattention, it might seem puzzling that stimulant medication is often helpful.
“Stimulants create what looks like improved attention and focus,” according to Aftab. “But they really do so by enhancing the salience of mundane activities — tricking the brain into assigning greater worth and significance to things like math homework and laundry.”
The brain’s “overall state” is affected by stimulant medication, wrote neuroscientist Michael Halassa. He summarized a study of brain functioning among adolescents conducted by researchers Benjamin Kay and colleagues:
“The drugs changed the large-scale configuration of brain networks underlying task processing. These effects were the largest and most reliable effects observed. In contrast, networks typically labeled as attentional showed no measurable change.”
Halassa pointed out that over three million children in the U.S. take stimulant medication for ADHD. But not all of them benefit from it. More research is needed to understand “how these medications impact [brain] circuit function,” which should improve how physicians match the right medication to an individual’s specific needs.
A Broader Perspective
When viewed as a form of neurodivergence, ADHD can be considered a variation from the norm (like height or eye color), rather than a deficit.
While executive functioning struggles make academic or work demands more challenging, people with ADHD also bring a range of strengths to the table: creativity, high levels of energy, and outside-the-box thinking.
When attempting to improve executive functioning, a skills-building approach that respects their differences and builds self-esteem is essential. And when stimulant medication is needed, it can be considered a supportive aid rather than an indictment of a person’s “deficits.”
According to PubMed, there are over 130,000 peer-reviewed research articles focused on ADHD. Yet, much is still unknown.
Researchers and treatment professionals are called upon to use a neurodiversity-affirming approach and respectful language in their understanding of ADHD.
As researcher Sue Fletcher-Watson points out in her commentary on neurodiversity research:
“The application of the neurodiversity paradigm to developmental sciences should focus not on denial of needs, or blind pursuit of talents, but on identification and acceptance of unmet needs without judgement, followed by provision of appropriate accommodations and supports.”
This is ADHD Awareness Month. Learn more about ADHD through ADDitude, a helpful resource for both individuals and families as well as treatment professionals.
A similar article was published on Medium.
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