News and Views

G is for Getting Diagnosed

The diagnostic process can be stressful or simple, and it varies from clinician to clinician.

It can be as simple as an interview or as complicated as complete neuropsychological testing.

It can be as easy as describing your difficulties in detail to the first clinician you see or as difficult as explaining yourself fifty times to as many clinicians.

The reasons you might be denied a diagnosis are many.

  • You might be (or appear to be) female.
  • You might be a person of colour.
  • You might be autistic.
  • You might have other psychiatric diagnoses already.
  • You might get (or have gotten) good grades in school.
  • You might be Predominantly Inattentive, rather than Predominantly Hyperactive/Impulsive.
  • You might be poor.
  • You might have parents who don’t believe in ADHD.
  • You might have parents who don’t want you labelled.
  • You might have parents who don’t want to deal with the stigma of having a child who has “something wrong with them.”

And that is just a partial list (and the most common ones I see).

The choice to try to obtain a diagnosis is not simple. There are a lot of factors to consider, from how the diagnosis might benefit or hinder you, to your history with psychiatric professionals, to your financial means.

It’s okay to get a formal diagnosis if you just want to know for yourself that you aren’t imagining things, and there’s a real reason why you struggle with so many things.

It’s okay to avoid a formal diagnosis if you have a history of trauma at the hands of medical and/or psychiatric professionals.

It’s okay to get a formal diagnosis if you aren’t struggling as much as someone else.

It’s okay to avoid a formal diagnosis if you can’t afford it and can’t access funding to pay for it.

It’s okay to get a formal diagnosis if you think treatment will help you better manage your life.

It’s okay to avoid a formal diagnosis if you think it will negatively affect how people treat you.

What matters is that you make an informed decision and explore your options. Just remember, the label doesn’t change who you are as a person.

It just helps to explain some of why you are who you are.

F is for Fidgeting

The kid who squirms in his seat during class.

The teen who jiggles her leg under her desk while writing a test.

The young adult whose post-secondary lecture notes are covered in doodles.

The working adult who clicks pens during meetings.

The stay-at-home mom whose feet twitch constantly while she’s reading a picture book to her preschooler.

It’s annoying to other people. Sometimes it’s annoying to us. It makes people think we’re nervous. It makes them think we want to be doing something else.

It’s fidgeting.

Fidgeting is the common word for the little things people do to help ground themselves and maintain their focus. Neurotypical people don’t do it as often as neurodiverse people do, but they do it all the same. Sometimes our stuff is more obvious than the neurotypical stuff, is all.

It’s all a type of stimming.

“Stimming” is short for “sensory stimulation” and it refers to the things we do to positively impact our sensory systems. You’ll usually see it used in conjunction with autism, because autistic people do it the most, but all people who have developmental disorders stim, and that means ADHDers stim, too.

Stimming can calm us if we’re feeling overwhelmed.

It can help us focus if we’re struggling.

It can keep our bodies in motion so that our ears and eyes can do their jobs better.

Sometimes a stim or fidget is disruptive, and that’s when we have to find other ways to get the same sensory input. It makes no sense to replace pacing with tapping your knee if what you need is the gross motor vestibular input. Rocking on an inflated rubber seat cushion would probably work much better in such an instance.

The important thing to remember is that we often don’t do these things consciously, and if we do make the conscious decision it’s because we recognize how we’re feeling and have realized that doing this particular thing makes us feel better. So finding ways to accommodate fidgeting/stimming is vital to our success.

How do you fidget or stim, and in what situations?

E is for Executive Dysfunction

Executive functions include the ability to make and follow plans; to control our behaviour and emotional reactions (not our actual emotions, but how we express them); and to manage our time and keep ourselves organized.

If you look at the diagnostic criteria for ADHD in the DSM-5, you will see a list of things that indicate that we have poor executive functions:

  • Doesn’t follow through on instructions and doesn’t finish projects or tasks.
  • Struggles to organize tasks and activities.
  • Loses important/necessary materials.
  • Forgets things on a daily basis.
  • Fidgets a lot.
  • Gets up and moves around when expected to sit still.
  • Makes a lot of noise.
  • Talks a lot.
  • Says things without thinking.
  • Doesn’t wait turns very well.
  • Interrupts in conversations.

In addition to these things, Executive Dysfunction often includes difficulty in getting started (initiation) as well as in switching tasks (inertia).

Some things can be learned: for example, ADHDers benefit from learning to use a planner and lists to keep track of tasks and to break down larger tasks into smaller steps.

Some things can be adapted, such as using a timer to remind yourself that you need to switch tasks.

But many things either can’t be dealt with independently or can’t be adequately managed, even with outside help. And that just ends up being really frustrating, for everyone.

One thing that ADHDers need from the non-ADHDers in their lives is support.

We need support to learn those things we don’t know how to do (and to find a method that will work for us, because often the linear structure of non-ADHD functioning just doesn’t work with our brains), and sometimes we need support to be able to do accomplish the things we can’t accommodate in other ways.

That might mean someone to do things with us.

It might mean someone to encourage us and keep us on task while we work.

It might mean someone to help us work out the steps for a big project.

And it might well mean someone to actually do the work for us, because we cannot do it ourselves consistently enough.

What’s your biggest challenge with regard to Executive Dysfunction?

D is for Disability

ADHD isn’t always a disability. It always causes difficulties for the people who have it, and part of the diagnostic criteria is that the symptoms cause distress in two or more areas of life. But no, it’s not always a disability.

Except when it is.

And that’s not me saying it’s horrible and evil and wrong or whatever, it’s me stating an objective fact.

If I cannot meet my work deadlines because my ADHD-skewed sense of time means I don’t start things until too late, that’s a disability.

If I don’t have clean clothes to wear on a regular basis because my ADHD-provided executive dysfunction means I almost never do the laundry, that’s a disability.

If I can’t maintain friendships because I always say the first thing that pops into my head and it usually offends people, that’s a disability.

If I don’t eat regular meals because I forget to eat even when I’m hungry, or because I forget I’m cooking food and ruin my meals, that’s a disability.

If I can’t maintain friendships because I keep forgetting to reply to e-mails, that’s a disability.

Many ADHDers are not disabled by their ADHD once they are receiving appropriate treatment and have found the thing they are able to hyperfocus on consistently enough to make a career in it.

Some ADHDers are disabled enough that they require support staff in order to maintain their homes and keep a job.

Both types of ADHDer (and everyone in between) are valid and worthwhile.

Don’t shy away from admitting that ADHD is often disabling. Don’t lie about it. Don’t add to the stigma of disability. Rise above that impulse and promote the idea that we are all worthy as we are, regardless of how much support we require. Push the narrative that “success” is as individual as we are, and that we should define our success ourselves and decide how we’re going to get there based on our personal abilities and disabilities.

Is your ADHD disabling? In what way(s)?

C is for Children

Naturally, the idea of ADHD is that it is a disorder of childhood. More attention to adults has been granted over the past couple of decades, but by and large the image is still that of hyperactive little boys. In fact, some insurance agencies don’t cover treatment for adults, and some doctors refuse to even refer adults to be assessed!

But let’s talk about ADHD in children for just a moment, shall we?

Because there are a few things we do need to discuss.

ADHD begins in childhood. Just when, nobody is certain, but the diagnostic criteria state that symptoms must be present prior to age 12 in order to qualify for the diagnosis. Given what we know about typical child development and what is impacted by ADHD, it’s not something that should really be diagnosed prior to age seven.

So here’s the why of all of that.

The behaviours that generally signify ADHD in children (e.g., extreme hyperactivity and/or chattiness, disorganization, lack of focus) are developmentally not fully in place prior to age seven. This means that it is totally possible for a three-year-old to be literally climbing the walls at preschool and not meet the criteria for ADHD by age seven.

In addition, most of what we know about ADHD and how it manifests is based on research performed on male children. It’s only recently (in terms of the science world) that research has been done on females. This means that females are often not recognized as having ADHD, because their behaviours are different from their male fellow ADHDers, even when they have the same type of ADHD.

And on top of all of that, some races and classes are more likely to get the ADHD diagnosis than others. Some are more likely to be dismissed as just being unintelligent or problem students, while others are more likely to end up with medication without a proper assessment, because it’s just easier to diagnose on the fly and get the parents/school out of your face.

All of these things mean that the world of ADHD is tricky to navigate and confusing for people who are newly diagnosed as well as for those who were diagnosed in childhood.

How old were you at diagnosis? Do you have any thoughts as to why it happened then?

B is for Behaviour

ADHD gets treated like it’s a behaviour problem when it isn’t.

That is, the behaviour can be a problem, but that doesn’t mean it should be addressed using behaviour management techniques like behaviour charts, behaviour contracts, and token systems.

See, the things we do as ADHDers are usually related to one of our particular symptoms. This means that we really don’t have a lot of control over how much we talk to our neighbours in class at school, whether or not we’re on time for work, or how well we keep our rooms clean. It’s not that we don’t care about the rules, it’s that we’re impulsive and act before thinking things through completely, we have no real concept of time (it’s fluid and not concrete at all), and we lack the ability to make and follow plans as quickly and easily as non-ADHDers often do.

So when a teacher at school implements one of those behaviour management charts for the whole class, say the kind with the clothespins that move up and down depending on the student’s behaviour, the kids with ADHD (whether or not they’re diagnosed) are going to either focus so hard on meeting those behavioural expectations that they can’t actually take in any of what they’re supposed to be learning, or they’re going to “act out” and lose points every single day but probably will learn more of the material.

Or when a manager or boss writes up an ADHD employee for being late too often and provides a list of what they need to do to correct the issue without discussing possible solutions with the employee, the ADHDer is probably going to struggle to meet these expectations and end up getting fired even though they’re doing their best.

And when a parent tidies up their child’s room when said child is not at home and throws out things that are important to the child (sometimes without realizing it’s important), it erodes the relationship between the child and parent, and it does nothing to help the child begin to look after the cleaning on their own.

What generally will work better in each of these hypothetical situations?

Well, the teacher might discuss the problem with the student and involve them in figuring out ways to be less of a disruption in class. That might mean fidget toys or a seat at the back of the room with permission to pace, or a seat at the front of the room with regular check-ins during class.

The manager might discuss the importance of timeliness with the employee and offer a couple of suggested helps, such as changing start and end times or setting timers to help get out the door.

And the parent might offer to help the child clean up their room right from the start. If the child is older, they might work together to create a map of the room and determine the step they need to follow to get the room cleaned up, and then make a checklist for regular weekly cleaning that the child can follow.

What is a way you’ve been helped by making adjustments to situations instead of struggling to meet expectations? Have you been hindered by the use of behaviour management techniques? In what way?

A is for ADHD

Attention Deficit Hyperactivity Disorder: Inattentive type, Hyperactive/Impulsive type, Combined type.

The image is typically that of a pre-teen boy, literally climbing the walls at school. The reality is as varied as the types listed above; as individual as the millions of people who have the disorder.

ADHD is the teenage girl who hyperfocuses on reading and writing, does well academically, and sucks at making friends, keeping her locker and her bedroom organized, and doing her homework more than 12 hours before it’s due.

It’s the twenty-something accountant who jumps out of planes for fun on the weekends.

It’s the entrepreneur who flits from one project to the next, sticking with an idea only until it’s ready to meet the world.

It’s the little boy who struggles to learn to read because the pictures are more interesting than the words and he keeps losing his place.

It’s the little girl who keeps getting in trouble for talking in class.

It’s the disorganized fifty-something professional whose house is a disaster, whose marriage is a shambles, who is constantly broke despite having a well-paying job, who is late for everything all the time.

There are many faces of ADHD, and these are just a few of them. Share yours in the comments below.

October is ADHD Awareness Month.