- Feb 11, 2022
- 17 min read

ADHD, OBVIOUSLY

What is up with this attention-deficit/hyperactivity disorder (ADHD) fad sweeping North America? Are you also seeing this everywhere you turn? My attention was drawn to the topic when within the span of a few weeks the most competent and productive middle-aged professional women I know simultaneously declared their status as proud members of the attention deficit community. (Me: “Wait, what?!”) And, of course, now that I’ve sought out more information, I’m clearly caught in some algorithmic loop that demands everything I see be related to ADHD. If none of that happened, I would still be very interested in this subject. Not only do I have my own neuro and behavioural issues but also a general interest in all things education-related. I’ve also spent a fair bit of time reading, thinking about, and discussing this and related themes in the past as I have an ex who wrote a thesis about the ‘90s fashion of labelling kids as disordered, titled “Children’s Attention Deficit/Hyperactivity Disorder Self-Help Books and the Politics of Correction.”

At the outset, I have all kinds of strong doubts and concerns (really an irrational bias at this point) when anything from the field of psychology, never mind a disorder, is trending. From that footing, what also has me seeking more information is that what I’m hearing from folks makes sense to me only out of context. When any of these details are paired to what I think I know in any number of areas (psychology, behaviour, child development, developmental disorders, education, our culture, or these people's upbringing) all the sense there loses its grip entirely.

Sure, we can all see how attention is a multifaceted thing (broad and narrow, internal and external, etc), how the ability to focus to any degree and along any parameter may manifest differently in different folks, and that these traits will sum to a presentation landing us all at a different place along a broad spectrum of ability to tune in and tune out. Great. However, the first hurdle for me is trying to understand a disorder encompassing both five-year-old boys (who are so impaired as to be unable to still themselves sufficiently to learn to read) and forty-year-old women (who always excelled at these tasks and all things school-related – the very people who were used by countless teachers as the subjective standard of attention and hypo-activity against which their male peers were contrasted). For me, this seems to create a disorder so broad and vague as to be meaningless. I mean, where else is the rule also the exception? And at that point why not label us all as ADHD by default, establish this as the normative set of behaviours, and then eliminate from that category the odd human who better approximates an artificial intelligence? I don’t know.

I'm sure I'm perfectly confused about all of the above. So much of reality is counterintuitive or runs against the logic we'd rather it conform to. I just don't yet know what I'm missing. Maybe you can tell me.

To try and learn more I went to the American Psychiatric Association and the latest guidelines in the Diagnostic and Statistical Manual of Mental Disorders. Who better? There, I found a child must show at least six of nine associated symptoms of inattention and/or hyperactivity and impulsivity to be diagnosed with ADHD. So not only must these symptoms be numerous, but to be considered as manifestations of this neurodevelopmental disorder they have to present in childhood. In addition to that, diagnosis is further restricted. Such symptoms must have clinically impaired one's functioning and done so in more than one setting: at home, on the soccer field, at the mosque, or in school (but not merely isolated to one sort of activity, such as silent reading or math.) As well, for these criteria to apply and form a diagnosis of ADHD, like any other diagnosis, symptoms of inattention or impulsivity/hyperactivity may not be better explained by another issue, such as: anxiety, oppositional behaviour, mood disorder, or anything else. Makes sense. Diagnosis also involves: gathering information from parents, teachers, and others close adults; the completion of various checklists; as well as having a medical evaluation to rule out other medical problems.

SYMPTOMS (AND DEFINITELY NOT SYMPTOMS)

So then, what are these symptoms? What I found is that symptoms associated with ADHD are not on a broad spectrum of inattention or impulsivity but are instead the frequent inability to exhibit certain behaviours. Notice how different those are. So, a parent or teacher is not asked to score how attentive a child appears to be (on a scale from “not at all” to “extremely”, say) when trying to perform a certain task. Instead, this adult who best knows the kid is asked, for example, how frequently the child is “not able to stay seated.” From where I sit, this is explicitly not how I hear people, particularly teachers, talking about a presentation of ADHD. This is not ticking a box next to “child sometimes has trouble staying seated” or “child becomes noticeably restless everyday before recess and lunch, after sitting and being forced to stay focus for two hours, or twenty minutes after self-detonating a twice-daily 355ml caffeine bomb.” None of that is ADHD and the inability to stay seated would not alone lead to a diagnosis. Another symptom is “unable to play quietly.” This is nothing like “child is louder than some other kids (or louder than every single child I’ve ever met, combined.)” And it's nothing like “child prefers to run and laugh outside to sitting and drawing or playing with Lego.” Again, those are not symptoms of ADHD but evidence of the child being human. On the list of inattentive type symptoms is, "does not seem to listen when spoken to." This is nothing at all like, "she's often seen daydreaming" or "he stares out the window instead of reading." Daydreaming is not ADHD. (Still, you can find this all over the place. There are ADHD articles and graphics everywhere listing "daydreaming" as a symptom of ADHD. See below.) Another inattentive symptom is, “does not follow through on instructions and does not complete work.” This is not “fails to follow verbal instructions from the librarian” or “consistently leaves their art assignments incomplete.” It’s also nothing like “child appears to hate reading (or writing or math) after telling them they're doing it wrong, suggesting they are stupid, or publicly shaming them every day for five years.” The above deliberate misreadings and errors of diagnosis (and possibly much of the ADHD people are told they exhibit) is just teachers creating a toxic, creativity destroying, anti-child environment in their school and classroom and then turning around and blaming children for this carefully engineered and sternly maintained noxiousness. (I've seen this and written about my experience of it, both as a student and as a classroom assistant, previously and won't offer more specifics here.)

Not one thing on the above graphic is a symptom of ADHD in children. Not one. This is disgusting.

So, all of this begs us to ask how frequently were those adults now being diagnosed as having ADHD (because they were undiagnosed as children) were unable to remain seated or play quietly across multiple settings when they were little? It's kinda something that gets noticed. As a teacher standing in front of a class it's almost impossible to fail to notice every fart or covert nose-picking. A child up out of their chair or squirming is rather glaring. I promise. How often were these kids, now adults, failing to complete their work or important tasks (to the level of neurodevelopmental disorder) that neither a teacher nor parent ever noticed? If only to me, that seems nearly identical to not having a disorder. That's like being unable to pay your rent, ever, but twelve different landlords didn't notice even once over twenty years. I mean, what tremendous confluence of factors conspired to prevent anyone from catching a whiff of your persistent inability to listening when spoken to? What teacher was perfectly unable to detect chronic severe inattention and/or hyperactivity?

As such, a late diagnosis feels less like discovering a cavity or a tumour and more like suddenly revealing, in 2022, flying narwhals, whole herds of them, are common and endemic to metropolitan airports. Still, I’m told all of this makes sense and that the explanation for late diagnosis, particularly in females, is twofold.

SEXISM, MISOGYNY, PATRIARCHY

Firstly, it is explained that the patriarchy is to blame. Due to our collective and deeply ingrained sexism the world was unable or unwilling (or both) to detect the nuances of the female presentation of this disorder. But could that be so? Or are we just hearing the word ‘patriarchy’ and then turning off our brains? What are you hearing and understanding from that assertion that I am missing? One could argue that patriarchy is so pernicious that its main vector for reproduction is not father-to-son but mother-to-daughter; however, that’s not what I think anyone is saying. The impression I have from my many readings is a largely unstated and fully unexplained insistence that (at least zoomed out to the population level) all of society and its institutions are not just dominated by men, obviously, but also sexist, obviously; and as such this sexism, obviously, manifests in any crude medical or psychological diagnostic tests. Obviously. The trouble I have with that is that, here, we’re talking about individuals all the way through. Further, I’m almost certain we’re nearly exclusively talking about you and, overwhelmingly, the closest women in your life. So, the statement “I was not diagnosed with ADHD due to sexism” is not, as framed, a disparagement of a vague generalization of 20th century Western civilization, or something; no, it seems to me to be a very specific and directed criticism about the beliefs and expressions of your mom and your elementary school teachers.

Am I wrong in thinking that most of us had a mother? And am I wrong in thinking that (certainly prior to 2000 and when folks were failing to diagnose you) the norm and stereotype we employ is that it was mom who spent time with the kids and was most actively engaged in and present for almost everything school-related? Seems so. And is it also true that most of us had a wildly disproportionate number of female teachers? That's true even today in every district I've encountered. And in most places the situation was worse in the '80s and '90s, as far as I can tell. And then are the overwhelming majority of the school counsellors, clinical social workers, therapists, and psychiatrists on the planet female? As far as I can tell. Right. And about ADHD, we’re not talking in stereotypes or snapshots of civilization, are we? We’re talking about you and your experience. Right?

Incorporating the above and going deeper still, is the ADHD diagnostic an objective quantitative reading of the pH of your urine or saliva? And is that a cold and distant measure taken by your principal or some random dude who showed up one day from the Department of Health? And is it given a bar code, packed on dry ice, and analyzed under a microscope by the guy who wrote the psych textbook or by a machine in a stuffy lab somewhere? No. Not at all. In fact, it’s as close to the exact opposite as possible. A little girl “missing out” on a diagnosis is very likely to have experienced this because she was ranked among the fittest in terms of focus, calmness, and ability to perform. And how was that assessment made? By the subjective, experience-based opinion of a collective of the closest women in her life. That is how this is whole thing is designed and, overwhelmingly, how it functions. Given what we know, it's only a truly extreme outlier that could deviate much from this. And, worth noting, it was by this very method (a consensus of subjective assessments by matriarchs), and against the standard set by the above girl, that most of those same ladies (swapping her mom for his mom, of course) performed this same communion and, by contrast to her skill-set and behaviour profile (how else?), the little boy sitting next to her in class was awarded the indelible label “ADHD kid” (aka: broken problem-child.) It really cannot have been otherwise. Can it? If so, how?

On that point, getting an ADHD diagnosis would have felt to you and been read socially as a staggering impediment. This was not anything like the medal of honour it is framed in the current social media milieu, in which neurodivergence and neurodiversity are not just accepted but trending and cool. Resultantly, to me at least, the argument appears to be that if our mothers, third-grade teachers, librarians, and school counsellors weren’t all so egregiously biased against females back in day they would have abused our little girls in equal measure to boys on these terms. They would have doubled the administration of powerful stimulants among their babies, for example. (Ritalin/Concerta: Common side effects include: anxiety, paranoia, irritability, euphoria, difficulty sleeping, loss of appetite, and weight loss. Serious side effects include: addiction and dependence, substance abuse, psychosis (delusions and/or hallucinations), delirium, mania, panic attacks, agitation, aggression, heart disease, seizures, and prolonged erections. Withdrawal symptoms include: dysphoria, depression, fatigue, drowsiness, lethargy, weakness, dizziness, apathy, irritability, headaches, chills, suicidal thoughts, and nightmares.) Along with sticking little girls on powerful psychoactives, they would have placed far more girls in learning disabled programs, giving them labels and associations that would have seen them treated as (not "differently-abled" in some manner, granting them equity-informed accommodations for their spelling tests or med school entrance exams but) fundamentally broken and unfit not just for school but, as a result, most forms of employment. I mean, I don't know how any of this would have been avoided. What was happening where you grew up? And what happened to the boys you know who were labelled and medicated at age seven? Did they all get law degrees?

EXECUTIVE DISFUNCTION

Secondly, they say non-diagnosis in girls occurs because they are less likely than boys to exhibit those hyperactive elements of the disorder and, as such, are less likely to be disruptive in class. Instead, we are told, girls mostly experience elements of executive disfunction. Executive function are most of those abilities we acquire that differentiate our adult self from our child self, things like: organization, prioritization, self-restraint, self-awareness, and more. Disfunction in these areas is not just sneakier than hyperactive disfunctions, they say, but girls with ADHD have these inabilities outsources to or compensated for by parents and teachers. This renders their deficiency very easily overlooked. (Have an assignment due next Tuesday? No problem, mom will remind you…) But does any of this actually make sense to anyone?

Clearly, I don’t understand or am missing something. Maybe the whole point. Still, if lacking executive function (or just some of those components or even merely being slightly less proficient than your classmates) is symptomatic of the disorder, how were these symptoms not just as open to being discovered? The ADHD criteria are the criteria, after all. And any teacher will happily tell you what common tasks and functions all their students excel or persistently fail at. Especially anything developmental. They’re all about comparing and ranking their kids and giving them a score out of five on any damn thing they can come up with. I mean, have you been to a school? They love that shit! Moreover, being incapable of managing due dates (sufficiently enough to be associated with a disabling neurodevelopmental problem) is surely as noticeable as any of the other eight criteria on the ‘inattentive’ side of the list of ADHD symptoms. And, to my mind, those are as obvious as anything on the ‘hyperactive’ list. As any teacher will tell you, things like avoiding tasks that require sustained mental effort, frequently losing essential items, or not listening when spoken to (all attention deficit symptoms) are precisely the kinds of things that get noticed. I mean, this is school we're talking about! And your teacher or father compensating for your inability to do any of these makes will not make them magically less apparent. If so, how? Maia being incapable of finding her shoes every day at recess or her ruler and protractor every single math lesson is as glaring as Miguel bouncing his knee all afternoon or climbing the bookshelf every time you turn your back on him.

Having stood at the front of classes myself, I can assert that you have to work very hard not to notice every one-off accident. Every time a kid drools or drops his pencil is perfectly apparent. (To me this would be like not noticing a streaker at a football game, or something.) How much harder would you have to work, then, to not pick up on chronic behaviours or inabilities – ones that deviate even slightly from any overt or even unspoken developmental or social norm – ones that display themselves all day long every day? (That would be like not noticing that your quarterback was running around without a uniform all game or all season long.) Now, take that reality and multiply it by ten (or, what, ten thousand?) Why? Because no one had only a single adult in their life and for just one day: they had a decades-long and highly intimate experience with a whole range of different adults and in a variety of contexts. And it's on that scale that an ADHD diagnosis is made. (So that, if only to me, seems closer to nobody in the stadium or at home on television noticing that this quarterback wore nothing but cleats for his entire career. Or a herd of flying narwhal at the airport...) What am I missing here?

So, I’d like to ask, are we arguing that your parents, aunts and uncles, and all of your teachers from K-12, as well as the youth pastor, your fourteen soccer, dance, and swim coaches, your best friend Carla’s parents (both of whom work in healthcare), and the lady upstairs who babysat you until you were fourteen, (including, let us not forget, a predatory and all-powerful pharmaceutical industry intent on getting every little kid in the nation hooked on their drugs) all somehow missed your disorder-level inability to A) be on time B) remember things C) complete a task D) stay focussed and E) not lose everything important in your life every day? That seems to me to be something rather different than the minor oversight it is framed as. Instead, it seems more like a radical rejection of nearly everything we’ve all experienced and claim to be true. How am I misrepresenting the situation?

But let’s put all of that aside as well. I still have lots of questions. For instance, let’s assume your executive functions were so discretely outsourced that no one noticed, even yourself. How then would you determine that these were missing or severely diminished back when you were a child? How would you know that’s what happened and it wasn’t that these traits started diminishing in adulthood (maybe after hitting your head that one time at the pool or after that period of heavy drinking your first year of college?) Relatedly, what were the structures, supports, and tools afforded to you that were not also afforded to, say, your brother? In your elementary school, were all the day planners, calendars, assignment reminders, due dates, homework strategies, and classroom rules only offered to one sex? And why would these mysteriously (and perfectly) override or conceal your own disorder and not provide the same helpful services for Carlos or Paul?

INTELLIGENCE AND A DESIRE TO PLEASE

Similarly, I’m actually reading articles about young children so capable and intelligent they were able to entirely avoid expressing any of the symptoms of their debilitating neurodevelopmental disorder. Others explain that the simple reality of being female and enculturated with a strong desire to please (rather than a genius level IQ) was enough to enabled them to override the most consequential aspects of their disorder. Again, if only to me, both seem like radical claims. How is this different from someone saying that as a six-year-old they outsmarted or wished away their autism or cerebral palsy or did so just to impress their mom or kindergarten teacher? Isn't that's what is being said? More than that, what does it mean to have "suffered" from a "disorder" one didn't express and no one else even noticed due to one's super-powers of exceptional intelligence or social sensitivity and responsiveness? Further, what does it mean to be on the most mild end of this spectrum (and to have skirted most or all of the downsides) and to only take the label as an adult, one affording you the same resources, accommodations, and (modern) empathy as those most impacted? This feels like arguing for an accessibility parking pass on the personal subjective assessment that you were not able to run as fast or jump as high as your friends in primary school and feel you may still be less able.

At least some part of this intelligence picture appears to be correct, but not as stated. I've found studies trying to make sense of the sex differences noted with ADHD. They explain that ADHD in girls tends to be less severe than in boys and that females with ADHD outperform males with ADHD. Girls with ADHD, we are told, have symptoms that are not just less extreme but also tend to have fewer symptoms than boys. More than that, researchers tell us they've ruled out sample bias, measurement problems, or ‘missing symptoms’ as an explanation of sex differences (and thereby excluding socially or culturally prescribed sexism toward girls); instead, they note the “genetic and cognitive liabilities between the sexes” (or inherent, biologically prescribed benefits afforded girls, or denied boys) as the most likely candidates.

SCIENCE OR PALM READING?

More than all of that though, it’s wild that anyone with a tacit understanding of psychology or behaviour (never mind experts in the field) would insist someone middle-aged is even capable of accurately portraying their childhood experience or can self-diagnosing a developmental disorder (that, as a child, requires of team of close observers with current first-hand accounts at the ready.) These practitioners spent decades convincing us that every one of us are incapable of recalling even general details (height, sex, skin colour, or clothing colour) of the individual who just left the room – immediately after being made to focus all our attention on that very person. They insist we can and commonly do fabricate virtually anything and everything and do so without any motivations we’re aware of. With that premise, they turn around and tell us about someone who read an article, or maybe five, who has learned the appropriate answers to get the diagnosis they seek, who then goes in for a confirmation of what is already a strong suspicion (or they wouldn’t be there) – and then is given a test that asks for a self-diagnosis of patterns of behaviour based on a purely subjective set of criteria? Well! To my mind, being involved in any part of this should result in the revocation of all one’s psych credentials. No, really. Could there be a clearer demonstration that a person learned nothing in all their years of schooling? I mean, this is a slightly less robust diagnostic method than palm reading. Seriously, what am I missing? I’ll argue all day long that you (and I) selectively and rather aggressively misremember everything; and that you (and I) do so constantly to paint for yourself (myself) into whatever narrative you’re (I’m) currently keen to inhabit and project. But what do I know?

DIS-ORDER?

For me, maybe more than all of the above, I don’t consider myself to be afflicted by ADHD. That said, I can happily report that I experience all the criteria adults (largely middle-aged women) are commonly raving about at the moment in clips on Instagram. I experience forgetfulness, restlessness, irritability, lack of attention to detail, trouble completing tasks, and/or speaking out of turn. These are the primary phenomena of my life, past and present, as far as I'm able to discern. (Would any of the people closest to me disagree with any of this?) In this light, indeed, what would it be like to not experience what I’m told are critical impairments? More, I can't even comprehend an inner mental life not predominantly obscured by a fog of mental noise or that isn't continually derailed, and re-derailed, by divergent thoughts. Indeed, double-indeed, how much more could I (we) get done and where would I (we) be now if none of this was present, or even if it was just slightly less dominant? What if every sight and sound didn’t distract and divert every thought, conversation, or task at hand? What would it even mean to be able to do two simple things, like listening and writing, at once? And what if that had been the norm from primary school on? Moreover, what if puberty hadn’t taken that distractive initial and converted it to technicolour and amplified it by four orders of magnitude from age ten on? The absence of all of the above is what I imagine it is like to be a machine and not anything at all like what I understand of the human experience. As such, it feels to me more like our human nature is the [dis]order most folks are seeking to overcome.

I'd love to know how none of these assessments of mine are on point or relevant. What else do I need to read?

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RESOURCES

"What is ADHD" - American Psychiatric Association

https://www.psychiatry.org/patients-families/adhd/what-is-adhd

"Sex Differences in ADHD Symptom Severity" - Arnett et al.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4385512/

"Journalist Lisa Ling on Having ADHD" - Distraction Podcast

https://www.distractionpodcast.com/2017/10/17/s2-ep-22-journalist-lisa-ling-on-having-adhd/

"The Mysterious Paradox of Being a High Achiever With ADHD" - Dixon

https://www.dixonlifecoaching.com/post/2018/05/07/the-mysterious-paradox-of-being-a-high-achiever-with-adhd

"Children’s Attention Deficit/Hyperactivity Disorder Self-Help Books and the Politics of Correction" - Gold