I am often asked if I think ADHD is over-diagnosed.
My answer – yes.
I also believe it is underdiagnosed.
The problem is that there is still not one agreed-upon cohesive and comprehensive protocol for diagnosing ADHD; a real, life-impacting disorder that affects a significant percentage of people. And yet there are still many practitioners who do not include an ADHD screening in their assessments. I believe, and evidence supports, there are enormous lifelong risks to mental health, physical health, employment, and healthy marriages/relationships if ADHD is NOT accurately assessed and diagnosed (in children and adults).
We have known for long enough that:
Self-concept (whether you frame it as self-esteem, strengths/weaknesses, temperament, or personality) impacts how you approach relationships, opportunities, your health, and your employment.
I will explain it.
Self Concept and ADHD
Perhaps you have grown up believing that your life’s challenges are due to having Anxiety (diagnosed or self-assessed). You get overwhelmed very easily, so you avoid trying new things, or certain situations or settings for fear that you may become too upset or angry and will end up either embarrassing yourself or others.
Or perhaps you struggle with Depression (again, diagnosed or self-assessed). Often you feel too reluctant to join in social situations, can’t concentrate enough to succeed, or become paralyzed when faced with certain obligations or opportunities. So, you struggle to get off the couch or started with your day in any meaningful way, further digging a hole and stalling your life.
Or you have always struggled to learn, regardless of how “bright” everyone said you were. Maybe you considered that you must have some underlying learning disabilities which held you back from pursuing specific interests or passions. All you knew was that keeping up in class was hard at best, and the process of studying for and taking tests seemed an insurmountable task.
The reality is that all of these things may be true (regardless of whether these factors are at clinically diagnosable levels or not). I have found something interesting in my practice working with parents, and speaking with many people in all areas of life. The story that people believe about their success and failure is sometimes based on inaccurate or incomplete knowledge about themselves.
I have said for years that, Autism aside, we are ALL on a spectrum.
We all have strengths and weaknesses in:
- how we process information (regarding speed, preferred method of access, etc.)
- how we can hold on to information as we use it (working memory)
- how well we can attend in different settings, etc.
Sometimes our strengths and weaknesses are within a “typical” range and don’t significantly impact our functioning. But sometimes, people consistently struggle to function at a peak or reliable manner, and it holds them back from feeling confident, or even comfortable, in various settings. I contend that how we view ourselves in those settings guides us in how we approach our lives.
Our explanation guides our intervention.
If I believe that “I struggle to keep up in class is because I am depressed or anxious,” I may look toward a particular type of therapy or medication to alleviate my challenges. But what if I learn that I am struggling because I have the neurobiological condition called ADHD? Perhaps, as a result, I have a slower processing speed than those around me? Or I have trouble keeping up because my working memory is weak. Without visual aids or having the material broken down into smaller parts, I get lost, frustrated, and overwhelmed. If I knew and accepted that I had ADHD, I might be open to getting appropriate education about the condition and be open to learning specific tools and strategies to make life easier. I might consider Coaching or medication to support me in my journey. Rather than just therapy aimed at helping me deal from the perspective of Anxiety or Depression, I might have newfound hope that I can improve my situation by following the path many others with ADHD have been following for years.
Substantial overlap between ADHD, Anxiety, and Depression
The statistics range regarding the percentage of people who have ADHD along with Anxiety (approximately 33%) and/or Depression (approximately 15%). Still, the data makes it clear that ADHD must be considered when one of these conditions is present. (28% Of Referrals To A Mood & Anxiety Clinic Had Undiagnosed ADHD)
I don’t suggest using Google or your friends for the diagnosis. Many things may also be at play that might impact behavior (ex. Thyroid condition, severe Sleep Apnea, PTSD, severe food allergies). Please be sure to go to a qualified professional who makes it part of their protocol to assess for ADHD.
In 2011, I attended the national CHADD conference and listened to Dr. Russell Barkley, and Dr. Ned Hallowell give a keynote presentation on the challenges and opportunities of ADHD. (ADHD Neither Gift Nor Curse) I have known and listened to both of these esteemed professionals for years, and it was fascinating to hear each speak from the other person’s position. Dr. Barkley, the
research, has always presented the hard, cold, facts about ADHD – the risks and the challenges. Dr. Hallowell, the clinician, has always talked about the hope and opportunities connected with having ADHD. As they said when they spoke together, both are, of course, true. But you must start with the diagnosis – knowing what the factors are that create your unique brain. Then you get the opportunity to shape how you use your strengths and compensate for your weaknesses.
If ever you feel you would like one-on-one support or have any questions, please feel free to reach out to me directly. [email protected]