What is ADHD? Is it real?
ADHD - Attention Deficit and Hyperactivity Disorder - is considered a neurodevelopmental disorder. In other words, it is a condition in which parts of the brain have developed in a way that certain skills are weaker. (There can frequently be strengths as well.) Without boring you with the details, there is scientific research - including brain scans - supporting this categorization and diagnosis. (Or, in other words, yes. It is real.)
(Other conditions or experiences can create similar – or even identical - symptoms, but only the innate neurodevelopmental condition is called ADHD. This will be elaborated upon shortly.)
ADHD symptoms can include a wide range of behaviors. The ones included in the name of the condition are erratic attention - “Attention Deficit,” and hyperactivity - “Hyperactivity Disorder.”
The wider range of symptoms can (but doesn’t always) include: impulsivity, stimulation seeking, executive function challenges such as poor time management, cluttered spaces, strong emotional reactions - called emotional dysregulation - and more.
In children, common manifestations include trouble sitting in class, difficulty waiting on lines, losing or having challenges in keeping track of assignments, and meltdowns.
In adults, common manifestations include difficulty staying focused on work, difficulty managing time, forgetting to follow through on planned tasks, and chronic procrastination. This list is far from exhaustive.
Where does ADHD come from?
ADHD is overwhelmingly genetic. It can also come from exposure to toxins during pregnancy, or difficulty in childbirth.
There are other factors that can cause behaviors similar to – or even the same as – ADHD, but are not symptoms of ADHD and may require different treatment plans.
These include anxiety, trauma, excessive use of screens, and more. It is for this reason that an experienced clinician needs to conduct a careful and thorough assessment to determine that the correct diagnosis is ADHD, and not a different condition.
Doesn’t everyone have trouble concentrating sometimes?
Of course! For something to qualify as a disorder, it needs to be more severe than the average person’s experience in two ways: severity of symptoms and impairment of function.
This means that the level of distraction needs to be more severe than that of the average person (either in intensity, frequency, or both) and needs to affect one's ability to function.
A comparable analogy is that of one who has a headache in contrast with one who suffers from migraines. Most people experience a headache sometimes, but they can be addressed with some basic interventions. One who suffers from migraines experiences more severe headaches, at a level of harshness and frequency that becomes disruptive in their day-to-day life.
Is ADHD only in kids?
Nope. It was thought that it was only relevant to children, but later research disproved this, and was widely shared in a groundbreaking book called Driven to Distraction (Edward Hallowell, John Ratey, 1994).
The hyperactivity of adults differs from that of kids (thankfully). Whereas hyperactivity in children is overt and physical, hyperactivity in adults can manifest as talking excessively, restlessness, fidgety behaviors, impatience, or racing thoughts.
There can even be challenges of ADHD that only become disruptive for the first time in one’s adult life. This frequently takes place when one has new responsibilities such as moving in to their own home, starting a business, getting married, etc.
Does ADHD only affect males?
No. It was thought that ADHD only affects males, but it has emerged that this is not the case. More women present with the inattentive presentation of ADHD rather than the hyperactive presentation, which can lead to the challenges being overlooked.
Additionally, many women do a good job of masking their ADHD symptoms out of a sense of shame and embarrassment, and do this quite well. For these reasons (and probably others as well) ADHD in girls and women is commonly missed. Unfortunately, the diagnosis is sometimes only first made when a woman is struggling with depression, often related to a sense of underachievement. Another time that it tends to be realized is when her child is diagnosed with ADHD.
They said that my son/husband has ADHD. If he has a problem with attention, how can he watch TV/play video games/read books for hours on end?
Although the name “ADHD” references an attention deficit, the truth is that this wording is imprecise. The ADHD brain does not have impaired ability to pay attention. Rather, the impairment is in the ability to control attention. Therefore, the brain pays attention to whatever grips it most strongly. This may include something interesting or enjoyable, or even something disruptive or frightening. Something the brain knows to be important, but is not emotionally charged, may then be unintentionally ignored. This may include tedious work that needs to be done, a family member talking to them, or tasks around the house they had committed to do.
If someone receives a diagnosis of ADHD, what should their next step be?
Treatment plans for ADHD vary based on the needs of the individual. They may need therapy, medication, coaching, or any combination thereof. A licensed therapist or prescriber who is specifically very familiar with ADHD, or an ADHD coach, can help within their respective competency and should direct you to whichever other professional you need. The easiest place to start is with the one who made the diagnosis.
What does ADHD medication do? Does it solve all problems?
There are many different medications for ADHD, which work differently than one another, and can be administered in different ways. The common denominator between the different options is that they help with focus as well as with emotional regulation.
In the field of ADHD coaching, it is said that “The pill can’t teach skill.” This refers to certain executive function skills such as management of time and spaces, and prioritizing tasks. Medication doesn’t improve these skills, as well as certain other ones, but it can become easier to learn them once focus is under control through medication.
What are the benefits/drawbacks of getting a diagnosis for myself/my child?
The benefits of receiving a formal diagnosis include: having a framework in which to understand one’s challenges, awareness of other issues one may have otherwise not even noticed, an appreciation of one’s ADHD challenges not being their fault, and the realization that they are not alone in this journey.
Potential drawbacks are more relevant for children than for adults. They include: a sense of stigma, a school or institution trying to force parents to medicate when they don’t want to, or a child using their ADHD as an excuse not to try at all. Additionally, if the ADHD related challenges a child is experiencing are minimal, they have strategies in place that are working, and the testing process will be onerous, it may not be worth the hassle at the moment.
Many of these challenges can be circumvented if: in the case of a young child, they are told they are getting help without mention of the term ADHD, or - in older kids – they know others with ADHD and are ready for a mature approach to a diagnosis.
What roles do therapy and/or coaching play? What is the difference between the two?
Therapy helps people process different experiences and emotions they have had or presently have. Difficult experiences can include an inordinate amount of negative feedback – sometimes in public or in front of their friends, frequently being asked to fulfill tasks they don’t know how to do and don’t know why, being made fun of for being “space cadets” or messy, being unproductive in yeshiva despite the best of intentions, failing to finish college, or losing a job or a relationship.
Coaching does not address these experiences of the past at all. Rather, coaching helps a client understand how their brain works, and then create strategies to succeed in their career, relationships, school, or wherever they are having difficulty, based on this knowledge (as well as leveraging their general strengths and interests).
In short, therapy addresses the past and emotions, while coaching addresses practical challenges in productivity.
Can ADHD be overcome?
The nature of a person’s ADHD brain doesn’t change, but the challenges can be addressed very effectively.
Dr. Russell Barkley compares this to diabetes – although diabetes is dangerous if ignored, there is treatment that can significantly mitigate its effects on day-to-day function, as long as it is administered and followed.
The same can be said of ADHD - with the right help and/or arrangements, the creative, fun, and talented individuals who have it can shine and achieve their great potential.
Rabbi Shmuel Reich, AAPC, Dip.OCD is an ADHD coach in private practice helping individuals, teens, parents, and couples navigate challenges presented by ADHD, OCD, or anxiety to achieve success and increased productivity at work, in school, and in relationships. He is also the host of The ADHD Heroes Podcast https://podcasts.apple.com/kg/podcast/the-adhd-heroes-podcast/id1760463263
Rabbi Reich can be reached for one-on-one coaching or speaking engagements via email at rsreichadhdcoach@gmail.com or through his website rsreichadhdcoach.com