MY DUDES.
So, I don’t know if you noticed, but…
I totally missed my Friday post.
Wah-wah.
And sadly, it’s not because I just blew it off or forgot or lost track of what day it was. I actually worked on it for hours, right up to and beyond midnight, in fact. It was already over a thousand words, too, and I was actually trying to figure out how to make it more manageable and concise when I went looking for just one more source…
And then I waved goodbye to Dinah and the rabbit hole swallowed me up.
For I had discovered the MOTHERLODE.
And the only reason I happened to stumble upon it is because of a very quintessential ADHD conundrum, the “meant to/instead” dichotomy. See, per last Monday’s slog post, I meant to share some fascinating tidbits comparing the primarily inattentive and combined presentations of ADHD. But instead, I’m going to not do that, because my brain decided it has other plans. And the power this dichotomy holds over us is, unfortunately, a seemingly inescapable part of our lives.
I meant to just grab half and half at Trader Joe’s, but instead I walked out with a dozen things, none of which were half and half.
I meant to finally send that important email, but instead I spent three hours reading up on nineteenth century British military engagements in Afghanistan.
I meant to be all ready and setup for my zoom appointment with my psychiatric nurse practitioner well ahead of time this month, but instead, since I had stayed up till 3am the night before lost in a very deep rabbit hole researching histamine intolerance and mast cell activation syndrome, I was so exhausted and frazzled the next morning, I completely lost track of time and was, in fact, so late, she had to call and check in with me for the first time in a year.
And like, that’s just a Wednesday for me, you know?
Anyway.
Our “instead” this time is a what was meant to be brief discussion about how and why ADHD is actually a big fucking deal, something all too often met with vehement skepticism or outright disdain, even amongst otherwise open-minded people who are quite accepting and supportive of mental health differences in general. And I’m not just here to refute these aggravatingly common and ultimately extraordinarily harmful misconceptions and dismissals for my sake or my husband’s sake or for the sake of all the other children and adults with ADHD out there. It’s actually even more personal than that for me.
How does something that’s already literally personal to you become even more personal?
Well, I mentioned in my first post-death post that my genius husband was finally able to do what none of the myriad psychiatrists and psychologists and other doctors and specialists over the years had been able to do precisely because he had finally arrived at his own tragically tardy ADHD diagnosis the year prior (and all because the sound of the dog licking himself lights my rage fuse like almost nothing else–thanks, reddit!).
But what I didn’t mention is that we have two kids.
And they both have ADHD as well.
Four for four. All diagnosed within the space of a year and a half.
So that’s how personal shit gets even more personal: when said shit affects your kids, too.
Some basic facts, then. ADHD is considered a neurodevelopmental/neurobiological disorder stemming from differences in the volume and rate of development of various regions of the brain, documented via MRI. It is a genetic difference with a very high heritability rate, although environmental factors can and do play a role in gene expression, and has been found to involve mutations in the same genes responsible for autism spectrum disorder. The mechanism by which ADHD symptoms become apparent involves an overall deficit of available neurotransmitters (chemical messengers) in the brain, namely dopamine, norepinephrine, and serotonin.
There seems to be ongoing controversy within the realm of ADHD research about the exact nature and ultimate usefulness of what have been known as the ADHD subtypes, and which are now generally referred to as presentations. But there is agreement that ADHD traits fall within two distinct clusters, inattentive traits making up one, and hyperactive/impulsive traits making up the other. So within that paradigm, the three presentations become:
ADHD-PI: presenting with primarily inattentive symptoms
ADHD-HI: presenting with primarily hyperactive/impulsive symptoms
ADHD-C: presenting with both inattentive and hyperactive/impulsive symptoms
For those of you who want to explore the full diagnostic criteria for ADHD, including examples of behavior for each of the clusters of traits, you can do that here. And I want to make an important point in relation to the very last section, which gives criteria for specifying the severity of symptoms, whether mild, moderate, or severe. You’ll notice the distinction hinges on how much the person’s symptoms contribute to “functional impairments” in various settings, whether social, occupational, and although not specifically listed here, this includes academic as well. This distinction is critical not just for identifying the severity of a person’s ADHD, but also for diagnosing ADHD in the first place.
The reason for this, which also ties in to the still shamefully prevalent belief that ADHD somehow doesn’t actually exist or it’s not that big of a deal and we’re all just lazy fuckers fakers, is that the things people with ADHD struggle with–disorganization, forgetfulness, motivation, delaying gratification, goal-setting, consistency, etc.–are things that almost everyone struggles with sometimes. But the key word there is sometimes.
And that’s where the criteria of “functional impairment” comes into play. Has your disorganization and inability to complete tasks on-time ever caused you to lose a job or three? Has your distractibility and inattention to detail been the source of car accidents or speeding tickets or the revocation of your license? Has your forgetfulness in returning texts or emails or phone calls (for you weirdos who still do that) contributed to losing friendships? Has your struggle with emotional regulation resulted in strained familial relationships or divorce? Has your inability to keep up a routine of daily hygiene resulted in thousands of dollars in dental costs to fix the damage? Do these types of things happen repeatedly, over and over and over again, despite your best intentions and your best planning and your very best efforts to finally, finally, FINALLY get your proverbial shit together this time?
Because THAT is the difference for people with ADHD. These very normal and universal parts of life that everyone deals with at some point or another are so all-encompassing for people with ADHD, they literally dictate our chances of success or failure at nearly everything we set out to do, regardless of intelligence or knowledge or ability. They are not simply inconveniences for us. They are the things that make even the simplest parts of daily life a near-constant struggle of confusion and frustration and self-loathing, especially for those of us on the severe end of that severity spectrum.
And this is where the MOTHERLODE came in.
(Also, yes, I do feel the need to keep putting that in all caps. Like, how could you not put a word like that in all caps? That’s just…disrespectful.)
My plan was to end this post by sharing some statistics from this 2014 literature review focusing on the under-diagnosis of ADHD in adults and the adverse outcomes resulting from symptoms persisting beyond adolescence (which they do for about 2/3 of people with ADHD), especially when a person remains undiagnosed, untreated, or under-treated. And I can’t remember which bit of specific information I went searching for to supplement it with, but the result was extremely serendipitous.
I present to you the MOTHERLODE:
This was just published in the journal of Neuroscience & Biobehavioral Reviews in September of this year, nearly 20 years after the first International Consensus Statement on ADHD was published. The authors’ aim was to review high-quality studies and meta-analyses in order to establish “empirically supported statements about ADHD,” with the specific goal of addressing this stated fact:
“Misconceptions about ADHD stigmatize affected people, reduce credibility of providers, and prevent/delay treatment.”
See what I mean?
For tonight, I’m just going to leave you with a few points from their summary of findings in order to illustrate the magnitude of how ADHD actually affects people, including those around them and society at large.
It’s pretty fucking bleak, friends.
People with ADHD are at increased risk for obesity, asthma, allergies, diabetes mellitus, hypertension, sleep problems, psoriasis, epilepsy, sexually transmitted infections, abnormalities of the eye, immune disorders, and metabolic disorders.
People with ADHD are at increased risk for low quality of life, substance use disorders, accidental injuries, educational underachievement, unemployment, gambling, teenage pregnancy, difficulties socializing, delinquency, suicide, and premature death.
Studies of economic burden show that ADHD costs society hundreds of billions of dollars each year, worldwide.
But thankfully, not all of it is bleak. And this last is a point that needs to be shouted from every fucking rooftop, every fucking day until it is properly understood and believed, because the cruel, pervasive stigma surrounding it could be said to quite literally be killing people:
Treatment with ADHD medications reduces accidental injuries, traumatic brain injury, substance abuse, cigarette smoking, educational underachievement, bone fractures, sexually transmitted infections, depression, suicide, criminal activity and teenage pregnancy.
I want to end by giving you all my sincerest and most heartfelt thanks for being here. The only way these outcomes change is by spreading awareness, increasing knowledge, and learning to support and celebrate neurodiversity. And I believe perhaps the most powerful and crucial path to change is found through pulling back the curtains we all work so tirelessly to keep impenetrable, in order to share our actual lived experience, and thereby, hopefully, foster greater understanding and acceptance of our differences.
So, again, thank you for being here to peek in at my reality. I hope you’re able to come away feeling like you’ve benefitted in some way, however small. Because those small things add up. And maybe by the time my kids are having kids (if that’s their thing, of course), we’ll be having an altogether different, more truthful, more factual, more positive conversation about ADHD and neurodiversity in general.
Okay, I finished that last sentence literally at 11:59pm, and finally realized the other day I needed to change my site’s timestamp to match my time zone, so it no longer appears as if I’m speaking nonsense when I celebrate getting a post published just in time on a goal day (but no need to worry–I’ll still appear to speak plenty of nonsense about other things, I’m sure). That being said, I still need to proofread one more time (always out loud for the final draft, people) and add some tags and all that fanciness. So technically this will be posted in the wee minutes of Tuesday morning.
And I will absolutely still consider it a victory.
Ware the Words 