“I attempted to pick up my son from school to take him to the hospital emergency room. The teacher said he had a seizure-like activity. When I arrived at school, he was restrained by two administrators as they escorted him to my car. He became very aggressive inside my car and hit me in the head so hard that I was bleeding. I attempted to call Crisis Response, but the operator said they weren’t available and dispatched police. Two officers arrived. My son has BFRBs (body-focused repetitive behaviors). One officer yelled at my son, ‘Look at me when I talk to you. You think it’s OK to just sit there and pick your nose and nails? You think it’s alright to hit your mom? Boy, if you were a little older, I’d lock you up right now!‘”

“I was arrested at age 21 for spray painting a small stencil of leaping wildebeests on a concrete overpass in broad daylight. I gave zero thought to the implications of spray painting in a public space. It was impulsive and creative. The consequences were huge. I wish that impulsivity were part of the conversation when educating public safety officials about ADHD.”

[Free Download: Common Signs of a Body-Focused Repetitive Behavior]

“When my son was in high school, he had a giant meltdown after a peer incident. The police were called. He’s a large kid and started sobbing. The police told him to stop crying or he’d be handcuffed. Needless to say, he was handcuffed. I wish the police knew more about the mental health aspects of ADHD. It was a humiliating situation for all involved.”

“Before my diagnosis, I was a chronic speed demon. I would often bump into and scuff other cars… My inattention put me and others at risk for harm. I wish law enforcement knew about health care disparities and the under-diagnosis of ADHD. Criminalizing people for a disease is cruel behavior.”

“I was diagnosed with premenstrual dysphoric disorder (PMDD) and oppositional defiant disorder (ODD) in 1993 and 1994. We now know how PMDD can impact ADHD and how untreated ADHD can look like ODD or be comorbid. None of that was considered 30 years ago for a female. I also masked well and was considered a gifted student. I was very quick to challenge adults who I believed were wrong and I was quick to argue with anyone for anything. I got into trouble a lot. I wish law enforcement knew more about neurodivergent struggles with emotional regulation and utilized calm, compassionate methods before reacting.”

[Self-Test: Premenstrual Dysphoric Disorder Symptoms]

Detained by Police? Follow These Steps

1. First, pause. It’s important to not say the first thought that goes through your mind.
2. Tell the officer you have ADHD. Under the Americans with Disabilities Act, you’re entitled to reasonable accommodations, including modified questioning, fidgets and frequent breaks, and access to your medication.
3. Before you answer questions, make sure to have someone you trust, such as a lawyer or a family member, with you to figure out exactly what happened. You must be truthful and accurate with police, so if you are forgetful and have time-blindness, it’s essential to have a lawyer or trusted person with you for support.

Police Training and ADHD Awareness: Next Steps

• Q&A: ADA Information for the Recently Diagnosed
• Read: Crime, Punishment, and Redemption for My Son with ADHD
• Free Download: An In-Depth Guide to Inattentive ADHD

SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

At 44, when I was diagnosed with ADHD, my neuropsychologist warned me that telling my family about it, given the personal background I provided, might not be the wisest idea.

Before I brought up ADHD to my family, they never questioned my previous medical diagnoses: migraines, a root canal, COVID-19, two bunionectomies, and two staph infections. My understanding of my health conditions was never challenged until it came to ADHD, when a single family member politely undermined my medical diagnosis, my grasp of reality, and my intelligence.

Why the ADHD denial?

To Deny ADHD Is to Uphold a Fraught Reality

Those who dismiss ADHD, I gather, often do it as an act of self-preservation. To deny ADHD is to avoid uncomfortable truths about opportunity and success.

From the moment small children can comprehend language, adult authority figures tell them that if they follow specific steps, a particular outcome is very likely or guaranteed. “Work hard, and you’ll get good grades.” “Success is no accident.”  “Practice makes perfect.” This rigid, unforgiving logic is the very foundation of the American Dream and a common justification not to help each other. Athletes, actors, musicians, authors, artists, scientists, and other recipients of professional honors, wealth, and prestige will parrot the same talking points.

[Read: Why It Hurts When Neurotypicals Claim an “ADHD Moment”]

My parents and teachers reiterated these adages too. All of my siblings ardently followed this advice, and they were richly rewarded for their legitimate hard work: private boarding schools in England, Ivy League graduate degrees, high incomes, networking with wealthy families, and professional achievements.

Not for me or the other one in 20 children in the 1980s who had ADHD, though.

The people who champion these simplistic platitudes don’t realize or account for the fact that learning isn’t that simple for those of us who are wired differently. If an undetected and untreated developmental disability stymied my academic and professional achievements – instead of my alleged lazy, unmotivated, unintelligent, and scatterbrained behaviors – then the reality for my family and all the other people who genuinely think they worked hard is shattered.

Despite steps to mitigate the effects of disability discrimination, this country still wrestles with the fact that not all opportunities for success are equal, especially in highly competitive, driven environments. Most upsetting is the fact that ADHD runs in families, meaning that “bad” genetics can threaten to upend one’s previously positive self-image and long-held beliefs about intelligence. The inability to accept reality, such as loved ones clinging to stigma over facts, takes hold in families and denies the possibility for compassion, empathy, and proper treatment.

Covert Denial and Faux Concern

I’ll give these skeptics and critics some credit: they know outright denials or rejections of an ADHD diagnosis are no longer socially acceptable. They really don’t want to appear brazenly ignorant by contradicting a widely recognized neurodevelopmental disorder.

[Read: “Is ADHD Really Real?” 6 Ranked Responses to ADD Skeptics]

What’s the “better” response? Very respectful, palatable contradictions that are cloaked in faux concern and passive-aggressive denial. “Being fidgety is normal in children, but now it’s a ‘condition!’” “The inability to focus and concentrate probably isn’t really ADHD.” “All of this ADHD nonsense is only a flashy trend.” “Is the rise in diagnoses social media’s fault?” In my case, I got the question, “Did you take this, um, ADHD test online? Because that’s not how diagnostic testing works.”

ADHD skeptics and critics don’t want to face the fact that one of the driving reasons neurotypical people flourished in life is because academic and workplace environments are mostly set up so only neurotypical people could thrive and prosper.

If there had ever been a proactive, organic nationwide movement to acknowledge and understand disabilities and work to equalize the playing field, then the Americans with Disabilities Act and the Individuals with Disabilities Education Act wouldn’t need to exist. Thankfully, legally mandated disability accommodations expand the chances of success to more people in the workplace, classroom, and other fields. However, with change comes unpredictability. Insecurity and fear drive prejudices and make ADHD accommodations difficult to obtain.

As for my family member who repeatedly attacked the credentials and professional licensure of the neuropsychologist who diagnosed me, I eventually got somewhat of an apology. “I think it’s really good you found ADHD. All of… that seems to be helping you.” I had no idea I had it so good.

ADHD Is Real: Next Steps

• Free Download: How Common Is ADHD in Adults?
• Read: The Definition of ADHD — Myths & Truths
• Read: The Controversy That Was Adult ADHD

Maria Reppas lives with her family on the East Coast. Visit her on Twitter and at mariareppas.com.

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Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

When we fell in love with the YouTube viral video “Xmas Jammies” 10 years ago, we didn’t know that Penn Holderness had ADHD. Since then, Penn and Kim Holderness, the First Family of ADHD, have regaled us with instant classics including “10 ADHD Lifehacks from Penn,” “Me and My ADHD,” and “How to Listen (Kinda) with ADHD.”

Aside from making us LOL, these witty and endearing videos have showcased the brilliant creativity, mind-blowing energy, and totally unique perspectives that ADHD can bring. ADHD is not 100% awesome, but the Holderness Family is very good at reminding us about the aspects and elements of this condition that do not suck.

In their new book, ADHD is Awesome: A Guide To (Mostly) Thriving With ADHD, Penn and Kim encourage readers to change the narrative around ADHD with something they call Operation Mind Shift. In this webinar, they will discuss…

• How to blow up the maddening myths about ADHD that persist
• How to talk to your loved ones about ADHD in a way that educates but doesn’t blame
• How to reframe your ADHD traits in a way that doesn’t capsize your self-esteem
• How to model ADHD positivity for your children
• How to embrace routine and control your environment while remaining zany and fun
• How to win “The Amazing Race” (just kidding, but they actually did win!)
• And much more

Watch the Video Replay

Enter your email address in the box above labeled “Video Replay + Slide Access” to watch the video replay (closed captions available) and download the slide presentation.

Living with ADHD: More Resources

• Download: How to Build a Dopamine Menu
• Get: Your Complete ADHD Guide
• Read: 9 ADHD Myths That Perpetuate Stigma
• Read: The Positives of ADHD

Obtain a Certificate of Attendance

If you attended the live webinar on May 13, 2024, watched the video replay, or listened to the podcast, you may purchase a certificate of attendance option (cost: $10). Note: ADDitude does not offer CEU credits. Click here to purchase the certificate of attendance option »

Meet the Expert Speaker

Kim and Penn have been married for 16 years. For 7 of those years, they have chronicled their marriage and their family with funny music videos, vlogs, skits, and a podcast. Their videos have resulted in over a billion views and 4.5 million followers across social media.

Penn and Kim honed their storytelling skills with 25 combined years in the TV news business. Today, they own their own company, Holderness Family Productions, where Kim is Chief Executive Officer and Penn is Chief Creative Officer.

As well as creating content for their channels, they also work alongside brands and agencies to shape product launches and marketing campaigns. Their book Everybody Fights about improving communication in marriage was released March 30, 2021. Their new book, ADHD is Awesome: A Guide To (Mostly) Thriving With ADHD was released April 30, 2024.

Webinar Sponsor

The sponsor of this ADDitude webinar is….

It’s so easy to beat ourselves up for our ADHD that we often forget about all the great things about neurodivergence. At Inflow, we’re here to celebrate your victories, big or small, and remind you that your ADHD can be a strength. Developed by leading clinicians (and fellow ADHDers!), Inflow’s CBT-based program is your starting point to managing your ADHD and embracing neurodiversity. Get your ADHD score today to kick off your Inflow journey.

ADDitude thanks our sponsors for supporting our webinars. Sponsorship has no influence on speaker selection or webinar content.

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Black children and adults with ADHD are less likely to receive an accurate diagnosis and proper treatment due to structural racism, low socioeconomic status, and stigma, all of which can worsen the symptoms of ADHD. Racial disparities in health care are critical to recognize and address because untreated symptoms of ADHD — including learning difficulties, impulsivity, inattention, and hyperactivity — can lead to harsh punishment of students in school, failure to graduate, substance use, and increased risk for incarceration.

In this webinar, you will learn:

• About risk factors for ADHD in Black individuals
• About the facets of racism and the present-day policies that impede proper diagnosis, care, and treatment of ADHD in Black communities
• About the serious consequences associated with untreated ADHD
• What adults and caregivers of children with ADHD need to know to find appropriate providers and ensure proper care and treatment
• How adults and caregivers of children with ADHD can effectively address stigma, build trusting relationships with clinicians, and overcome other barriers to treatment
• About strategies, including Parent Behavioral Training Programs, that can be effective for managing ADHD in families of color

Watch the Video Replay

Enter your email address in the box above labeled “Video Replay + Slide Access” to watch the video replay (closed captions available) and download the slide presentation.

Download or Stream the Podcast Audio

Click the play button below to listen to this episode directly in your browser, click the  symbol to download to listen later, or open in your podcasts app: Apple Podcasts; Audacy; Spotify; Amazon Music; iHeartRADIO.

Healthy Equity in ADHD: More Resources

• Get: 2024 Scorecard of ADHD Treatments
  
• Read: The Ongoing Work of Normalizing ADHD in BIPOC Communities
• Read: Why We Must Achieve Equitable ADHD Care for African American and Latinx Children
• Download: How Common Is ADHD in Adults?

Obtain a Certificate of Attendance

If you attended the live webinar on March 7, 2024, watched the video replay, or listened to the podcast, you may purchase a certificate of attendance option (cost: $10). Note: ADDitude does not offer CEU credits. Click here to purchase the certificate of attendance option »

Meet the Expert Speaker

Napoleon Higgins, M.D., is a child, adolescent, and adult psychiatrist in Houston, Texas. He is the owner of Bay Pointe Behavioral Health Services and Kaleidoscope Clinical Research.

Dr. Higgins is the Executive Director of the Black Psychiatrists of America, CEO of Global Health Psychiatry, President of the Black Psychiatrists of Greater Houston, Psychiatry Section Chair of the National Medical Association, and Past President of the Caucus of Black Psychiatrists of the American Psychiatric Association.

Dr. Higgins is co-author of Bree’s Journey to Joy: A Story about Childhood Grief and Depression, How Amari Learned to Love School Again: A Story about ADHD, Mind Matters: A Resource Guide to Psychiatry for Black Communities and author of Transition 2 Practice: 21 Things Every Doctor Must Know In Contract Negotiations and the Job Search. (#CommissionsEarned)

Dr. Higgins has worked with and founded programs that help to direct inner-city young men and women to aspire to go to college and finish their educational goals. He has worked with countless community mentoring programs and has special interest in trauma, racism, and inner-city issues and how they affect minority and disadvantaged children and communities.

#CommissionsEarned As an Amazon Associate, ADDitude earns a commission from qualifying purchases made by ADDitude readers on the affiliate links we share. However, all products linked in the ADDitude Store have been independently selected by our editors and/or recommended by our readers. Prices are accurate and items in stock as of time of publication.

Listener Testimonials

“Fantastic webinar. The examples really brought home the points and he did a good job of showing how complicated this is to navigate.”

“Thank you for providing info about culturally competent ADHD treatment. Dr. Higgins highlighted what us Black parents have always known — that race matters when it comes to medical and educational resources. I wish this information could be proliferated in every school across the nation!”

“Great speaker, and very insightful. I enjoyed this presentation very much.”

Follow ADDitude’s full ADHD Experts Podcast in your podcasts app:
Apple Podcasts | Google Podcasts | Spotify | Google Play | Amazon Music | RadioPublic | Pocket Casts | iHeartRADIO | Audacy

Emotion dysregulation, which research has shown to be a fundamental component of ADHD,^{2, 3} is one such symptom. Another is gender differences, particularly in females who tend to mask or internalize their symptoms.⁴ “There’s some research on whether there might be a completely different presentation [of ADHD], at least in females, with a different time of onset and a different level of severity,” said Dave Anderson, Ph.D., in a recent ADDitude webinar on understanding the evolution of ADHD.

If you could add any symptom to the DSM diagnostic criteria for ADHD, what would it be? The answers we received from ADDitude readers included many familiar ADHD behaviors like rumination, daydreaming, time blindness, insomnia, sensory sensitivity, anger, and anxiety. Some readers even suggested changing the name entirely.

“‘Attention deficit’ seems to be the exact opposite of my experience,” said Amanda, an ADDitude reader in Utah. “I cannot pull myself away from the things I am interested in! And hyperactivity represents such a small portion of diagnosed individuals (primarily boys younger than 12). It is only one of dozens of significant symptoms that affect the greater population.”

Below, ADDitude readers share the symptoms that they feel are central dimensions of ADHD. What would you choose to add? Tell us in the Comments section, above.

[Download: 3 Defining Features of ADHD That Everyone Overlooks]

ADHD Symptoms Not in the DSM

“I would love to see separate sets of diagnostic criteria for boys, girls, adult men, and adult women, because (generally speaking) ADHD can look quite different in each of those four groups. Yes, there is some overlap, but I don’t think it serves girls or adult men and women to compare them to a single ADHD picture, that of the stereotypical hyperactive young boy. The rest of us know that isn’t the only face of ADHD.” — Jen, Missouri

“I think the biggest thing I would like to see is more of a focus on emotional dysregulation and the intense emotions that you can feel as a symptom of ADHD. This is one of the main ADHD symptoms that I personally struggle with, and it was never recognized. I was misdiagnosed with bipolar as a teenager because my intense emotions were more associated with BD than with ADHD.” — Kate, Florida

“I’d make sure that comorbidities are noted more directly with the DSM diagnosis of ADHD.” — An ADDitude reader

“I believe today’s criteria don’t adequately address adult patients. The word ‘adult’ obliquely refers to patients age 17 and older, but ADHD may manifest differently in older adults. Our prefrontal cortex continues to develop into our mid-20s, does it not? Typically, career advances are met with increased responsibility and visibility, and ADHD traits can become more of an encumbrance further up the corporate ladder (as I learned in my 40s and 50s). Clinicians would likely benefit from a subset of criteria for adults 25 and older.” — Greg, Ohio

[Read: A Critical Need Ignored: Inadequate Diagnosis and Treatment of ADHD After Age 60]

“Feeling like you have multiple thoughts at once; thinking spherically as opposed to linearly.” — Sunshine, Colorado

“Apparently, sleep issues are a telltale sign [of ADHD] for young children, yet I read every sleep training book I could get my hands on when [my daughter] was a baby, and not one of them mentioned [ADHD]. I didn’t learn this until she was in high school, which I feel is not just criminal negligence by so-called sleep experts but a huge disservice to parents and to kids with ADHD who could be assessed earlier.” — Kelly, California

“The emotional regulation symptoms of ADHD are sorely lacking.” — An ADDitude reader

“The social impacts of ADHD and how it impacts the ability to maintain friendships is a big hallmark for me. In general, I wish the DSM had a great deal more nuance, especially when it comes to identifying ADHD in girls and adults.” — LeAnn, Wisconsin

“I would differentiate between symptoms that boys have versus symptoms that girls have.” — Tracy, New York

“Anything about sensory challenges. To me, this is actually what ADHD is all about: difficulty blocking out sensory input. ADHD encompasses the challenges and ways people deal with sensory overwhelm. The fact that the DSM — and as a result, many practitioners — don’t understand this is so frustrating. Without this understanding, they are missing so many people who are probably unable to get support.” — Katie, Maryland

“Communication lapses: The tendency [for my son] to think that he communicated something verbally because he already thought it in his mind. We’ve had many incidents where family dynamics were impacted by communication lapses. From his point of view, the communication happened even though nothing verbal was spoken, so the other person wasn’t in the know. This also happens with my spouse (who was diagnosed at 52 after our son).” — Julieann, Ohio

“Clumsiness — anecdotally, this is very common among ADHDers, even being accident-prone. I see this a lot in the chat rooms I frequent for ADHDers.” — Diane, New Hampshire

“If it is not already in there, I believe the aspect of emotional dysregulation and/or rejection sensitivity dysphoria is such a huge component of ADHD that gets so very little attention – especially when it comes to treatment for younger children. But even for me as an adult, when I learned about the term RSD and what it meant, it stopped me in my tracks and totally changed the way I looked at my ADHD.” — Geoff, Rhode Island

“I would add criteria under affective disorders relating to anxiety and personality disorders like BPD/OCD to ensure it isn’t ADHD before making one of those other diagnoses.” — Greg, Canada

“Include not recalling content in a conversation literally right after or immediately after the information is shared. I think my kids are ready to kill me; they have told me that they purposefully don’t talk with me that much because I never remember. It’s awful.” — Shannon, Ohio

“I would make sure that something like survivalist, problem-solver, or despiser of mundane tasks were all in there!” — Blythe, Oklahoma

“A ‘constant state of overwhelm’ would be one. Or ‘takes tons of effort just to exist.’” — Natalie, Pennsylvania

ADHD Symptoms Not in the DSM: Next Steps

• Download: Common ADHD Diagnosis Mistakes
• Read: ADHD in Adults Looks Different. Most Diagnostic Criteria Ignores This Fact.
• Watch: The Grave Consequences of Persistent Gender Role Expectations in ADHD
• Read: ADHD Needs a Better Name. We Have One.

Sources

¹ PsychDB. (n.d.) History of the DSM. https://www.psychdb.com/teaching/1-history-of-dsm

² Hirsch, O., Chavanon, M., Riechmann, E., & Christiansen, H.. (2018). Emotional dysregulation is a primary symptom in adult attention-deficit/hyperactivity disorder (ADHD). Journal of Affective Disorders, 232, 41-47. https://doi.org/10.1016/j.jad.2018.02.007

³ Soler-Gutiérrez, A.M., Pérez-González, J.C., & Mayas, J. (2023). Evidence of emotion dysregulation as a core symptom of adult ADHD: a systematic review. PLoS One, 18(1), e0280131. https://doi.org/10.1371/journal.pone.0280131.

⁴ Young, S., Adamo, N., Ásgeirsdóttir, B.B., et al. (2020). Females with ADHD: an expert consensus statement taking a lifespan approach providing guidance for the identification and treatment of attention-deficit/ hyperactivity disorder in girls and women. BMC Psychiatry, 20, 404. https://doi.org/10.1186/s12888-020-02707-9

Why is attention deficit still dismissed, overlooked, and misunderstood at school? It’s important to note that ADHD is not considered a learning disability in special education law.¹ Of the 13 categories listed in the Individuals with Disabilities Education Act (IDEA), ADHD is classified under “other health impairments” and not as a specific learning disability. Perhaps it’s time for a change.

Explicitly naming ADHD in the IDEA could help unlock more specific and helpful accommodations in IEP and 504 Plans. It could also facilitate the teacher training needed to guarantee an equitable education. For now, though, that training is rare and misunderstandings abound.

The Misunderstood Era of ADHD

We asked caregivers to reflect on their child’s relationship with teachers, or to look back on their own experiences in the classroom. What do educators most often misunderstand about ADHD? About learning differences?

“My 10-year-old son is answering this question, and he says, ‘They often don’t realize that we need more breaks, and think more creatively about problems and solving them, which can sometimes look different than the way the teacher would want to see the problem solved.’” — Jonathan, Texas

[eBook: The Teacher’s Guide to ADHD School Behavior]

“My 14-year-old son is a student in a public high school in New York City. I can’t believe that the school still treats his occasional unregulated behavior with both detentions and suspensions. They take any backtalk from him personally and punish him for it instead of recognizing that it is a symptom of a neurodivergent condition and treating it as such.” — Josephine, New York

“[Educators think] ADHD students are not fit for public school, and that they will not flourish in a public school setting.” — Lisa, Texas

“As a former educator, I was not adequately trained to understand or identify learning differences. I took an entire credit course on ADHD and did not know that I myself had ADHD.”

“Because of my daydreaming, I often didn’t pay attention. Then my anxiety would keep me from answering when questioned by a teacher. I feel like I was written off as ‘stupid’ in elementary school.” — Debbie, Ohio

[Read: 10 Ways We Would Fix the U.S. School System]

“Educators do a great job trying to understand ADHD. School administrators that handle behavioral issues are where we run into problems…” — An ADDitude reader

“Educators don’t seem to have an understanding of invisible disabilities and take ADHD as a personal affront to their authority.” — Denise, Alabama

“Even now, too many educators believe having ADHD is a choice. It is not! I was labeled unruly and unwilling to ‘settle down’ or take my studies seriously.” — Cee, West Virginia

“Fidgeting does not mean that I am not listening. This accusation was placed on me at a teacher training. When I stressed out, I started to crochet to calm my mind and was written up for rudeness.” — Ann, California

“I think they don’t know a lot about the differences between ADHD and LD. Even today, educators use the term ‘ADHD’ just because a child cannot focus in class. They fail to understand that even kids with LDs will not stay focused when they do not understand what is being taught.” — Boon Eu, Malaysia

“I think they understand [ADHD], but they don’t have the resources to respond appropriately. The most important thing, in my opinion, is for teachers to be kind and not label kids as naughty or deliberately disruptive.” — Jen, Australia

“Educators with enough sensitivity or compassion can work well with ADHD kids because they can intuitively make changes to help the child. Others, who just aren’t as sensitive or compassionate, can be taught about ADHD but will never be excellent teachers for ADHD kids. I left the regular school system because I got tired of teachers telling me that my kids were lazy or just weren’t trying, even after we did educational assessments to prove that they had ADHD.” — Sarah, Canada

“Many teachers do not see past disruptive behavior. My report card always said I was ‘distracted’ or ‘bored.’ As a result, they put me in advanced classes and never even talked about [my] ADHD. My kids weren’t as disruptive as I was, but I feel like most people get annoyed and ignore the behaviors rather than try to question or find the source of the it.” — Stephanie, Florida

“Educators don’t understand that you can’t just try harder like everyone else. They think you can adopt neurotypical learning styles and succeed. So, they push these tactics that work for neurotypical students rather than receive training on what else to do.” — Anne, New Zealand

“Most educators, then and now, still marginalize students with any neurodivergent condition. Some of that seems to be on the parents; not all guardians are willing to have their children tested and diagnosed. It may seem odd that adults still worry about stigma — but as a parent to an ADHD teen, an ADD sufferer myself, and a language teacher for the past 12 years in elementary schools, it has become painfully obvious that these issues still aren’t adequately addressed. I believe this is due to the challenge of educating every unique individual in what, to me, has become an outdated and ineffective educational system — one in which we still warehouse youth. Large-group learning can’t help but require conformity. And that’s obviously not a solution.” — Sandra, Pennsylvania

“Most think it is an excuse and not a real diagnosis. Also, my child is autistic with ADHD. If the teachers have ADHD experience, they don’t realize or understand that there is a difference when comorbidities are involved. Different methods are needed.” — Maureen, Texas

“They think that ADHD is something that can be changed if the person tried harder. People with ADHD can be ‘extra’ if they are not in environments that are conducive to learning. Instead of realizing that the environment is the problem and making appropriate accommodations, they view the person with ADHD as the problem. They require students to ‘suffer through it’ because they think this will somehow make the ADHD go away.” An ADDitude reader

Misunderstood ADHD in the Classroom: Next Steps

• Download: What Every Teacher Should Know About ADHD
• Read: “We Are Behind the Times:” Only 4 in 10 Educators Receive ADHD Training
• Read: How to Talk to and Uplift Students with ADHD

Sources

¹Jones, L. (n.d.) Are kids with ADHD covered under IDEA? Understood. https://www.understood.org/en/articles/are-kids-with-adhd-covered-under-idea

Far too many people of color still believe that our children are over-diagnosed and over-medicated for ADHD. They believe that giving our children ADHD medication means we are not capable of disciplining them, so we use pills to control them.

At the same time, many clinicians and education professionals still perceive ADHD as a disorder of little white boys and attribute the very same behaviors in Black children as seriously problematic, with no thought that ADHD might be the issue. This mindset continues to inflict serious consequences on Black children.

[Sign Up: The Clinicians’ Guide to Differential Diagnosis of ADHD]

Welcoming Clinicians of Color

One of the most impactful and important changes of the last 25 years is that we finally have some treating professionals who look like us and sound like us; not nearly enough, but some. This makes a tremendous difference in understanding, diagnosing, and treating ADHD in our communities. We are much more likely to trust doctors and other mental health professionals who we feel at least partially understand us and can relate to our experiences. We now have African-American and other coaches of color who were not available a generation ago. Given the importance of coaching, especially for teens and adults with ADHD, this is a huge positive change.

More adults today not only acknowledge and embrace their diagnosis, but actually celebrate it through advocacy and public-facing activities. African-American and Latinx men and women have launched Facebook pages, virtual support groups, blogs, and podcasts in which they address the challenges of, and solutions to, living with ADHD. Aside from bringing ADHD “out of the closet,” these advocates help reduce the stigma around the disorder and give hope to many with ADHD who have felt isolated and alone.

In some ways, we’ve been fighting the same battle for the 30 years of my career as an ADHD advocate. But we also have made great progress around neurodivergence in communities of color.

Let’s work together to make giant strides for the next 25 years!

Advocating for Diversity in ADHD Care: Next Steps

• Download: Step Up and Speak Out About ADHD
• Watch: Scrutinizing Barriers to Health Equity, Diagnosis, & Treatment
• Read: The History of ADHD and Its Treatments
• Read: Cultural Considerations for Clinicians

Evelyn Polk Green, M.Ed., is a past president of the Attention Deficit Disorder Association (ADDA) and Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD).

SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

ADHD was not included in the DSM until 1968, when it was called Hyperkinetic Reaction of Childhood. The name was changed to attention deficit disorder in 1980. Doctors and scientists once used the terms “Clumsy Child Syndrome” and “Organic Brain Disease.”

ADDitude asked readers whether they thought ADHD was a terrible name for the condition: 52% said yes, 34% were neutral, and 14% said the name was appropriate. Here, readers offer their suggestions for an ADHD name change:

[Download: 25 Things to Love About ADHD]

• Neuro Spicy
• Capacity Management Syndrome
• Exceptional Artistic Ability of the Genius Variety
• Can’t Live Up to Your Bullsh*t Expectations Syndrome
• Variable Attention Trait Disorder (VAT)
• Executive Malfunction Disorder
• Emotional Regulation Disorder
• Zoomies
• Dysregulated Attention Disorder (DAD)
• Selective Attention Impulsive Disorder (SAID)
• Neuro-Overload Disorder (NOD)
• Chronic Overwhelm Disorder (COD)
• Racecar Brain
• Dopamine Attention Variability Executive Dysfunction (DAVE)

Other Names for ADHD: Next Steps

• Download: How Common Is ADHD in Adults?
• Read: Do You Speak ADD? Humorous ADHD Definitions
• Read: Is ADHD a Spectrum Disorder?

SUPPORT ADDITUDE
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The Persistence of ADHD Into Adulthood

The essay’s authors, psychiatrist Nassir Ghaemi, M.D. (Tufts University School of Medicine), and Mark L. Ruffalo, MSW, DPsa (University of Central Florida College of Medicine), cite slim evidence, specifically two prospective follow-up studies of children with ADHD tracked to adulthood. These studies, they claim, show that only 20% of subjects with childhood ADHD still have it by adulthood.

The truth is that one of those cited studies, and its limitations, gave expert commentators pause when it first appeared seven years ago.² For one, the adult sample included 18- and 19-year-old subjects, a razor-thin slice of young adulthood. Moreover, the study’s authors used only self-reports in structured interviews to establish the existence of adult ADHD. Yet, we know self-reports to be unreliable until subjects reach their late 20s and 30s.³ By contrast, the study established childhood ADHD diagnoses using parent reports and structured interviews. Therefore, using self-reports risks under-identifying ADHD persistence into young adulthood.

A more recent study of ADHD persistence followed children originally diagnosed between ages 7 and 10.⁴ Researchers administered eight thorough re-evaluations from ages 10 to 25, on average. The results showed that most children went through an up-and-down pattern of remission. That is, results sometimes fell below full DSM diagnostic criteria but at other times fulfilled criteria. Only 10% of children with ADHD achieved full, sustained remission at young adulthood. That left 90% with persistent residual symptoms of ADHD into adulthood.

The waxing and waning of symptoms likely reflects treatment effects as well as the nature of ADHD being overly sensitive to environmental factors affecting symptom expression. Factors might include supportive teachers or bosses, or, on the other hand, the stress of starting middle school or college. Hormonal changes may also play a role in ADHD symptom severity.

[Read: ADHD in Adults Looks Different. Most Diagnostic Criteria Ignores This Fact.]

Adult ADHD Is Not New or Novel, but Psychiatry Has Not Yet Caught Up

Let’s flip the script here: The diagnosis of ADHD (then called hyperkinetic reaction of childhood or adolescence) first appeared in the DSM-II.⁵ That same year saw a published study of minimal brain dysfunction (another early name for ADHD) in young adult patients, some having persistent symptoms since adolescence.⁶ In other words, adult ADHD is not a diagnosis du jour, as Ghaemi and Ruffalo assert, but part and parcel of ADHD from the start. That said, a different issue could be considered: Why has diagnostic criteria for adult ADHD lingered so far behind the work already done in the field for 55 years?

For example, a decade ago the age-of-onset criterion for an ADHD diagnosis was finally raised from 7 to 12 years old. Still, even the older cutoff misses the adolescent phase, which brings increased demands for attention, impulse control, organization, and overall self-regulation. ADHD-related difficulties often become more apparent during middle school, following years of challenges going masked and unrecognized. Indeed, we find evidence that 16 is a better age threshold for symptom emergence.⁷

At the same time, clinicians are still evaluating adults using ADHD symptom criteria developed for children, which under-represent indicators of executive dysfunction. Even the term ADHD obscures the consensus that the condition is better understood as a neurodevelopmental syndrome of self-dysregulation. ADHD is a chronic delay in the onset and efficient employment of self-regulation capacities and skills. Empirically based reviews of adult ADHD specific symptoms have addressed this issue.⁸ Yet, the absence of adult-specific criteria constrains adult diagnoses and thereby access to evidence-based treatments.

[Read: ADHD Symptoms Checklist – Signs of Hyperactive, Inattentive, Combined Subtypes]

The Effects of Biases Against ADHD

Finally, the framing and wording used in “The Making of Adult ADHD” repeats the stigma and biases many adults with ADHD (diagnosed or not) encounter in daily life. Every day, they endure skeptical comments by loved ones and the public, on social media and via other outlets. This “denialism” can and does wield a profound negative effect. Research on the effects of stigmatization and dismissal of ADHD-related concerns)^9,10 has shown that unconstructive criticisms cause individuals to experience withdrawal from others and heightened sensitivity, hindering their coping skills and preventing them from reaching out for professional support.

In fact, a psychiatrist-in-training published his experience with recognizing his own adult ADHD after harboring misconceptions about it.¹¹ He observed first-hand the bias against the diagnosis (and against mental health issues generally) within healthcare and within his own specialty, which stoked his fears of disclosure. He courageously recounts his coming to terms, seeking help, and benefitting from specialized treatment.

To this psychiatrist and to other adults with ADHD, the diagnosis is well-established,¹² even as behavioral health fields are still catching up. There is more work to do, no doubt. A heartening development underway is the first set of U.S. empirically based guidelines for the assessment and treatment of adult ADHD and corresponding practice tools tailored to support these patients. I am hopeful that these guidelines (used alongside many existing international ones) will offer a helpful hand to those who are working to support adults with ADHD.

Adult ADHD Symptoms Are Real: Next Steps

• Read: How the DSM-5 Fails People with ADHD — and a Better Way to Diagnose
• Read: ADHD Is a Whole-Life Experience. The DSM Needs to Reflect That.
• Learn: What do I need to understand about ADHD that is not fully represented in the DSM?

Disclosure: Dr. Ramsay is on the scientific advisory board of ADDitude magazine. He has no conflicts of interest relevant to the content of this commentary.

Sources

¹Ruffalo, M. L., & Ghaemi, N. (2023): The making of adult ADHD: The rapid rise of a novel psychiatric diagnosis. Psychiatric Times, 40(9), 18-19.
²Faraone, S. V., & Biederman, J. (2016). Can attention-deficit/hyperactivity disorder onset occur in adulthood? JAMA Psychiatry, 73(7), 655-656. doi:10.1001/jamapsychiatry.2016.0400.
³Barkley, R. A., Murphy, K. R., & Fischer, M. (2008). ADHD in adults: What the science says. Guilford.
⁴Sibley, M. H., et al. (2022). Variable patterns of remission from ADHD in the Multimodal Treatment Study of ADHD. American Journal of Psychiatry, 199, 142-151.doi: 10.1176/appi.ajp.2021.21010032
⁵American Psychiatric Association (1968). Diagnostic and statistical manual (2nd ed.)
⁶Harticollis, P. (1968). The syndrome of minimal brain dysfunction in young adult patients. Bulletin of the Menninger Clinic, 32, 102-114.
⁷Barkley, R. A., Murphy, K. R., & Fischer, M. (2008). ADHD in adults: What the science says. Guilford.
⁸Fedele, D. A., et al. (2010). Potential symptoms of ADHD for emerging adults. Journal of Psychopathology and Behavioral Assessment, 32, 385-396. doi: 10.1007/s10862-009-9173-x
⁹Beaton et al. (2022). Experiences of criticism in adults with ADHD: A qualitative study. PLoS ONE, 17(2), e0263366. doi: 10.1371/journal.pone.0263366;
¹⁰Morley, E., & Tyrrell, A. (2023). Exploring female students’ experiences of ADHD and its impact on social, academic, and psychological functioning. Journal of Attention Disorders, 27(10), 1129-1155. doi: 10.1177/10870547231168432
¹¹Klein, E. J. (2020). When the edges blur: A future psychiatrist’s perspective on Attention-Deficit/Hyperactivity Disorder. Psychological Services, 19(1), 29-31. doi: 10.1037/ser0000446
¹²Faraone, S. V., & Biederman, J. (2016). Can attention-deficit/hyperactivity disorder onset occur in adulthood? JAMA Psychiatry, 73(7), 655-656. doi:10.1001/jamapsychiatry.2016.0400.

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Back in the 1990s, I co-wrote one of the first three books laying out the proposition that adults could and do have ADD. It was called Adult ADD: A Reader Friendly Guide to Identifying, Understanding, and Treating Adult Attention Deficit Disorder (#CommissionsEarned). Unfortunately, the American Psychological Association, the American Medical Association, the American Psychiatric Association, along with CHADD, the largest organization for parents with children with ADD, all disagreed with its premise.

In the Wild West days before the Internet, I was part of a small group that traveled around the country, speaking at conferences, and sharing information about adult ADD. One city at a time, we offered hope and help for adults who were struggling with something that didn’t officially exist.

[Read: ADHD in Adults Looks Different. Most Diagnostic Criteria Ignores This Fact.]

These were not the tightest-run conferences! Once, in San Francisco, I went to check into the conference hotel and the clerk stated that I had no room reserved. It turned out that the event coordinators failed to reserve any rooms for speakers to sleep in. Only conference rooms were reserved. A fellow event speaker said that, surely, no one would have made THAT mistake. But this was an ADD conference and, indeed, a mistake of this magnitude had been made.

An Adult ADHD Revolution Ignites

Speakers often gathered after these conferences to share ideas and information, as we early radicals trudged on. One member of our group, Stephen Copps, M.D., wrote one of the first books on treating adults who had ADD with medication. He was threatened with possible loss of his medical license. He was a pediatrician, and therefore, not trained to work with adults. The Attention Deficit Disorder Association (ADDA) came to his defense, citing him as a pioneer in this field. His license was not revoked.

Information on adult ADD was banned from CHADD conferences until 2001. I had just written What Does Everybody Else Know That I Don’t? and I was the first to be permitted to speak on the topic. I was assigned a tiny room with a kitchen and bathroom because planners doubted there would be much interest. The room was flooded with people standing in the tub, sitting on the toilet, filling the halls, and listening outside windows. It was a pivotal event that marked the beginning of adult ADHD as a topic at conferences.

The early partnership between ADDA and CHADD was wrought with challenges. CHADD was walking the scientific-approved line, while ADDA was blazing a path forward. At one conference, I had to meet secretly with then-president of CHADD, Evelyn Polk Green. She snuck into my room late at night, in her pajamas, and we tried to find ways to build bridges.

[Read: Adult ADHD Is Misunderstood — Realistic Solutions for Managing Life, Time & Emotions]

ADDitude magazine was one of the earliest supporters of innovative ideas and information. Ellen Kingsley, the founder, gave me the opportunity to write some of the first published articles on adult ADHD. Susan Caughman, her successor, continued on this path, as ADHD coaching became the next forbidden topic to be challenged.  

Looking back, it’s amazing to see how far we’ve come.

Adult ADHD Is Real: Next Steps

• Free Download: How Common Is ADHD in Adults?
• Read: How Adults with ADHD Think
• Read: Why We Need U.S. Guidelines for Adults with ADHD

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#CommissionsEarned As an Amazon Associate, ADDitude earns a commission from qualifying purchases made by ADDitude readers on the affiliate links we share.

Click each image below to learn more about how our understanding of ADHD has evolved over the last 25 years.

As important as it is to recognize how far we’ve come, it’s crucial to acknowledge the long road ahead. Psychology, after all, is a relatively young science, and there is still so much we have to discover and improve upon — from dismantling stigma to creating equitable access to care for all.

Evolving ADHD: How Our Understanding Has Changed

While some aspects of ADHD haven’t changed significantly in the last 25 years — like the symptom groupings of inattention and hyperactivity/impulsivity outlined in various versions of the DSM — following are a few notable changes in the ways we diagnose and understand ADHD today.¹

From “Subtypes” to “Presentations”

In 1994, the DSM-IV designated three subtypes of ADHD — inattentive, hyperactive/impulsive, and combined. Over time, however, research proved the subtypes unreliable across development. That is, an individual who was diagnosed with the combined subtype as a child could go on to exhibit relatively more inattentive symptoms in adolescence or adulthood, to the point that they no longer meet criteria for the combined subtype. In recognition that ADHD symptoms may present differently across time, subtypes became “presentations” in the DSM-5, released in 2013.

The notion of a mental health condition presenting differently across individuals and across time is not new. The symptoms of depression, for example, have hundreds of different combinations, and we still call it depression. The 2013 update made room for this variability in ADHD.

[ADD Test: Could You Have Inattentive ADHD?]

Chronic Symptoms and Remission Rates

The last 25 years of research tell us that ADHD tends to be chronic; the majority of kids and teens diagnosed with ADHD will still meet clinical criteria for the condition in adulthood. Today, it’s generally accepted that ADHD doesn’t just “go away.”² There is some evidence that hyperactive/impulsive symptoms do remit or lessen to some degree over development. Inattentive symptoms largely persist into adulthood and may continue to cause impairment in a variety of ways, from work settings to relationships.

While researchers are still learning how ADHD might present and impact individuals in adulthood, both from a strength-based and impairment approach, more studies are needed on ADHD across the lifespan. ADHD in older adults, for example, isn’t well understood.

Comorbidities Are the Rule, Not the Exception

ADHD, we now know for sure, rarely presents in isolation — mood disorders, anxiety, learning differences, and substance use disorders are commonly comorbid with the condition.³ Shared underlying genetic and brain-based systems could explain the connection, but living with ADHD itself can also cause certain comorbidities to develop.

Consider that ADHD symptoms remain highly stigmatized; perceptions abound that children with ADHD simply aren’t trying hard enough and need to be disciplined. When a child with ADHD is on the receiving end of this kind of negative feedback from parents and other adults, they could go on to demonstrate oppositional, defiant, and/or argumentative behaviors toward adults — partly because they have come to believe authority figures aren’t on their side.

[Read: What Is Complex ADHD? Symptoms, Diagnosis & Treatment]

ADHD is also highly linked to peer rejection, academic difficulties, and a host of other negative developmental outcomes that could increase one’s risk for a depressive episode or anxiety about one’s abilities.¹ So, although individuals with ADHD may be biologically predisposed to comorbid diagnoses, environmental factors can facilitate their development as well.

Increasingly Complex Understanding of ADHD’s Etiology and Outcomes

Our understanding of risk factors for ADHD, including developmental and environmental factors, along with the developmental sequelae of ADHD, has evolved considerably.

Genetic, Environmental, and Epigenetic Research

We’ve seen huge advances in our understanding of gene influences on ADHD and other mental health disorders, and the way that environmental factors might exert large effect sizes on the presentation of symptoms. Advancements in epigenetics, the field of research that examines how the environment changes gene expression over time, has helped us move away from the idea of a single cluster of genes that determines ADHD.

There are, in fact, many, many genes that could play a role in the risk profile for ADHD — and those genes are perhaps also shared with many other mental health conditions. One thing is certain from this research: As science evolves, it suggests that the answers we seek — regarding whether there are objective markers of ADHD or genes that define it — are likely quite complex.

ADHD Outcomes

Evidence shows that ADHD, especially if untreated, affects multiple domains of life; individuals with ADHD are more likely to be in traffic accidents, to experience peer difficulties and tumultuous interpersonal relationships, and to drop out of school, be expelled from school, and experience academic failure earlier.³ The latter is particularly troubling when we consider that ADHD has historically been underrecognized and undertreated in marginalized and disadvantaged communities; academic difficulties and expulsions can start the school-to-prison pipeline, which disproportionately impacts Black youth.⁴ Individuals may end up incarcerated before ever learning that they have ADHD and that it was the root cause of their difficulties in school and early life.

Spotlight: Compelling ADHD Research Today

New Diagnostic Constructs

Researchers are working to capture certain presentations possibly in the form of modifiers or subtypes of ADHD. Cognitive disengagement syndrome (CDS), characterized by excessive mind-wandering, mental confusion, and slowed behaviors, has been proposed as a potential modifier for the ADHD diagnosis or a subtype. (CDS was previously referred to as sluggish cognitive tempo).⁵ Whether difficulties with emotional regulation as well as sleep difficulties represent subtypes or modifiers of ADHD are other topics of research.

The Search for Objective Markers of ADHD Symptoms

Diagnosing clinicians think of “FIDI” — frequency, intensity, duration, and impairment — when considering if a patient’s symptoms point to ADHD or, frankly, any other mental health condition. ADHD diagnoses today are still largely based on behavioral symptoms and, to some degree, the clinician’s subjective impressions of a patient’s experience. (That’s assuming the clinician completes a thorough, quality diagnostic interview.)

The question is: Are there better markers that can help us objectively diagnose ADHD? Could there be, say, task-based markers or biological markers that would allow us to index risk for ADHD or at least combine the results with a diagnostic interview to tell us, with high confidence, if a patient has ADHD? These questions have characterized the last few decades of ADHD research, and while there’s hope that we might reach an additive model at some point, the science is not there yet.

ADHD and Sex Differences

We’ve learned a lot about sex differences in ADHD and how symptoms potentially present differently across males and females. It’s commonly thought that females may be more likely to present with the inattentive cluster of symptoms and less likely to present with hyperactive-impulsive symptoms. At the same time — because of stigma, stereotypes related to gender role presentations, and clinician bias — when females do present with ADHD symptoms, those symptoms may be incorrectly or wholly attributed to anxiety or depression. Researchers are also studying whether ADHD in females has a different time of onset and severity.

Neuroscience of ADHD

Functional magnetic resonance imaging (FMRI) has emerged as a tool to identify brain areas, circuitry, or networks that might be implicated in ADHD. Some core research findings have stood the test of time: Frontal structures and networks of the brain appear to be underutilized/under-activated in ADHD. At the same time, the default mode network (DMN) — brain networks that are meant to be active when an individual is not focused on a task — has been found to be overactive in individuals with ADHD, and likely interferes when focus is required.⁶

A look at the field of neuroscience shows how open science has become in the last 25 years. Institutions are sharing their data sets to make for larger combined study data sets — valuable for testing and replicating findings of earlier research. There are also ongoing multiple large-scale national and multinational studies dedicated to understanding brain science as it relates to ADHD and various other mental health conditions.

ADHD Treatment: How Evidence Is Expanding to Fill Gaps

ADHD Treatment Then

In 1998, the evidence base for ADHD treatment was around medication, behavioral parent and school interventions, and combined multimodal treatment.⁷ Stimulant medication was known to be effective in addressing ADHD symptoms in children, particularly during school hours, by increasing focus and enabling students to complete academic tasks. It was also understood that coaching parents and teachers on certain behavioral skills could help them manage their child’s/student’s ADHD symptoms through the course of the day, even during “hot zones” (e.g., mornings, homework time, bedtime). Medication and behavioral treatment together were considered more effective than either one alone.

Treatment challenges and gaps identified at the time included the following:⁷

• The prevalence of non-evidence-based treatments being applied to ADHD. Take play therapy, for which there was no evidence that skills learned in the therapist’s office transferred to the outside world. This was true in 1998, and it’s true today. (This is not to say that there is no benefit to play-based interventions, only that there is no evidence that it helps ADHD.) The evidence base was also thin for applying standard individual cognitive behavioral interventions to target ADHD symptoms.
• The short-term effects of interventions. Be it medication or behavioral interventions, questions abounded about the sustained effectiveness of an ADHD treatment, especially once an intervention was removed.
• The symptom improvement ceiling. In terms of behavior, many interventions for ADHD at the time only brought children within one standard deviation of the typical range for children of their age.

ADHD Treatment in the Present

When developing evidence-based treatment practices, 25 years is a short span of time. From examining a potential intervention in a few cases to executing randomized research trials and replicating results, it takes considerable time and resources to show that a treatment works. Still, there have been important advances in ADHD treatment in the last quarter century.

How the ADHD Treatment Evidence Base Has Expanded⁸

• More focus on the factors affecting the success of established treatments: A key question researchers are asking today: Does addressing caregivers’ mental health concerns improve ADHD treatment outcomes for their children?
• Proven effectiveness of behavioral peer interventions and organizational skills training: Today, strong evidence shows that these interventions improve these common areas of impairment in children with ADHD.
• Greater understanding of sequencing of psychosocial and psychiatric interventions: It’s well established that medication and behavioral interventions together make for greater treatment outcomes. That said, if choosing to sequence, evidence indicates that starting with psychosocial treatment (parent training/school training) might produce better outcomes than starting on medication first.
• Interest in incorporating adolescent-specific techniques, like motivational interviewing and collaborative problem-solving, to better engage these individuals in treatment.
• Efforts to ensure diverse populations are represented in ADHD treatment research, though much more work is needed in this area.

Smoke But No Fire: ADHD Interventions with Weak Strength of Evidence

A handful of interventions have sprung up over the years, and some have gained popularity for their purported impact on ADHD symptoms. The reality is that, judging by studies, there is only weak evidence that the following interventions are effective enough to merit consideration as established evidence-based practices for ADHD.⁸

• Cognitive training — computer-based programs that encourage a child to practice certain skills in hopes of boosting executive functions — doesn’t seem to work for ADHD, though some encouraging findings show that adults can help mediate the transfer of these skills to real life.
• There is hope that at some point, research will indicate more clearly how and whether neurofeedback might be effective for ADHD. However, at this point, there is neither a standardized understanding of how neurofeedback can be applied nor evidence that it truly generalizes to real-world skills.
• Physical activity and taking omega-3 supplements can certainly form part of a healthy lifestyle, but studies do not indicate that these interventions specifically have a significant impact on ADHD symptoms.

Challenges — and Hopes — for the Future of ADHD

Ongoing challenges in the field of ADHD are as follows:

• ADHD is highly stigmatized. To this day, the validity of the diagnosis is still debated, and it’s still commonly called an excuse for laziness and lack of effort.
• Psychiatric interventions are also heavily scrutinized and stigmatized. Despite decades of research on treatments for ADHD, and the fact that ADHD medications are some of the most well-studied of any psychiatric medication class, there is still a lot of trepidation surrounding them. A shortage of child and adolescent psychiatrists and an incredible wealth of media narratives about the “evils” of psychiatry fuel stigma.
• Mental health parity and access to care remain grave concerns. Access to care is even more difficult for historically marginalized and/or underserved populations, as well as individuals of lower socioeconomic status.
• Psychosocial treatments require significant investment. Whether it’s behavioral parent training or organizational skills training, these treatments, while effective, are high-effort and usually require ongoing maintenance — a tough ask for patients and families.
• Use of unproven treatments sets the field and individuals back in many ways. When families and patients pursue interventions that claim to help ADHD, only to find that such interventions are ineffective, the result could discourage these individuals from seeking help and from thinking that they can be helped. At worst, it increases mental health stigma and leads to the development of comorbid mental health concerns.
• Negative life experiences tied to ADHD may decrease one’s ability and willingness to seek help. Individuals with ADHD (especially undiagnosed) are vulnerable to peer rejection, academic failure, and other unfortunate outcomes that can cut off avenues for help.

But across the board, the future of ADHD looks bright. There is much to be excited and hopeful for.

ADHD Science and Treatment Continue to Advance

Evolving tools and science will help us further understand ADHD and ultimately allow us to go beyond today’s largely behavior-based approach to diagnosing the condition. There is good reason to believe that the future of ADHD holds precision medicine — the ability to better delineate risk factors for the condition and a tailored course of treatment for individuals.

A major priority is expanding the mental health workforce and recruiting diverse and representative clinicians to meet patient treatment needs. The field is also envisioning novel ways to reach patients, such as capitalizing on telehealth. In the larger scheme of treatment, we see interest in the development of intensive interventions — treatments that are shorter in term but just as effective in reducing symptoms and impairment.

Societal Awareness of ADHD and Turning Tides

Yes, ADHD is stigmatized. But awareness and acceptance have undoubtedly improved over the last 25 years, and efforts are ongoing to fight stigma and build equity in mental health care. The changing ways we talk about mental health are evidence of these efforts; we’re opting for “neurodivergence” and other non-stigmatizing terms to capture individual differences and the inherent diversity of human brain function. For the future of ADHD, perhaps the greatest hope of all comes from the growing societal belief that mental health care is a fundamental human right.

ADHD Then and Now: Next Steps

• Read: Reflections on the Dark Ages of ADHD Misconceptions
• Read: The 15 Most Corrosive ADHD Myths
• Watch: Unlocking the Future of ADHD: Advances in Research, Diagnosis, & Treatment

The content for this article was derived from the ADDitude ADHD Experts webinar titled, “ADHD Then and Now: How Our Understanding Has Evolved” [Video Replay & Podcast #447] with Dave Anderson, Ph.D., which was broadcast on March 21, 2023. This article is part of our “25 Years of ADDitude” collection, which reflects on the past, present, and future of ADHD and ADDitude since the publication’s founding in 1998.

Sources

¹ Sonuga-Barke, E., Becker, S. et al .(2022). Annual research review: Perspectives on progress in ADHD science – from characterization to cause. The Journal of Child Psychology and Psychiatry, 64(4), 506-532. https://doi.org/10.1111/jcpp.13696

² Sibley, M. H., Arnold, L. E., Swanson, J. M., Hechtman, L. T., Kennedy, T. M., Owens, E., Molina, B. S. G., Jensen, P. S., Hinshaw, S. P., Roy, A., Chronis-Tuscano, A., Newcorn, J. H., Rohde, L. A., & MTA Cooperative Group (2022). Variable Patterns of Remission From ADHD in the Multimodal Treatment Study of ADHD. The American Journal of Psychiatry, 179(2), 142–151. https://doi.org/10.1176/appi.ajp.2021.21010032

³ Franke, B., Michelini, G., Asherson, P., Banaschewski, T., Bilbow, A., Buitelaar, J. K., Cormand, B., Faraone, S. V., Ginsberg, Y., Haavik, J., Kuntsi, J., Larsson, H., Lesch, K. P., Ramos-Quiroga, J. A., Réthelyi, J. M., Ribases, M., & Reif, A. (2018). Live fast, die young? A review on the developmental trajectories of ADHD across the lifespan. European Neuropsychopharmacology : The Journal of the European College of Neuropsychopharmacology, 28(10), 1059–1088. https://doi.org/10.1016/j.euroneuro.2018.08.001

⁴ Behnken, M. P., et. al. (2014). Linking early ADHD to adolescent and early adult outcomes among African Americans. Journal of Criminal Justice, 42(2), 95–103. https://doi.org/10.1016/j.jcrimjus.2013.12.005

⁵ Becker, S. P., Willcutt, E. G., Leopold, D. R., Fredrick, J. W., Smith, Z. R., Jacobson, L. A., Burns, G. L., Mayes, S. D., Waschbusch, D. A., Froehlich, T. E., McBurnett, K., Servera, M., & Barkley, R. A. (2023). Report of a work group on sluggish cognitive tempo: key research directions and a consensus change in terminology to cognitive disengagement syndrome. Journal of the American Academy of Child and Adolescent Psychiatry, 62(6), 629–645. https://doi.org/10.1016/j.jaac.2022.07.821

⁶ Cortese, S., Kelly, C., Chabernaud, C., Proal, E., Di Martino, A., Milham, M. P., & Castellanos, F. X. (2012). Toward systems neuroscience of ADHD: a meta-analysis of 55 fMRI studies. The American Journal of Psychiatry, 169(10), 1038–1055. https://doi.org/10.1176/appi.ajp.2012.11101521

⁷ Pelham, W. E., Jr, Wheeler, T., & Chronis, A. (1998). Empirically supported psychosocial treatments for attention deficit hyperactivity disorder. Journal of Clinical Child Psychology, 27(2), 190–205. https://doi.org/10.1207/s15374424jccp2702_6

⁸ Evans, S. W., Owens, J. S., Wymbs, B. T., & Ray, A. R. (2017). Evidence-based psychosocial treatments for children and adolescents with attention deficit/hyperactivity disorder. Journal of Clinical Child and Adolescent Psychology : The Official Journal for the Society of Clinical Child and Adolescent Psychology, American Psychological Association, Division 53, 47(2), 157–198. https://doi.org/10.1080/15374416.2017.1390757

African Americans and other individuals of color are less likely to get an accurate ADHD diagnosis and proper treatment. Why? Stigma, myths, and misconceptions about ADHD, historical mistrust of the medical community, and a shortage of clinicians of color who are knowledgeable about ADHD all contribute to proper care and treatment challenges.

Education and outreach are important ways community members, clinicians, educators, and other allies can help improve outcomes for individuals with ADHD in BIPOC communities.

In this webinar, you will learn:

• About the factors that hamper proper ADHD diagnosis and treatment in communities of color
• About the historical context for the persistent ADHD myths and misconceptions that contribute to stigma and stereotypes in these communities
• How educators and clinicians can overcome ethnic and cultural barriers to ADHD care
• About practical strategies for improving outcomes for individuals with ADHD in communities of color

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More on Health Equity & ADHD

• Download: How to Prepare for Your ADHD Evaluation
• Read: Why ADHD Is Different for People of Color
• Read: We Need to Talk About ADHD Stigma in BIPOC Communities

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Meet the Expert Speaker

Evelyn Polk Green, M.S.Ed., is a past president of both ADDA (the Attention Deficit Disorder Association) and CHADD (Children and Adults with Attention-Deficit/Hyperactivity Disorder). She is an adult with ADHD and the mother of two adult sons, Perry and Robert, both of whom also have ADHD. Active in ADHD and mental health advocacy for almost 30 years, Evelyn has served as a leader representing the family and educator voice in the ADHD and mental health communities in many capacities, including as a member of the Network on Children’s Mental Health Services funded by the MacArthur Foundation. Learn more about Evelyn here.

Listener Testimonials

“Dr. Polk Green is fantastic. I attended her last webinar. She is an amazing resource. Thank you for having her present to us.”

“Very informative and empowering.”

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As a young student, he had trouble paying attention and was very slow finishing his work. But he wasn’t hyperactive so it never occurred to me that he might have ADHD. As I later wrote in my books, “Thus began 12 years of academic agony for us.”

Unbeknownst to me, Alex had not only ADHD — his two greatest challenges were executive function deficits and slow processing speed — but significant coexisting challenges as well. In later years, we learned that his deficits in executive functioning also caused difficulty with written expression, memorization of math facts, organization, and task initiation and completion. With all these untreated challenges, anxiety also became a problem.

[ADHD @ School: Sign Up for This Free 10-Week Class for Parents]

ADHD was not included in any of the federal education or civil rights protections when Alex was struggling in middle and high school. Consequently, teachers had no obligation to provide extra supports or accommodations. In fact, many teachers doubted that ADHD existed and believed it was an excuse made up by parents to cover up for a child’s laziness, poor academic work, or behavioral problems. One teacher humiliated Alex in front of his algebra class by saying, “Your mother may baby you, but I’m not going to do that.”

A Minefield of ADHD Myths

Back then, misinformation about ADHD was rampant. Trying to understand ADHD behaviors and learning challenges was confusing to us as parents. Here are a few ADHD myths we were told that have been disproven.

• ADHD occurs only in boys.
• A child must be hyperactive to be diagnosed with ADHD.
• ADHD is a behavior problem.
• Poor parenting causes ADHD.
• Parents need to punish children with ADHD more often.
• Students with ADHD can do better if they try harder.
• Children outgrow ADHD during the teen years and no longer need medication.
• Children with ADHD should have weekends and summers free of medication.
• Taking ADHD medication leads to drug abuse.

ADHD Facts: Greater Understanding – and More to Learn

Today, parents, teachers, and treatment professionals are grateful for our expanded knowledge about ADHD. We are thankful for the field’s pioneering researchers — Russell Barkley, Ph.D., Lily Hechtman, M.D., Alan J. Zametkin, M.D., Martha Denckla , M.D., Peter Jensen, M.D., Patricia Quinn, M.D., Stephen Hinshaw, Ph.D., and the late Joseph Biederman, M.D., among so many others — who greatly improved our understanding of ADHD in children, teens, and adults. As we move forward in our understanding of ADHD, we hope to see more research on underdiagnosed populations, including girls, women, and minorities.

[Read: Why We Must Achieve Equitable ADHD Care for African American and Latinx Children]

We are grateful for the organizations like Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD) and the Learning Disabilities Association of America (LDA) that have provided the educational training that has unlocked better learning for today’s students with ADHD. We also know more about managing ADHD in school thanks to experts like Beverley Holden Johns, Sydney Zentall, Ph.D., and Rick Lavoie, M.A., M.Ed., also among many others.

We’ve come a long way from the dark ages to a more enlightened present day. As a mother and a former teacher, I am grateful.

ADHD Misconceptions: Next Steps

• Free Download: Debunking Annoying ADHD Myths
• Read: The 15 Most Corrosive ADHD Myths
• Read: “How My Understanding of ADHD Has Evolved Over Time”

Chris A. Zeigler Dendy, M.S., passed away unexpectedly in July 2023. She will be remembered for her outstanding contributions to improve ADHD understanding in education. This article is part of our “25 Years of ADDitude” collection, which reflects on the past, present, and future of ADHD and ADDitude since the publication’s founding in 1998.

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