The most common misconceptions about ADHD

Unfortunately, misconceptions about ADHD are widespread. Even some doctors (who do not specialize in ADHD) repeatedly make untenable statements. This leads to incorrect diagnoses and increases the suffering of people with ADHD. The errors presented on this page were made by doctors or therapists - and these are not isolated cases. If the misconception leads to harm to the patient, it is a case of medical malpractice that can trigger a liability for damages.

Here we summarize the most popular misconceptions about ADHD.

• 1. Misconception: “Attention works when you’re interested, so it can’t be ADHD.”
• 2. Misconception: “If you’re not hyperactive, you can’t have ADHD.”
• 3. Misconception: “Professional success, studies or a doctorate exclude ADHD.”
• 4. Misconception: “No one knows what ADHD is. There are no biomarkers for ADHD.”
• 5. Misconception: “ADHD medications are like drugs / are addictive.”
• 6. Misconception: “Only children or teenagers have ADHD.”
• 7. Misconception: “Almost only boys have ADHD.”
• 8. Misconception: “In a suitable environment, ADHD is not a problem.”
• 9. Misconception: “ADHD medication helps everyone”
• 10. Misconception: “If you’re gifted, you can’t have ADHD”
• 11. Misconception: “ADHD also has many benefits”
• Knowledge of people with ADHD from the point of view of doctors: when is it pseudo-knowledge, when is it reliable?

1. Misconception: “Attention works when you’re interested, so it can’t be ADHD.”¶

Wrong.¹

• In ADHD, it is not the “technical ability” to pay attention that is impaired, as people with ADHD can even pay attention for a very long time and intensely if they are interested. This is known as hyperfocus. Hyperfocus is a very narrowly focused attention that blocks out irrelevant stimuli very well or even to an above-average degree.
• In ADHD - on closer inspection - the “technical ability” to direct attention is also not impaired, because the attention of people with ADHD can switch between hyperfocus (this is the positive term) or task switching problems (this is the negative side of hyperfocus) and distractibility (the opposite of hyperfocus: irrelevant stimuli can be faded out here with above-average difficulty).
• Attention and attention control therefore “technically” work in ADHD. However, they are subject to a regime, a profile, a mode that is inappropriate for everyday life. In the case of severe, survival-threatening stress, this mode of increased focus on activities that are personally perceived as important (on threatening dangers) or increased distractibility during less relevant activities (are there dangers somewhere?) would be helpful for survival. In ADHD, attention runs in this stress mode without adequate stressors being present.
  Very important: people with ADHD cannot change this at will. In this respect, directing attention works differently than for those who are not affected.
• In ADHD, the ability to be motivated by extrinsic and intrinsic stimuli is reduced. In order to feel the same motivation as non-persons with ADHD, people with ADHD need significantly higher incentives, such as rewards. With personal motivation induced by appropriate incentives, the attentional performance - including sustained attention - of people with ADHD is so good that they can no longer be reliably distinguished from non-affected people. What looks like egotism from the outside, like a “can do but don’t want to”, is actually the inability to direct one’s own will in the same way as those who are not affected, or to be able to evoke one’s own motivation. Other ADHD symptoms that disappear or are significantly reduced when a motivational state has been achieved are impulsivity, probably also hyperactivity and, at least in part, the symptoms caused by spatial-visual working memory. More on this under ⇒ Motivational shift towards own needs explains regulatory problems.
• Apart from this, there is also ADHD without attention problems. The ADHD-HI subtype is characterized by predominant hyperactivity with little or no attention problems.

2. Misconception: “If you’re not hyperactive, you can’t have ADHD.”¶

Wrong.

There are different subtypes of ADHD. The same basic disorder is always involved, which is primarily characterized by a dopamine and noradrenaline action deficit in the (dorsolateral) PFC and in the striatum:

• ADHD-HI: predominantly hyperactive, few to no attention problems
• ADHD-C: Hyperactivity and attention problems
• ADHD-I: predominantly inattentive, little to no hyperactivity

The only difference between the subtypes is how they show stress. ADHD-HI and ADHD-C react stress outwardly, they often explode without being able to hold it in. The ADHD-I subtype tends to bottle up stress and then block it internally. These are not willful reactions, but deeply predisposed personality types that also exist in people who are not affected.

In addition, hyperactivity in adults turns into inner restlessness, a constant drivenness (always having to do something) combined with an inability to relax. The hyperactivity is often only recognizable in finger tapping or foot tapping.

ADHD-I with predominant inattention with little or no hyperactivity is extremely difficult to diagnose in both children and adults.

3. Misconception: “Professional success, studies or a doctorate exclude ADHD.”¶

Wrong.²

This becomes apparent at first glance when you look at the list of prominent people with ADHD: ⇒ Prominent people with ADHD.
Bill Clinton has a doctorate and a degree and once had a pretty good job - something he shared with John F. Kennedy and Abraham Lincoln.
Bill Gates does not want to be said to have been unsuccessful either, and even if it may seem obvious at first glance, it has not been proven that the many errors in Microsoft products are a direct consequence of Bill Gates’ ADHD.

The fact that the list has a clear heavyweight of (highly successful) actors, musicians and artists is largely due to the fact that ADHD is not necessarily a disadvantage in show business. However, we know a large number of people with ADHD who have studied, obtained doctorates and have been successful, at least temporarily, as well as their suffering and the price they pay for it.

A person with ADHD who is passionate about something can be more successful than average in this respect - as long as they manage to organize their social and emotional tasks away. Furthermore, more gifted people in particular are very good at compensating for their ADHD - at least for a while.

There is also the phenomenon, related to the influence of sex hormones, that ADHD occurs more frequently in boys during adolescence (1.6 to 1), while among adults the proportion of women catches up very strongly. Often there is undiagnosed ADHD-I in childhood and severe comorbidities such as depression or anxiety disorders, which are unfortunately 3 to 4 times more common in untreated ADHD than in those not affected.

4. Misconception: “No one knows what ADHD is. There are no biomarkers for ADHD.”¶

Wrong.

The symptoms of ADHD are largely mediated by a dopamine and noradrenaline action deficit in the (dorsolateral) PFC, striatum and cerebellum. There are also a number of other neurophysiological biomarkers.
This dopamine deficiency can be caused by a large number of factors:

• Gene variants (without environmental influences) that were inherited
  • Many gene variants are known to reliably trigger ADHD symptoms.
  • There are gene variants that alone can cause ADHD
  • Many gene variants only have a very small influence. The severity of the reduction in dopamine and noradrenaline levels required for a disruptive dimension of ADHD often results from a combination of several genes and environmental influences.
• Epigenetically modified genes that have been inherited
  • E.g. irreversible environmental influences in the parents (see above); nicotine consumption by the parents before conception.
    Epigenetic genetic changes are probably only passed on over a few generations (provided no new negative environmental influences are added). Prevention is possible here through particularly warm, securely bonding parental behavior.
• Environmental influences that irreversibly alter dopamine levels (through epigenetic changes)
  • E.g. early childhood stress, chronic stress, toxins, medication / nicotine / alcohol consumption of the mother during pregnancy, certain diseases (e.g. encephalitis), birth circumstances (e.g. lack of oxygen during birth)
• Environmental influences with reversible impact
  • E.g. food intolerances, deficiency of certain vitamins or minerals, hypothyroidism, sleep problems
  • Reversible environmental influences alone are very rarely strong enough to cause ADHD on their own.

A detailed description of the possible causes of ADHD, including thousands of directly linked sources, can be found at ⇒ Origin and ⇒ Neurophysiological correlates of ADHD symptoms.

It is true that standard diagnostics are not yet able to determine the specific cause of ADHD symptoms in all people with ADHD. This will probably change when full gene analyses are affordable and approved. At present, a full gene analysis would still cost around €1000. We were unable to identify any current data,

5. Misconception: “ADHD medications are like drugs / are addictive.”¶

Wrong.

Not only since Paracelsus is known: The dose makes the poison.
Drinking water is usually quite reliably lethal if you drink 6 liters at once or 10 liters a day. After heavy physical exertion, even smaller quantities are sufficient. Nevertheless, in appropriate doses, it is not only not poison, but essential for survival. Most people tend to drink too little.

The main difference is not the substance, but the application.
If a deficit is replenished to the normal level, this is referred to as medication.
If a substance is increased beyond healthy levels, it is called a poison or drug.

Stimulants are still the first choice of medication for ADHD: Methylphenidate and amphetamine medications. As drugs, they are used in such low doses and with such a slow onset and release that they only fill the existing dopamine and noradrenaline deficit. Consequences are that they have no intoxicating effect whatsoever. Drugs work by high concentrations and a fast, strong and short-term occupation of the receptors beyond the healthy level, thus causing a strong excess of dopamine and noradrenaline.
To illustrate: you can fill a pothole on the road (drug) or you can use the same material to create a bump on the asphalt (drug). A hump damages the chassis in the same way as an unfilled pothole.
It is therefore not a given drug that represents a danger, but a drug that is not given in the case of an existing deficit.

From a scientific point of view, amphetamine drugs are the first choice of medication for adults.³. The amphetamine drug Vyvanse is a precursor bound to lysine, which is only very slowly converted into the active ingredient in the intestine and blood. Even an abusive dosage could not trigger a drug effect.
There are also a number of other medications for ADHD, but they work less well than stimulants and cannot be started and stopped as quickly.

In ADHD, dopamine and noradrenaline levels in the PFC and striatum are reduced. Stimulants increase this effect - as medication in a controlled manner and without the risk of intoxication or addiction to the healthy level, as drugs in an uncontrolled manner, with intoxication and a considerable risk of addiction beyond the healthy level. This is the reason why untreated ADHD has a significantly increased risk of addiction. People with ADHD benefit from the drugs (cocaine, speed, marijuana/THC, nicotine, alcohol): they increase dopamine and noradrenaline levels in the problematic regions - keyword self-medication through substance abuse.

A large number of studies show that ADHD treatment with stimulants neither leads to habituation or withdrawal symptoms nor increases the risk of addiction (on the contrary, it significantly reduces it). Stimulants can be discontinued at any time without any problems - only the ADHD symptoms then return. The existing studies on long-term use also show no serious disadvantages or side effects.

Of course, all ADHD medications can have side effects, just like any effective medication. Even subjects who are given placebos (pills made of pure filler material without any active ingredient) in double-blind drug tests show side effects.

Very slow dosing reduces the risk of side effects.
Nevertheless, they are and remain medicines and may therefore only be prescribed after careful medical examination.

Find out more about why medication is particularly important as a first measure for newly diagnosed ADHD at ⇒ ADHD treatment guide.

6. Misconception: “Only children or teenagers have ADHD.”¶

Wrong.

In more than 60% of people with ADHD, ADHD that first appeared in childhood persists into adulthood - for life.
Recent studies also increasingly report ADHD diagnosed for the first time in adulthood, especially in women aged 40 and over. This could be related to changes in the oestrogen balance, which influences the dopamine balance.

⇒ ADHD in adults.

In the ADHD-I subtype, depression and anxiety disorders are more common in adulthood.

7. Misconception: “Almost only boys have ADHD.”¶

Wrong.

In childhood, 60% more boys are diagnosed than girls.

In adulthood, however, women catch up to the point where the gender ratio is balanced: ⇒ ADHD in adults.

8. Misconception: “In a suitable environment, ADHD is not a problem.”¶

This generalized statement is not correct. However, there is a certain environmental influence.

This justification is sometimes used to claim that medication or psychotherapy is not needed - that people with ADHD simply need to accept the person with ADHD as they are or create the right environment.

It is often the parents who advocate this. However, it is precisely these parents who fail to create an environment in which the child is not rejected as it is and who themselves fail to accept the child as it is and do not tackle it, belittle it or tell it how it should be different so that it is right.
Some parents fail to separate inappropriate behavior from the person. Instead of saying “Your behavior is not ok”, they say “You are not ok” - which is wrong.
In some cases, inappropriate handling of the child results from the fact that ADHD is strongly hereditary and there is therefore a high probability that at least one parent has ADHD themselves. However, this is not necessarily the case. We know parents with ADHD who treat their children with ADHD in an extremely respectful and appropriate manner.

At the other extreme, the view is held that people with ADHD simply have to be left as they are. The fact that this is also misleading becomes clearer when this idea is applied to other disorders. Nobody would think that schizophrenics only need to be told that the voices they think they hear are actually there - then they would no longer have delusions. Or that you only have to turn the other cheek to people with ADHD so that they calm down again.

However, it is true that people with ADHD have fewer problems if they can devote themselves to activities that really interest them. It is no coincidence that many people with ADHD are successful in the areas of show business and IT.
It is also possible to reduce the deficits typical of ADHD by delegating conflict-laden issues away. A person with ADHD who is passionate about programming and earns good money with it in a job can easily delegate the less popular activities such as housekeeping or tax returns to third parties and pay them for them. However, this is not possible for all people with ADHD. And even those who were able to turn their passion into a career had to get through their school years themselves and submit to the extrinsic demands of teachers and the timetable. It is also not foreseeable that delegating homework away from less popular subjects could ever become so fashionable that people with ADHD would experience any noticeable relief as a result.

9. Misconception: “ADHD medication helps everyone”¶

Studies show that ADHD medication can only slightly improve cognitive performance, e.g. attention, in people without ADHD. An increase in academic performance was not observed in people without ADHD ⁴
Due to the inverted-U profile of the effects of dopamine, an increase in dopamine levels in non-affected people (based on an optimal average level) is generally detrimental. At most, severe chronic stress, which lowers dopamine levels, can lead to a dopamine deficiency in non-affected individuals, for which ADHD medication also helps non-affected individuals. We believe it is possible that this could be the case in exam situations. There is ample evidence for the abuse of stimulants by non-affected students in exam situations. However, there are no reports of voluntary long-term use after the end of exams.
In fact, students who abuse stimulants for exam periods have higher than average ADHD symptoms.⁵⁶

10. Misconception: “If you’re gifted, you can’t have ADHD”¶

Giftedness and ADHD are by no means mutually exclusive.⁷
We know a large number of gifted and highly gifted people with sometimes very severe ADHD. The increased coping ability of gifted people is able to mask many ADHD problems. Our impression is that many gifted people with ADHD waste their giftedness on coping with their ADHD instead of being able to use their giftedness fruitfully.

11. Misconception: “ADHD also has many benefits”¶

ADHD counselors state that ADHD also has a lot of benefits that just need to be recognized:⁸

• Creativity
• Helpfulness
• Operational readiness
• Sensitivity
• Emotionality
• Honesty
• Enthusiasm
• Spontaneity
• Charm
• Inventiveness
• Fantasy
• Perceptual accuracy
• Unconventionality
• Artistic vein

Another example is a report that portrays ADHD as (in our opinion, clearly exaggerated) beneficial based on an obviously gifted painter.⁹

These “benefits” should not be misused to deny people with ADHD their suffering or to minimize ADHD.
Such comparisons are not made for other disorders - for good reason:

Depression

• Less aggressive

Fear

• Increased caution

Compulsions

• Increased care
• Increased cleanliness (compulsion to wash)

In the case of anxiety, depression and Compulsions, individual stress symptoms (care, reduction of aggression, caution) have become dysfunctional. They don’t help with anything, but are a burden and make life more difficult.
ADHD symptoms are congruent in their symptom totality with those of severe (chronic) stress (even if the cause is different). The congruence arises at the symptom level (syndrome), not at the cause level (disorder).
It is true that increased imagination and creativity can help solve problems in emergency situations.
Stress symptoms have a benefit. Otherwise these symptoms would not exist during stress. The benefit is an increased ability to survive when combating a stressor.
However, ADHD is stressful because there is no stressor and the condition is permanent. If there is a stressor, the symptoms may be beneficial. It is true that ADHD sufferers can function quite coolly in an emergency situation, while others lose their heads.
Despite these “benefits”, ADHD is still not “useful” because non-affected people also get these symptoms if a corresponding stressor occurs and is long and severe enough.
In people who are not affected, the symptoms disappear again with the stressor, in those with ADHD they remain.
ADHD is a regulatory disorder of the stress systems. And in general at the symptom level. By definition, a regulatory disorder is not an advantage.
In addition, these symptoms are accompanied by persistent restlessness and the presence of many other symptoms that occur with severe stress. And all in all, these are by no means pleasant, but highly stressful. To describe increased emotionality (a rollercoaster from elation to depression) as an advantage seems dubious from the outset.

You can advertise a car with extremely high fuel consumption by saying that the occupants get the opportunity to go to the toilet more often. Consequences of having to refuel more often. Is that really an advantage?
It may be that there is nothing in the world that does not have a positive side. However, reducing ADHD to certain alleged benefits does not do justice to this syndrome.

(*)Incidentally, this can be seen quite impressively in the SHR (Spontaneously Hypertensive Rat) animal model, the most widely used animal model for ADHD. These animals have an overactivated HPA axis (stress axis). With dexamethasone (a corticosteroid that switches off the HPA axis), these animals suddenly have neither increased blood pressure in old age nor ADHD symptoms.

Knowledge of people with ADHD from the point of view of doctors: when is it pseudo-knowledge, when is it reliable?¶

Of course, this is just a humorous exaggeration. But it has a kernel of truth

While some doctors and therapists engage in substantive discourse with their patients, others make it very clear that they are not prepared to engage in a substantive discussion of the technical realities of ADHD.

Doctors don’t always have it easy with their patients these days. Thanks to the Internet, many patients are ostensibly informed. If someone has a new medical problem and then reads up on it on the Internet, this usually only leads to a semblance of knowledge for the person with ADHD, which doctors are well advised not to deal with in depth.
Why should ADHD be any different?
The difference with ADHD is:

• There are very in-depth and extensive sources of information on ADHD on the internet (ADxS.org is just one of them)
• ADHD is a lifelong disorder, which gives (adult) people with ADHD a lot of time to deal with it intensively and thus gather detailed knowledge that can sometimes seriously supplement that of doctors, for whom ADHD is just one of the many disorders to be considered.
• People with ADHD can develop hyperfocus when intrinsically interested (which is common in relation to things that concern themselves) and acquire a high level of knowledge in a short period of time

Nevertheless, not all people with ADHD are well informed when they visit their doctor. The doctor then still has to find out whether the person with ADHD has reliable knowledge or - as the doctor is used to with other medical problems - has only briefly read up on something and reports typical ADHD impulsiveness. This is difficult to accomplish in the limited time of a medical consultation.

Nevertheless, it is a doctor’s very own responsibility to keep their specialist knowledge up to date. Deviating statements from patients, which they substantiate with sources from primary or secondary specialist literature, must at least prompt doctors to check their knowledge. Failure to do so would be a breach of professional duties.

Statements such as the common errors collected on this page cannot be justified even without conflicting statements from persons with ADHD, but always represent malpractice that is likely to impair the mental and physical health of the people with ADHD. People with ADHD who feel impaired by such medical or therapeutic errors are therefore more than entitled to bring this up - in a factual and friendly manner. This is because it not only affects their own health, but also that of others.
Sometimes it can help to print out the richly linked sources from ADxS.org and give them to the doctor,