The Most Common Misconceptions About ADHD

Unfortunately, misconceptions about ADHD are widespread. Even some doctors (who do not specialize in ADHD) repeatedly make untenable claims. This leads to incorrect diagnoses and increases the suffering of people with ADHD. The misconceptions presented on this page have been expressed by doctors or therapists—and these are not isolated cases. If a misconception results in harm to the patient, it constitutes medical malpractice, which may give rise to liability for damages.

Here, we summarize the most common misconceptions about ADHD.

1. Misconception: “If I’m interested in something, I can pay attention, so it can’t be ADHD.”¶

Wrong.¹

• In ADHD, it is not the “technical ability” to pay attention that is impaired, because when they are genuinely interested in something, people with ADHD can actually maintain their attention for very long periods and with great intensity. This is known as “hyperfocus.” Hyperfocus is a very narrowly focused attention that blocks out irrelevant stimuli very effectively—or even to an above-average degree.
• In ADHD—upon closer examination—it is not the “technical ability” to direct attention that is impaired, because the attention of people with ADHD can shift between hyperfocus (the positive term) or difficulties switching tasks (the negative side of hyperfocus) and distractibility (the opposite of hyperfocus: irrelevant stimuli are particularly difficult to filter out in these cases).
• Attention and the ability to direct attention do, therefore, function “technically speaking” in ADHD. However, they are subject to a pattern, a profile, or a mode that is ill-suited to everyday life. In the case of severe, life-threatening stress, this mode—characterized by heightened focus on activities perceived as personally important (such as imminent threats) or increased distractibility during less relevant activities (are there any dangers out there?)—would be helpful for survival. In ADHD, attention operates in this stress mode even in the absence of adequate stressors.
  Very important: People with ADHD cannot change this at will. In this respect, the way attention is directed works differently than it does for people who are not affected.
• In ADHD, the ability to be motivated by both extrinsic and intrinsic stimuli is reduced. To feel the same level of motivation as people without ADHD, people with ADHD require significantly greater incentives, such as rewards. When personal motivation is triggered by appropriate incentives, the attention performance—including sustained attention—of people with ADHD is so good that they can no longer be reliably distinguished from people without ADHD. What appears from the outside to be selfishness—as if they “can, but don’t want to”—is in reality an inability to direct their own will in the same way that non-affected individuals can, or to generate their own motivation. Other ADHD symptoms that disappear or are significantly reduced once a state of motivation has been achieved include impulsivity, likely hyperactivity as well, and—at least in part—the symptoms caused by spatial-visual working memory. More on this under ⇒ A Shift in Motivation Toward One’s Own Needs Explains Regulatory Problems.
• That said, ADHD can also occur without attention problems. The ADHD-HI subtype is characterized by predominant hyperactivity with no or only minor attention problems.

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

Wrong.

There are various subtypes of ADHD. In all cases, it is the same underlying disorder, which is primarily characterized by a deficit in dopamine and norepinephrine activity in the (dorsolateral) PFC, the basal ganglia (including the striatum), and the cerebellum:

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

The subtypes differ only in how they express stress. ADHD-HI and ADHD-C react to stress outwardly; they often lose their temper without being able to control it. The ADHD-I subtype tends to internalize stress and then becomes emotionally blocked. These are not deliberate reactions, but rather deeply ingrained personality types, which also exist in people without ADHD.

In addition, hyperactivity in adults manifests as inner restlessness—a constant sense of being driven (always having to do something)—combined with an inability to relax. The hyperactivity is often only recognizable in the form of tapping fingers or rocking one’s foot.

ADHD-I, characterized by predominantly inattentive symptoms with little or no hyperactivity, is extremely difficult to diagnose in both children and adults.

3. Myth: “Professional success, a college degree, or a Ph.D. rule out ADHD.”¶

Wrong.²

This becomes apparent at first glance when you look at the list of famous people with ADHD: ⇒ Famous People with ADHD.
Bill Clinton has a Ph.D. and went to college, and he also once had a pretty good job—something he had in common with John F. Kennedy and Abraham Lincoln.
Nor would anyone say that Bill Gates has been unsuccessful, and even though it may seem obvious at first glance, there is no proof that the many flaws in Microsoft products are direct consequences of Bill Gates’ ADHD.

The fact that the list is heavily weighted toward (highly successful) actors, musicians, and artists is largely because ADHD isn’t necessarily a disadvantage in show business. However, we know of many people with ADHD who have college degrees, doctorates, and have been successful—at least at times—and we are also aware of their struggles and the price they pay for it.

A person with ADHD who pursues something with passion can achieve above-average success in that area—provided they manage to delegate their social and emotional responsibilities to others. Furthermore, highly gifted individuals in particular are very capable of compensating for their ADHD—at least for a while.

In addition, there is a phenomenon related to the influence of sex hormones: ADHD is more common among boys during adolescence (1.6 to 1), whereas among adults, the proportion of women catches up significantly. Often, there is undiagnosed ADHD-I in childhood, along with serious comorbidities such as depression or anxiety disorders, which, unfortunately, are 3 to 4 times more common in individuals with untreated ADHD than in those without the condition.

4. Misconception: “There are no biomarkers for ADHD.”¶

That’s true, but it’s not an argument against ADHD.

It is true that ADHD, as a syndrome, does not have any common causal biomarkers.³
ADHD is a syndrome. This means that many different underlying conditions can produce similar symptoms. ADHD shares this characteristic with many other disorders, such as autism, Tourette syndrome, restless legs syndrome, post-concussion disorder, depression, schizophrenia, bipolar disorder, chronic fatigue syndrome, fibromyalgia, irritable bowel syndrome, functional dyspepsia, metabolic syndrome, premenstrual syndrome, postural tachycardia syndrome, burnout syndrome, Ehlers-Danlos syndrome, and mast cell activation syndrome. This shows that existing causal biomarkers are by no means necessary for the existence of a syndromic disorder.

Type 1 diabetes and Type 2 diabetes also do not share any common causal biomarkers, but they do share biomarkers that are involved in the development of symptoms.

We see a similar pattern with ADHD. Even though there are no common causal biomarkers, there are common symptomatic biomarkers.
A key factor in ADHD is likely to be an abnormality in extracellular dopamine and norepinephrine levels in the (dorsolateral) PFC, the basal ganglia (including the striatum), and the cerebellum. It is true, however, that these abnormalities also occur in other disorders, meaning they have low specificity.
Since catecholamines cause very similar symptoms when their levels deviate from the average—whether higher or lower—this deviation is the common characteristic.
It is likely to be, for the most part, a downward deviation.
These fluctuations in dopamine and norepinephrine levels can result from a wide variety of causes:

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

Wrong.

It has been known for a long time—not just since Paracelsus—that the dose makes the poison.
Drinking water is usually quite reliably fatal if you drink 6 liters at once or 10 liters a day. After intense physical exertion, even smaller amounts are enough. Nevertheless, in appropriate amounts, it is not only not a poison but essential for survival. Most people tend to drink too little.

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

The first choice of medication for ADHD continues to be stimulants: methylphenidate and amphetamine-based medications. When prescribed, they are used in such low doses and with such a gradual onset and taper-off that they merely replenish the existing dopamine and norepinephrine deficits. As a consequence, they have no intoxicating effect whatsoever.
Drugs, on the other hand, work by binding to receptors in high concentrations and in a rapid, intense, and short-lived manner that exceeds healthy levels, thereby causing a significant excess of dopamine and norepinephrine.
To illustrate: You can fill a pothole in the road (medication), or you can use the same material to create a bump in the asphalt (drug). A bump damages the suspension just as much as an unfilled pothole.
So it is not a medication that has been administered that poses a risk, but rather a medication that has not been administered when there is an existing deficiency.

From a scientific perspective, amphetamine-based medications are the first choice of medication for adults.⁴ The amphetamine medication Vyvanse (lisdexamfetamine) is a lysine-bound prodrug that is converted very slowly into the active ingredient once in the bloodstream. Even if taken in excessive doses, it would not produce any drug-like effects.
In addition, there are several other medications for ADHD, but they are less effective than stimulants and cannot be started or stopped as quickly.

In ADHD, the effects of dopamine and norepinephrine are reduced in the (dorsolateral) prefrontal cortex (PFC), basal ganglia (including the striatum), and cerebellum, among other areas. Stimulants enhance these effects—when taken as medications, they do so in a controlled manner and without the risk of intoxication or addiction, bringing levels back to a healthy range; when taken as illicit drugs, they do so in an uncontrolled manner, leading to intoxication and a significant risk of addiction that exceeds healthy levels. This is why untreated ADHD carries a significantly increased risk of addiction. People with ADHD derive a benefit from these substances (cocaine, methamphetamine, marijuana/THC, nicotine, alcohol): they increase dopamine and norepinephrine levels in the affected regions—a form of self-medication through substance abuse.

Numerous studies show that treating ADHD with stimulants does not lead to tolerance or withdrawal symptoms, nor does it increase the risk of addiction (but rather, significantly reduces it). Stimulants can be discontinued at any time without any problems—the only thing that happens is that the ADHD symptoms return. Furthermore, existing studies on long-term use show no concerning disadvantages or side effects.

Of course, all ADHD medications can have side effects, just like any effective treatment. Even participants who receive placebos (pills made of inert filler material without any active ingredient) in double-blind drug trials experience side effects.

Administering the medication very slowly reduces the risk of side effects.
Nevertheless, they are and remain medications and may therefore only be prescribed after a thorough medical examination.

For more information on why medication is particularly important as a first step in the treatment of newly diagnosed ADHD, visit ⇒ Guide to ADHD Treatment.

P.S.: If ADHD medications were addictive, no person with ADHD would ever forget to take them. Unfortunately, many people with ADHD repeatedly forget to take their ADHD medications and don’t realize it until their ADHD symptoms reappear.

6. Myth: “Only children and adolescents have ADHD.”¶

Wrong.

In more than 60% of people with ADHD, ADHD—which first appeared in childhood—persists into late adulthood—for life.
Recent studies are also increasingly reporting cases of ADHD diagnosed for the first time in adulthood, particularly among women aged 40 and older. This could be related to changes in estrogen levels, which affect dopamine levels.

⇒ ADHD in Adults.

In adults with the ADHD-I subtype, depression and anxiety disorders are more common.

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

Wrong.

During childhood, 60% more boys than girls are diagnosed.
In adulthood, however, women are diagnosed just as often as men: ⇒ ADHD in Adults.

8. Misconception: “In the right environment, ADHD isn’t a problem.”¶

This statement is not entirely accurate when generalized in this way. However, a suitable environment does have some influence.

Based on this reasoning, some people claim that medication or psychotherapy is unnecessary—that with ADHD, all one needs to do is simply accept people with ADHD as they are or create the right environment.
The fact that this is equally misleading becomes clearer when one applies this idea to other clinical conditions. No one would suggest that all we need to do is explain to people with schizophrenia that the voices they think they hear are actually real—and then their delusions would disappear. Or that we should simply turn the other cheek to people with ADHD so they can act out their aggression.

Nevertheless, this view is held—sometimes even by parents. But apparently, even these parents are unable to create such an environment.
But that isn’t these parents’ fault—it’s simply impossible to shape the world in such a way that a person with ADHD doesn’t suffer in it.
Because suffering comes from within, not from without.

It is true, however, that people with ADHD have fewer problems when they can engage in activities that truly interest them. It is no coincidence that many people with ADHD are successful, particularly in the fields of show business and IT.
It is also possible to reduce the deficits typical of ADHD by delegating conflict-prone tasks to others. A person with ADHD who is passionate about programming and earns a good living from it can easily delegate less enjoyable tasks—such as managing household finances or filing tax returns—to third parties and pay them to handle these tasks.
However, this isn’t possible for all people with ADHD. And even those who were able to turn their passion into a career had to get through school themselves and conform to the extrinsic demands of their teachers and the rigid class schedule.

A world in which people with ADHD could thrive would have to make it possible to delegate homework entirely—or at least the homework from less favorite subjects.
This example should sufficiently illustrate the absurdity of the idea.

9. Myth: “ADHD medications help everyone, don’t they?”¶

Wrong.

Studies show that ADHD medications can only slightly improve cognitive performance—such as attention—in people without ADHD. No improvement in academic performance was observed in people without ADHD.⁵⁶
Due to the inverted-U profile of dopamine’s effects, an increase in dopamine levels in non-affected individuals (starting from an optimal average level) is generally detrimental. At most, in the event of severe chronic stress that lowers dopamine levels, a dopamine deficiency may develop in non-affected individuals, in which case ADHD medications can also help them. We believe it is possible that this could be the case during exam situations. Indeed, there is ample evidence of stimulant abuse by students without ADHD during exam periods. However, there are no reports of voluntary, long-term use after exams have ended.
In fact, students who misuse stimulants during exam periods exhibit an above-average number of ADHD symptoms.⁷⁸⁹

10. Myth: “Highly gifted people cannot have ADHD”¶

Wrong.

Giftedness and ADHD are by no means mutually exclusive.¹⁰
We know a large number of highly and exceptionally gifted individuals, some of whom have very severe ADHD. The enhanced coping skills of highly gifted individuals can mask many ADHD-related problems. In our experience, many gifted individuals with ADHD waste their giftedness on coping with their ADHD instead of being able to put their giftedness to productive use.

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

Guides on ADHD state that ADHD also has a number of advantages that simply need to be recognized:¹¹

• Creativity
• Willingness to help
• Operational readiness
• Sensitivity
• Emotionality
• Honesty
• Enthusiasm
• Spontaneity
• Charm
• Creativity
• Imagination
• Accuracy of perception
• Unconventionality
• artistic streak

Another example is a feature story that portrays ADHD in a positive light (which, in our view, is clearly exaggerated) by focusing on an obviously gifted painter.¹²

These “advantages” should not be misused to deny the suffering of people with ADHD or to downplay ADHD.
In the case of other types of malfunctions, such comparisons are not made—and for good reason:

Depression

• less aggressive

Fear

• increased caution

Compulsions

• increased diligence
• increased cleanliness (compulsive washing)

In cases of anxiety, depression, and compulsions, certain stress-related symptoms (meticulousness, reduced aggression, and caution) have become dysfunctional. They do not help in any way; instead, they are a burden and make life more difficult.
The symptoms of ADHD, taken as a whole, are identical to those of severe (chronic) stress (even though the causes are different). This overlap occurs at the level of symptoms (syndrome), not at the level of causes (Disorder).
It is true that a more vivid imagination and greater creativity can help solve problems in emergency situations.
Stress symptoms serve a purpose. Otherwise, these symptoms would not occur in response to stress. Their purpose is to increase one’s chances of survival when dealing with a stressor.
However, ADHD is burdensome because there is no specific stressor and the condition is chronic. If there is a stressor, the symptoms may actually be beneficial. It’s true that people with ADHD can remain completely calm in an emergency, while others lose their composure.
Despite these “advantages” in certain areas, ADHD is not “useful” overall, because even people without the condition can experience these symptoms when a corresponding stressor arises and has a prolonged and severe enough effect.
In people without ADHD, the symptoms disappear once the stressor is gone; in people with ADHD, they persist.
ADHD is a regulatory disorder of the stress systems. Specifically, this applies generally at the level of symptoms. By definition, a regulatory disorder is not an advantage.
Furthermore, these symptoms are accompanied by persistent restlessness and the presence of many other symptoms that occur during severe stress. And symptoms such as those associated with severe, life-threatening stress are, taken together, by no means pleasant, but rather highly distressing—even when they occur without an adequate stressor. To describe heightened emotionality (a roller coaster of emotions ranging from elation to despair) as an advantage seems doubtful to us from the outset.

You could advertise a car with extremely high fuel consumption by pointing out that passengers will have more opportunities to use the restroom. This is one of the consequences of having to refuel more often. So 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 is particularly evident in the SHR (spontaneously hypertensive rat) animal model, the most commonly used animal model for ADHD. These animals have an overactive HPA axis (stress axis). When treated with dexamethasone (a corticosteroid that suppresses the HPA axis), they suddenly exhibit neither elevated blood pressure in old age nor ADHD symptoms.

12. Myth: “ADHD must have been present before the age of 7 or 12”¶

That’s not quite right.

The DSM-5 requires only the presence of at least two symptoms—as listed under the categories of inattention and/or hyperactivity—before the age of 12.
ICD-10 still had an age limit of 6 years here, while ICD-11 aligns with the 12-year limit in DSM-5. Unlike DSM-5, however, the age limit in ICD-10 and ICD-11 is not a rigid barrier that categorically excludes a diagnosis; rather, it leaves the decision up to the clinician.

Neither the DSM nor the ICD requires that all symptoms—or a sufficient number of symptoms—must have been present before a certain age for a diagnosis to be made.

The rigidity of the DSM’s time-based limitations has been rightly criticized by prominent authors, including Barkley and Cortese et al.¹³.

13. Misconception: “Stimulants should be avoided because they increase the risk of cardiovascular problems”¶

Wrong.
It is true that ADHD medications increase cardiovascular risk. Non-stimulants such as atomoxetine increase this risk even more than stimulants.
Overall, however, ADHD medications reduce the risk of death because they actually do a little more than that.
Therefore, a blanket refusal based on an increased cardiovascular risk would constitute medical malpractice.

In detail:
ADHD medications do indeed increase the risk of cardiovascular disease. However, they do not increase the risk of heart attacks, which are the leading cause of death from cardiovascular disease. For more on this, see Heart Problems Comorbid with ADHD in the article “ ” Choosing a Medication for ADHD or ADHD with Comorbidities

ADHD itself, however, is associated with a reduced life expectancy of 8 to 11 years:

ADHD medications help people with ADHD in so many ways that, overall, they increase life expectancy. Among other things, they reduce the risk of suicide, accidents, and comorbid disorders—as documented by relevant studies.

A study published in March 2024 study involving nearly 150,000 Swedish ADHD patients found that taking ADHD medication was associated with a 19% reduction in the risk of death over the following 2 years.
A collection of relevant studies can be found at Reduced premature mortality, fewer suicides in the article “ : Consequences of ADHD”, which we strongly recommend in this context.

Regardless of this, in individual cases, persons with ADHD and very specific cardiovascular problems or risks may be well advised to avoid ADHD medications that increase these risks. In such cases, it is advisable to take a closer look at guanfacine, which, however, is not (yet) approved for adults in Germany and would therefore be considered off-label.

This misconception comes in other forms as well.
Another approach is a blanket rejection of ADHD medications because they increase the risk of Parkinson’s-like symptoms in old age. Yes, they do, but only slightly, and often only the risk of tremors. On the other hand, they reduce the risk of death. To put it bluntly: Most people with ADHD would probably rather live with a shaky hand in old age than be dead with a steady hand.

People with ADHD and Their Knowledge: When Is It Superficial, and When Is It Reliable?¶

Of course, that’s just a humorous exaggeration. But there’s a true essence to it.

These days, doctors don’t always have an easy time with their patients. Thanks to the Internet, many patients have a false sense of knowledge. When someone has a new medical problem and starts researching it online, this usually results in only a superficial, superficial understanding on the part of the people with ADHD—and doctors would be well advised not to delve too deeply into such information.
Why should it be any different with ADHD?
The difference with ADHD is:

• There are very in-depth and comprehensive online resources on ADHD (ADxS.org is just one of them)
• ADHD is a lifelong disorder, which gives (adult) people with ADHD plenty of time to grapple with it in depth and thus gain detailed knowledge that can, at times, seriously complement that of doctors for whom ADHD is just one of many disorders to consider.
• People with ADHD can develop hyperfocus when they have an intrinsic interest (which is common when it comes to matters that concern them personally) and acquire a great deal of knowledge in a short period of time

Nevertheless, by no means are all people with ADHD well-informed when they visit their doctor. The doctor is left with the difficult task of determining whether the person with ADHD has a solid understanding of the condition or—as the doctor is accustomed to seeing with other medical issues—has only skimmed through some information and is reporting symptoms with the impulsivity typical of ADHD. This is difficult to accomplish within the limited time available during a medical consultation.

Nevertheless, it is a doctor’s fundamental responsibility to keep his or her professional knowledge up to date. When patients make statements that differ from the norm— —and support them with sources from primary or secondary professional literature —doctors must, at the very least, be prompted to review their knowledge. Failure to do so would constitute a breach of professional duties.

Statements such as the common misconceptions compiled on this page can never be justified; rather, they always constitute malpractice that is likely to impair the mental and physical health of people with ADHD. People with ADHD who feel harmed by such medical or therapeutic errors are therefore more than justified in raising the issue—in a factual and courteous manner. After all, it affects not only their own health but also the health of others.
Sometimes it can be helpful to print out the sources extensively linked on ADxS.org and give them to your doctor. After all, that is what ADxS.org is for—not for self-treatment, but to provide background information that enables people with ADHD to have a more informed dialogue with their doctors and psychotherapists.