The most common misconceptions about ADHD
Misconceptions about ADHD are unfortunately widespread. Even some doctors (not specialized in ADHD) make untenable statements again and again. This leads to incorrect diagnoses and increases the suffering of those affected.
We summarize here the most popular misconceptions about ADHD.
- 1. Misconception: “With interest, yes attention works, so it can’t be ADHD.”
- 2. Misconception: “If you’re not hyperactive, you can’t have ADHD.”
- 3. Misconception: “Degree, doctorate, success or successful self-employment preclude ADHD.”
- 4. Misconception: “No one knows what ADHD is. There are no biomarkers in ADHD.”
- 5. Misconception: “ADHD medications are like drugs / addictive.”
- 6. Misconception: “ADHD only has children or adolescents.”
- 7. Misconception: “ADHD is almost all boys.”
- 8. Misconception: “Given the right environment, ADHD is not a problem.”
1. Misconception: “With interest, yes attention works, so it can’t be ADHD.”
- In ADHD, it is not the “technical ability” to pay attention that is impaired, because with the appropriate interest, affected persons can even pay attention for a very long time and intensively. This is the so-called hyperfocus. Hyperfocus is a very narrowly directed attention that blocks out irrelevant stimuli very well or even more than average.
- In ADHD - on closer inspection - even the “technical ability” to direct attention is not impaired, because the attention of the affected person 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 blanked out with above-average difficulty here).
- Attention and attention directing thus function “technically” in ADHD. However, they are subject to a regime, a profile, a mode that is inappropriate for everyday life. In severe, survival-threatening stress, this mode of increased focus on activities personally perceived as important (on threatening dangers) or increased distractibility on less relevant activities (are there dangers somewhere?) would help survival. In ADHD, attention runs in this stress mode without adequate stressors.
Very important: those affected cannot change this at will. In this respect, it is correct to say simplistically that the control of attention does not function as it does with non-affected persons.
- In ADHD, the ability to be motivated by extrinsic as well as intrinsic stimuli is reduced. In order to feel the same motivation as non-affected persons, ADHD sufferers need significantly higher incentives, such as rewards, With personal motivation induced by appropriate incentives, the attentional performance - including sustained attention - of ADHD sufferers is so good that they can no longer be reliably distinguished from non-affected persons. What looks like egoism from the outside, like “being able but not wanting”, is in reality the inability to direct one’s own will in the same way as non-affected persons can, or to cause 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. For more on this, see ⇒ Motivation shift towards own needs explains regulation problems.
- Apart from that, ADHD also exists without attention problems. The ADHD-HI subtype is characterized by predominant hyperactivity without or with only a few attention problems.
2. Misconception: “If you’re not hyperactive, you can’t have ADHD.”
There are different subtypes of ADHD. These are always the same basic disorder, which is primarily characterized by a dopamine and norepinephrine effect deficit in the (dorsolateral) PFC and in the striatum:
- ADHD-HI: predominantly hyperactive, little to no attention problems
- ADHD-C: Hyperactivity and attention problems
- ADHD-I: predominantly inattentive, little to no hyperactivity
The subtypes differ only in how they show stress. ADHD-HI and ADHD-C react stress outwardly, they rather explode sometimes without being able to hold it. The ADHD-I subtype tends to eat stress into itself and then blocks internally. These are not voluntary reactions, but deeply predisposed personality types, as they also exist in non-affected people.
Besides, hyperactivity in adults turns into an inner restlessness, a constant being driven (always having to do something) in connection with an inability to relax. The hyperactivity is often only recognizable in finger tapping or foot bobbing.
ADHD-I, with predominant inattention with little or no hyperactivity, is extremely difficult to diagnose in both children and adults.
3. Misconception: “Degree, doctorate, success or successful self-employment preclude ADHD.”
This becomes apparent at first glance when looking at the list of prominent ADHD sufferers: ⇒ Prominent ADHD sufferers.
Bill Clinton has a doctorate and a degree and also once had a pretty good job - something he shared with John F. Kennedy and Abraham Lincoln.
Bill Gates would also not like to be said to have been unsuccessful, 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 result of Bill Gates’ ADHD.
The fact that the list has a clear heavyweight of (highly successful) actors, musicians and artists is very much due to the fact that ADHD is not such a malus in show business as it is in “serious” professions. However, we know a large number of studied, graduated and at least temporarily successful people with ADHD - and also their difficulties and suffering.
An ADHD sufferer who is on fire for something can be more successful than average in this regard - as long as he or she manages to organize away his or her social and emotional tasks. Furthermore, especially highly gifted people are very capable of coping with their ADHD - at least for a while.
In addition, there is the - misunderstood but empirically proven - phenomenon that in adolescence ADHD is more common in boys (1.6 to 1), but in adults females catch up very strongly, then often with ADHD-I undiagnosed in childhood and severe comorbidities such as depression or anxiety disorders, which unfortunately are 3 to 4 times more common in untreated ADHD than in non-affected individuals.
4. Misconception: “No one knows what ADHD is. There are no biomarkers in ADHD.”
The symptoms of ADHD are mainly caused by a dopamine and norepinephrine deficit in the (dorsolateral) PFC, striatum and cerebellum. In addition, there are several other neurophysiological biomarkers.
This dopamine deficiency can result from a variety of causes:
- Gene variants (without environmental influences) that were inherited
- Environmental influences with reversible impact
- E.g. lead, food intolerances, deficiency of certain vitamins or minerals, hypothyroidism, sleep problems
- Environmental factors that irreversibly alter dopamine levels (through epigenetic changes)
- E.g. early childhood stress, chronic stress, toxins / medication / nicotine / alcohol consumption by the mother during pregnancy
- Epigenetically modified genes that have been inherited
- E.g. irreversible environmental influences in parents (see above); nicotine use by parents before conception.
Epigenetic gene changes are likely to be passed down only a few generations (unless new negative environmental influences are added) and are subject to strong prevention by warm, secure-binding parental behaviors
- E.g. irreversible environmental influences in parents (see above); nicotine use by parents before conception.
In addition, the ADHD-typical time perception problems arise from comparable changes in the cerebellum.
Individual genes have only a very small influence. The strength of reduction in dopamine and norepinephrine levels required for a disruptive dimension of ADHD arises from a confluence of multiple genes and environmental influences. Reversible environmental influences alone are most rarely strong enough to cause ADHD on their own.
5. Misconception: “ADHD medications are like drugs / addictive.”
Not only since Paracelsus is known: the dose makes the poison.
Drinking water is usually quite reliably lethal if you drink 3 liters at once or 5 liters a day. Nevertheless, in appropriate doses, it is not poison.
The essential difference is not the substance, but the application.
When a deficit is replenished to the normal level, it is called a drug.
If a substance is increased beyond healthy levels, it is called a poison or drug.
The drugs of first choice for ADHD are still stimulants: Methylphenidate and amphetamine medications. As drugs, they are used in such low doses and with such slow onset and release that they only replenish the existing dopamine and noradrenaline deficit. As a result, they have no intoxicating effect. Drugs have an effect by high concentrations and a fast, strong and short-term occupation of the receptors beyond the healthy level, thus causing a strong dopamine and noradrenaline excess.
Illustrated: you can fill a pothole on the road (drug) or you can put a hump on the asphalt with the same material (drug). A hump damages the chassis in the same way as an unfilled pothole.
So it’s not a given drug that’s a danger, it’s a drug not given in an existing deficit.
The first-choice drug for adults, the amphetamine drug Elvanse, is a lysine-bound precursor that is only very slowly converted to the active ingredient in the intestine and blood. Even an abusive dosage could not trigger a drug effect.
In addition, there are several other medications for ADHD, but they are less effective than stimulants and cannot be started and stopped as quickly.
In ADHD, dopamine and norepinephrine action levels in the PFC and striatum are reduced, among other things. Stimulants raise this effect - as drugs controlled and without risk of intoxication or addiction to the healthy level, as drugs uncontrolled, with intoxication and considerable risk of addiction beyond the healthy level. This is the reason why untreated ADHD has a significantly increased risk of addiction. Sufferers benefit from drugs (cocaine, speed, marijuana/THC, nicotine, alcohol): they increase dopamine and norepinephrine levels in the problematic regions - keyword self-medication through substance abuse.
A large number of studies show that ADHD treatment with stimulants does not lead to habituation or discontinuation symptoms, nor does it increase the risk of addiction (on the contrary, it reduces it). Stimulants can be discontinued at any time without any problems - only the ADHD symptoms will return. The existing studies on long-term use also show no questionable disadvantages or side effects.
Of course, all ADHD drugs can have side effects, like any effective drug. Even the subjects who receive placebos (pills made of pure filler 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 medications and therefore may only be prescribed after careful medical examination.
For more on why medication is especially important as an acute intervention for newly diagnosed ADHD, see ⇒ ADHD Treatment Guide.
6. Misconception: “ADHD only has children or adolescents.”
In 60% of those affected, 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 older. This may be related to changes in estrogen balance, which affects dopamine balance.
ADHD symptoms change with age.
In adults, the hyperactivity of the subtypes ADHD-HI and ADHD-C turns into a permanent inner restlessness, an inner being driven, which shows itself in always having to do something and is accompanied by an inability to relax and enjoy oneself. The motor hyperactivity is often only recognizable in finger tapping or foot bobbing.
In the ADHD-I subtype, depression and anxiety disorders become more frequent in adulthood.
7. Misconception: “ADHD is almost all boys.”
In childhood, 60% more boys are still diagnosed than girls.
In adulthood, however, women catch up to a balanced sex ratio: ⇒ ADHD in adults.
8. Misconception: “Given the right environment, ADHD is not a problem.”
This statement is so flatly wrong. However, there is a certain environmental influence.
With this reasoning, it is sometimes claimed that medication or psychotherapy is not necessary - with ADHD, one simply has to accept those affected as they are or create the right environment.
Often it is the parents who represent this. But it is precisely these parents who fail to create an environment in which the child, as it is, is not rejected and who themselves fail to accept the child as it is and not to 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 okay”, they say “You are not okay” - which is wrong.
Partly, an inappropriate handling of the child results from the fact that ADHD is strongly hereditary and therefore there is a high probability that at least one parent has ADHD himself. However, this is not mandatory. We know parents with ADHD who deal with their ADHD-affected children in an extremely appreciative and appropriate way.
At the other extreme, the view is held that one simply has to leave affected persons as they are. That this is just as misleading becomes clearer when this idea is applied to other disorders. No one would think that one only has to explain to schizophrenics that the voices they think they hear are actually there - then they would no longer have delusions. Or one would only have to turn the other cheek to sufferers of aggression disorders so that they would calm down again.
It is true, however, that ADHD sufferers have fewer problems when they can devote themselves to activities that really interest them. It is no coincidence that many ADHD sufferers are successful in the areas of show business and IT.
It is also possible to reduce the ADHD-typical deficits by delegating conflict-laden topics away. An ADHD sufferer who is passionate about programming and earns good money doing it in a job can easily delegate the less popular activities such as household management or tax returns to third parties and pay them for it. However, this is not possible for all sufferers. And even those who were able to turn their passion into a profession had to get through their school years themselves, bowing to the extrinsic demands of teachers and the timed schedule. It is also not foreseeable that delegating homework away from less popular subjects could ever become so fashionable that ADHD sufferers would experience a perceptible relief as a result.
Dodson: 3 Defining Features of ADHD That Everyone Overlooks. ADDitudeMag. Download 06.01.2020. Note the ADHD professional prominence of ADDitudeMag’s Scientific Advisory Board. ↥
Dodson (2015): 7 Bigges Diagnosis Mistakes Doctors Make, ADDitudeMag. Note the ADHD professional prominence of ADDitudeMag’s Scientific Advisory Board. ↥