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. The misconceptions presented on this page were made by doctors or therapists - and this does not mean individual cases. If the erroneous assumption leads to harm to the patient, it is a matter of medical malpractice, which can trigger liability for damages.

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: “Professional success, graduate studies, or doctoral degrees preclude ADHD.”
• 4. Misconception: “No one knows what ADHD is. There are no biomarkers in ADHD.”
• 5. Misconception: “ADHD medications are like drugs / are addictive.”
• 6. Misconception: “Only children or adolescents have ADHD.”
• 7. Misconception: “Almost only boys have ADHD.”
• 8. Misconception: “In an appropriate environment, ADHD is not a problem.”
• 9. Misconception: ADHD medication helps everyone after all
• Affected person knowledge from a physician’s perspective: when bogus knowledge, when resilient?

1. Misconception: “With interest, yes attention works, so it can’t be ADHD.”¶

Wrong.¹

• 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 - the “technical ability” to direct attention is not impaired either, because the attention of the affected person can alternate 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: the affected persons cannot change this voluntarily. In this respect, the directing of attention works differently than 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 evoked 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 a “can do but don’t want to” is in reality the inability to direct one’s own will in the same way as non-affected persons can, or to evoke one’s own motivation. Other ADHD symptoms that disappear or are significantly reduced when a motivational state has been achieved include impulsivity, arguably hyperactivity, and, at least in part, the symptoms caused by spatial-visual working memory. For more on this, see ⇒ Motivational shift toward own needs explains regulation problems.
• Apart from that, ADHD also exists 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. These are always the same basic disorder, which is primarily characterized by a dopamine and norepinephrine action deficit in the (dorsolateral) PFC and 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 explode more often without being able to hold it. The ADHD-I subtype tends to eat stress inside and then blocks internally. These are not voluntary reactions, but deeply predisposed personality types, as they also exist in non-affected people.

In addition, hyperactivity in adults turns into an inner restlessness, a constant being driven (always having to do something) in connection with an inability to recover. 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: “Professional success, graduate studies, or doctoral degrees preclude ADHD.”¶

Wrong.²

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 though 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 necessarily a disadvantage in show business. However, we know a large number of people with ADHD who have studied, earned doctorates, and have also been successful at least some of the time - and likewise their suffering and the price they pay for it.

An ADHD sufferer who is passionate about something can be more successful than average in this regard - as long as they manage to organize their social and emotional tasks away. Furthermore, especially more gifted people are very well able to compensate for their ADHD - at least for a while.

In addition, there is the phenomenon related to the influence of sex hormones that in adolescence ADHD occurs more often in boys (1.6 to 1), while among adults, however, the proportion of women catches up very strongly. Often there is ADHD-I undiagnosed in childhood here and severe comorbidities such as depression or anxiety disorders, which unfortunately are 3 to 4 times more common in untreated ADHD than in unaffected individuals.

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

Wrong.

The symptoms of ADHD are significantly mediated by a dopamine and norepinephrine action deficit in the (dorsolateral) PFC, striatum, and cerebellum. In addition, there are quite a few other neurophysiological biomarkers.
This dopamine deficiency can result from a large number of causes:

• Gene variants (without environmental influences) that were inherited
  • Many gene variants are known to reliably cause ADHD symptoms.
  • There are gene variants that alone can cause ADHD
  • Many gene variants have only a very small influence. The severity of the reduction in dopamine and norepinephrine levels required for a disruptive dimension of ADHD often results from a confluence of multiple genes and environmental influences.
• 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 probably only passed on over a few generations (provided that no new negative environmental influences are added). Here, prevention is possible through particularly warm, securely bonding parental behavior.
• Environmental factors that irreversibly alter dopamine levels (through epigenetic changes)
  • E.g., early childhood stress, chronic stress, toxins, medications/nicotine/alcohol consumption by 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 most rarely strong enough to cause ADHD on their own.

A detailed account 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 affected individuals. This will probably change when full gene analyses are affordable and approved. Currently, a full gene analysis would still cost around 1000 €. We could not identify 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 athletic exertion, even smaller amounts are sufficient. Nevertheless, in appropriate doses, it is not only not poison, but necessary for survival. Most people tend to drink too little.

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 medications, 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.

From a scientific point of view, amphetamine drugs are the first choice for adults.³. The amphetamine drug Vyvanse is a precursor bound to lysine, which is only very slowly converted to the active substance 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 work less well than stimulants and cannot be started and stopped as quickly.

In ADHD, among other things, dopamine and noradrenaline action levels in the PFC and striatum are reduced. Stimulants raise this effect - as medications 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 the 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 significantly 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, go to ⇒ ADHD Treatment Guide.

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

Wrong.

In more than 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 in adults.

In the ADHD-I subtype, depression and anxiety disorders become more frequent in adulthood.

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

Wrong.

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

In adulthood, however, women catch up, to the point of gender balance: ⇒ ADHD in adults.

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

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

With this justification, it is sometimes claimed that medication or psychotherapy is not necessary - in the case of ADHD, one must simply accept the affected person as he or she is or create the right environment.

Often it is the parents who represent this. But it is these same 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.
In part, 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 themselves. However, this is not mandatory. We know parents with ADHD who deal with their ADHD-affected children in an extremely appreciative and appropriate manner.

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 away conflict-laden topics. An ADHD sufferer who is passionate about programming and earns good money from 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. Nor is it foreseeable that delegating homework away from less popular subjects could ever become fashionable to the point that ADHD sufferers would experience any perceptible relief as a result.

9. Misconception: ADHD medication helps everyone after all¶

Studies show that ADHD medications can only slightly improve cognitive performance, such as attention, in people without ADHD. An increase in academic performance has not been found in non-affected individuals.⁴

Affected person knowledge from a physician’s perspective: when bogus knowledge, when resilient?¶

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

While some physicians and therapists engage in substantive discourse with their patients, others make it very clear that they are unwilling to engage in substantive discussion of the technicalities of ADHD. At times, this may be due to the personality of the physician. However, there are also more pertinent reasons.
Doctors don’t always have it easy with their patients these days. Thanks to the Internet, many patients are ill-informed. If someone has a new medical problem and then reads up on it on the Internet, this usually only leads to an illusory knowledge among those affected, which doctors are well advised not to deal with in depth.
Why should it be any different with ADHD?
The difference in ADHD is:

• There is very profound and extensive information about ADHD on the net (ADxS.org is just one of them)
• ADHD is a lifelong disorder, which gives (adult) sufferers a lot of time to deal with it intensively and thus to gather a detailed knowledge that can sometimes seriously complement that of physicians, for whom ADHD is only one of the many disorders to be considered.

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

Nevertheless, it is a doctor’s very own task to keep his specialist knowledge up to date. Divergent statements by patients who substantiate them with sources from primary or secondary specialist literature must at least prompt physicians to review their knowledge. To fail to do so would be a breach of professional duty.

Statements such as the common errors collected on this page cannot be justified even without conflicting statements from affected persons, but always represent malpractice that is capable of impairing the mental and physical health of affected persons. Affected persons who feel impaired by such medical or therapeutic errors are therefore more than entitled to raise this - in a factual and friendly manner. After all, it affects not only their own health, but also that of others.