Uncomfortable Truths About the ADHD Nervous System
Easily bored, sensitive to distractions, creative, and intense. If you grew up with ADHD symptoms, chances are you always felt “different.” Now here’s a scientific explanation of the neurological underpinnings of behaviors and feelings associated with attention deficit hyperactivity disorder. Learn how a person with ADHD thinks!
Here is a truth that people with attention deficit hyperactivity disorder (ADHD or ADD) know from an early age: If you have an ADHD nervous system, you might as well have been born on a different planet.
Most adults with ADHD have always known that they think differently. They were told by parents, teachers, employers, spouses, and friends that they did not fit the common mold and that they had better shape up in a hurry if they wanted to make something of themselves.
As if they were immigrants, they were told to assimilate into the dominant culture and become like everyone else. Unfortunately, no one told them how to do this. No one revealed the bigger secret: It couldn’t be done, no matter how hard they tried. The only outcome would be failure, made worse by the accusation that they will never succeed because ADHD in adulthood means they didn’t try hard enough or long enough.
It seems odd to call a condition a disorder when the condition comes with so many positive features. People with an ADHD-style nervous system tend to be great problem-solvers. They wade into problems that have stumped everyone else and jump to the answer. They are affable, likable people with a sense of humor. They have what Paul Wender called “relentless determination.” When they get hooked on a challenge, they tackle it with one approach after another until they master the problem — and they may lose interest entirely when it is no longer a challenge.
If I could name the qualities that would assure a person’s success in life, I would say being bright, being creative with that intelligence, and being well-liked. I would also choose hardworking and diligent. I would want many of the traits that people with ADHD possess.
The main obstacle to understanding and managing ADHD has been the unstated and incorrect assumption that individuals with ADHD could and should be like the rest of us. For neurotypicals and adults with ADHD alike, here is a detailed portrait of why people with ADHD do what they do.
Why People with ADHD Don’t Function Well in a Linear World
The ADHD world is curvilinear. Past, present, and future are never separate and distinct. Everything is now. People with ADHD live in a permanent present and have a hard time learning from the past or looking into the future to see the inescapable consequences of their actions. “Acting without thinking” is the definition of impulsivity, and one of the reasons that individuals with ADHD have trouble learning from experience.
It also means that people with ADHD aren’t good at ordination — planning and doing parts of a task in order. Tasks in the neurotypical world have a beginning, a middle, and an end. Individuals with ADHD don’t know where and how to start, since they can’t find the beginning. They jump into the middle of a task and work in all directions at once. Organization becomes an unsustainable task because organizational systems work on linearity, importance, and time.
Why People with ADHD Are Overwhelmed
People in the ADHD world experience life more intensely, more passionately than neurotypicals. They have a low threshold for outside sensory experience because the day-to-day experience of their five senses and their thoughts is always on high volume. The ADHD nervous system is overwhelmed by life experiences because its intensity is so high.
The ADHD nervous system is rarely at rest. It wants to be engaged in something interesting and challenging. Attention is never “deficit.” It is always excessive, constantly occupied with internal reveries and engagements. When people with ADHD are not in The Zone, in hyperfocus, they have four or five things rattling around in their minds, all at once and for no obvious reason, like five people talking to you simultaneously. Nothing gets sustained, undivided attention. Nothing gets done well.
Many people with ADHD can’t screen out sensory input. Sometimes this is related to only one sensory realm, such as hearing. In fact, the phenomenon is called hyperacusis (amplified hearing), even when the disruption comes from another of the five senses. Here are some examples:
- The slightest sound in the house prevents falling asleep and overwhelms the ability to disregard it.
- Any movement, no matter how small, is distracting.
- Certain smells, which others barely notice, cause people with ADHD to leave the room.
Individuals with ADHD have their worlds constantly disrupted by experiences of which the neurotypical is unaware. This disruption enforces the perception of the ADHD person as being odd, prickly, demanding, and high-maintenance. But this is all that people with ADHD have ever known. It is their normal. The notion of being different, and that difference being perceived as unacceptable by others, is made a part of how they are regarded. It is a part of their identity.
Sometimes, a person with ADHD can hit the do-or-die deadline and produce lots of high-quality work in a short time. A whole semester of study is crammed into a single night of hyperfocused perfection. Some people with ADHD create crises to generate the adrenaline to get them engaged and functional. The “masters of disasters” handle high-intensity crises with ease, only to fall apart when things become routine again.
Lurching from crisis to crisis, however, is a tough way to live life. Occasionally, I run across people who use anger to get the adrenaline rush they need to get engaged and be productive. They resurrect resentments or slights, from years before, to motivate themselves. The price they pay for their productivity is so high that they may be seen as having personality disorders.
Why People with ADHD Don’t Always Get Things Done
People with ADHD are both mystified and frustrated by secrets of the ADHD brain, namely the intermittent ability to be super-focused when interested, and challenged and unable to start and sustain projects that are personally boring. It is not that they don’t want to accomplish things or are unable to do the task. They know they are bright and capable because they’ve proved it many times. The lifelong frustration is never to be certain that they will be able to engage when needed, when they are expected to, when others depend on them to. When people with ADHD see themselves as undependable, they begin to doubt their talents and feel the shame of being unreliable.
Mood and energy level also swing with variations of interest and challenge. When bored, unengaged, or trapped by a task, the person with ADHD is lethargic, quarrelsome, and filled with dissatisfaction.
Why Our ADHD Motors Always Run
By the time most people with ADHD are adolescents, their physical hyperactivity has been pushed inward and hidden. But it is there and it still impairs the ability to engage in the moment, listen to other people, to relax enough to fall asleep at night, and to have periods of peace.
So when the distractibility and impulsivity are brought back to normal levels by stimulant medication, a person with ADHD may not be able to make use of his becalmed state. He is still driven forward as if by a motor on the inside, hidden from the rest of the world. By adolescence, most people with ADHD-style nervous systems have acquired the social skills necessary to cover up that they are not present.
But they rarely get away with it entirely. When they tune back into what has gone on while they were lost in their thoughts, the world has moved on without them. Uh-oh. They are lost and do not know what is going on, what they missed, and what is now expected of them. Their reentry into the neurotypical world is unpleasant and disorienting. To individuals with ADHD, the external world is not as bright as the fantastic ideas they had while lost in their own thoughts.
Why Organization Eludes People with ADHD
The ADHD mind is a vast and unorganized library. It contains masses of information in snippets, but not whole books. The information exists in many forms — as articles, videos, audio clips, Internet pages — and also in forms and thoughts that no one has ever had before. But there is no card catalog, and the “books” are not organized by subject or even alphabetized.
Each person with ADHD has his or her own brain library and own way of storing that huge amount of material. No wonder the average person with ADHD cannot access the right piece of information at the moment it is needed — there is no reliable mechanism for locating it. Important items (God help us, important to someone else) have no fixed place, and might as well be invisible or missing entirely. For example:
The child with ADHD comes home and tells Mom that he has no homework to do. He watches TV or plays video games until his bedtime. Then he recalls that he has a major report due in the morning. Was the child consciously lying to the parent, or was he truly unaware of the important task?
For a person with ADHD, information and memories that are out of sight are out of mind. Her mind is a computer in RAM, with no reliable access to information on the hard drive.
Working memory is the ability to have data available in one’s mind, and to be able to manipulate that data to come up with an answer or a plan of action. The mind of a person with ADHD is full of the minutiae of life (“Where are my keys?” “Where did I park the car?”), so there is little room left for new thoughts and memories. Something has to be discarded or forgotten to make room for new information. Often the information individuals with ADHD need is in their memory…somewhere. It is just not available on demand.
Why We Don’t See Ourselves Clearly
People from the ADHD world have little self-awareness. While they can often read other people well, it is hard for the average person with ADHD to know, from moment to moment, how they themselves are doing, the effect they are having on others, and how they feel about it all. Neurotypicals misinterpret this as being callous, narcissistic, uncaring, or socially inept. Taken together, the vulnerability of a person with ADHD to the negative feedback of others, and the lack of ability to observe oneself in the moment, make a witch’s brew.
If a person cannot see what is going on in the moment, the feedback loop by which he learns is broken. If a person does not know what is wrong or in what particular way it is wrong, she doesn’t know how to fix it. If people with ADHD don’t know what they’re doing right, they don’t do more of it. They don’t learn from experience.
The inability of the ADHD mind to discern how things are going has many implications:
- Many people with ADHD find that the feedback they get from other people is different from what they perceive. They find out, many times (and often too late), that the other people were right all along. It isn’t until something goes wrong that they are able to see and understand what was obvious to everybody else. Then, they come to believe that they can’t trust their own perceptions of what is going on. They lose self-confidence. Even if they argue it, many people with ADHD are never sure that they are right about anything.
- People with ADHD may not be able to recognize the benefits of medication, even when those benefits are obvious. If a patient sees neither the problems of ADHD nor the benefits of treatment, he finds no reason to continue treatment.
- Individuals with ADHD often see themselves as misunderstood, unappreciated, and attacked for no reason. Alienation is a common theme. Many think that only another person with ADHD could possibly “get” them.
Why People with ADHD are Time Challenged
Because people with ADHD don’t have a reliable sense of time, everything happens right now or not at all. Along with the concept of ordination (what must be done first; what must come second) there must also be the concept of time. The thing at the top of the list must be done first, and there must be time left to do the entire task.
I made the observation that 85 percent of my ADHD patients do not wear or own a watch. More than half of those who wore a watch did not use it, but wore it as jewelry or to not hurt the feelings of the person who gave it to them. For individuals with ADHD, time is a meaningless abstraction. It seems important to other people, but people with ADHD have never gotten the hang of it.
William Dodson, M.D., is a member of ADDitude’s ADHD Medical Review Panel.