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3 Defining Features of ADHD That Everyone Overlooks

The textbook signs of ADD — inattention, hyperactivity, and impulsivity — fail to reflect several of its most powerful characteristics; the ones that shape your perceptions, emotions, and motivation. Here, Dr. William Dodson explains how to recognize and manage ADHD’s true defining features of rejection sensitivity, emotional hyperarousal, and hyperfocus.

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  1. @DPS3

    I’ve found several academic papers that align with the view held by Dr Dodson. Here’s just a few:

    A)
    “The current criteria for diagnosis of ADHD (DSM‐IV) have been developed and validated for children and are inappropriate for adults. However, since DSM‐IV criteria are currently the main recognised diagnostic criteria in use, clinicians are left with little alternative.”

    1. https://www.jneuropsychiatry.org/peer-review/diagnosing-adhd-in-adults-limitations-to-dsmiv-and-dsmv-proposals-and-challenges-ahead-neuropsychiatry.pdf
    2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4376140/

    B)
    “APA launched DSM-5 in May 2013.1 In 2010, the APA ADHD and Disruptive Behavior Disorders Work Group (referred to hereafter as the DSM-5 Work Group) proposed changes to the criteria for attention deficit hyperactivity disorder (ADHD).”

    “DSM-IV ADHD criteria and the proposed DSM-5 criteria were not tested in field trials with adults.”

    1. Matte B, Rohde LA, Grevet EH: ADHD in adults: a concept in evolution. Atten Defic Hyperact Disord 2012; 4:53–62

    2. Clarke DE, Narrow WE, Regier DA, et al.: DSM-5 field trials in the United States and Canada, part I: study design, sampling strategy, implementation, and analytic approaches. Am J Psychiatry 2013; 170:43–58

  2. “The problem: These criteria only describe how ADHD affects children ages 6-12.”

    I’m concerned about the lack of sources in this article overall, particularly when it comes to this comment at the beginning of the article. The DSM-V specifically calls out differences in the number of symptoms to look for in children under 16 vs older teens and adults, and I can’t find any other literature that supports this comment.

    I have a hard time trusting the entire article when the central argument of the introduction doesn’t seem to be substantiated by anything other than the author’s personal opinion.

  3. You state that people with ADHD are great lie detectors. Why is that? What is the evidence for that? Are there any articles about that? Because searching for it only comes up with information about kids with ADHD lying.

  4. RSD is so hard. It’s hard to watch what it does to your child, and it’s hard to successfully manage it. I am so glad that it’s better understood now; how many children and adults had to go through life feeling this way without knowing what it was, or be called a drama queen or overly sensitive during that time? It’s heartbreaking. My child has this in addition to ADHD and watching her hide under a table and cry because she thinks we don’t love her anymore is the most awful feeling in the world.

  5. Dear Dr. Dodson,

    I am a first time visitor. I find your discussion of an interest based nervous system *deeply* troubling, enough to make sign up just so I could post this comment. What you describe is the subject of an entire industry of peak performance study, starting with the national bestseller “Flow”, by Mihaly Csikszentmihalyi, first published 30 years ago, in 1990. NONE of those writers, researchers, psychologists, journalists, and educators refer to being ‘in the zone’ as *pathological* or in need of medication. Indeed, it is a very good thing, and people want to know how to call upon it at will, and sustain it.

    I hope that you will review the work in this field, and rewrite or delete this post in light thereof.

  6. Hi, I am a clinical psychologist with a degree in Biochemistry as well. This article explains some interesting concepts about ADHD. However, I take issue with one statement:
    An effective ADHD management plan needs two parts:

    medication to level the neurological playing field
    a new set of rules that teach you how to get engaged on demand

    The point that medication is NEEDED to level the neurological playing field shows an overly simplistic (and overly medicalized) view of ADHD. The neurological playing field can be leveled through means other than medication and it is important that individuals with ADHD undertand that.

  7. This article by a different author directly contradicts the claim here regarding Guanfacine and Clonidine, that 1/3 of people respond well to one treatment or the other, but that 60% respond to both treatments combined. Which assertion is correct and what are the sources for this information?

    https://www.additudemag.com/clonidine-for-adhd/

    “Guanfacine and clonidine appear to work equally well for different patient populations. Individuals respond differently to different medications. If you don’t experience benefits from taking one medication, work with your physician to stop taking it, and try the other option. Most patients experience benefit from one or the other.”

  8. Wow….what can i say… everything i read is myself to a T, my life, my childhood, my schooling is all making a lot more sense to me. My brother, after many many years of ADHD specialist appointments finally was diagnosed with Adult ADHA. Because of growing up with him, i have quite an understanding of adhd but never quite like this. My brother has always told me that he thinks i am ADHD also as we are very very similar in the way our mind works. I am now 39 years old and the older i get the more stranger i get and the more i am not coping with life in general. I have yet to be diagnosed ADHD but everything i just read here all makes so much sense to me….its exactally how my mind works…i am feeling a feeling of relief as if someone understands me…..i am currently having a very hard time in life due to my emotional outbursts which is putting pressure on my relationship almost ending it but this is amazing, even reading it to my partner he also was in amazement with how accurate it is to me…..i have now booked myself in to see a specialist and hopefully i can learn and understand finally why my life had been harder than most to function….and hopefully with this new knowledge and understanding i can now move forward in a positive way with the right tools that work for my ADHD mind…..Thankyou Thankyou Thankyou…
    Please email me any more information that may help me in any way.

  11. Some wheat in the chaff. Mostly this article is junk science though. (Sorry)

    Rejection sensitivity isn’t an ADHD trait. Its a non-ADHD trait that may well be activated by ADHD. The same happens with high functioning autism and other MH which can leave feelings of shame, confusion and self-criticism over “why can’t I get round this?”

    Its true that DSM does mislead, in that symptoms tend to differ adult/child. Its also true that interest plays a part and a state of intense focus exists. But ADHD isn’t interest based. That’s pure junk. It might be how it *seems*, but that’s all. Rather, the ability to regulate stimulation (engage/disengage/switch, i.e. wilfully set and choose what to attend to and what not) is the underlying problem. “Interesting stuff” is not the underlying characteristic – it just increases the likelihood that the brain will be able to reach a stimulation threshold to engage.

    It’s also a self fulfilling definition. We tend to *define* “interesting” in the first place, by observation, being what the brain seizes on and pays attention to. Then, naturally things that are “interesting” are those that get locked onto. Circular logic. Not actually helpful or, really, even accurate.

  12. Thanks for this interesting article, I am 53 years old and have been diagnosed as ADHD since primary school. I have never been advised by doctors or psychologists of these “other” symptoms of ADHD, I in fact took these to be normal!
    Especially “RSD”! Who knew?
    Thanks again.

  13. I strongly disagree with the statement that only medication can manage rejection sensitivity. While I have and take medication for ADD, I have found Dialectical Behavioral Therapy (DBT) extremely helpful. It teaches skills such as mindfulness, building tolerance to negative experiences, coping, and communication. Before DBT, I seriously suffered from rejection sensitivity. Now I am learning to live with my emotions.

    More about DBT:https://www.additudemag.com/dbt-for-adhd-dialectical-behavioral-therapy/

  14. Dear Doctor Dodson,
    Thank you.
    One thing that the adult adhd afflicted have likely tried, pre formal diagnosis, is a self medication regime based around street stimulants and depressants. Which of course, sans formal treatment, contribute to the shame spiral. But most importantly they also cloud the ability to successfully diagnose. I spent a long time fighting with the precepts of Alcoholics Anonymous. But that too was bashing the star shape into the round hole- there were many behaviours which fit, but not an alcoholic is not an alcoholic. Although some valuable management skills can be picked up the biggest blockage was in RSA. That was and is the key defining thing for this adult ADHD afflict.

    Now I might have some chance of avoiding the devastating lows that come with the pain in the chest and the destruction of the bridges in the process. Truly being able to name a thing aids in gaining power over it.
    Thank you. Thank you.

  15. This is the first time I have seen ADHD described in this manner. Thank you! I have always described my child’s ADHD as easy (mostly) when it comes to being hyper. It’s the fits of rage (emotional arousal) that is so difficult to deal with. I agree the Intuniv XR works…but in our experience at some point it is no longer effective and has to be stopped for a long period of time before use again. Thanks again for so eloquently describing this condition!

  16. So, I haven’t been diagnosed with ADHD, are we absolutely sure that emotional hyperarousal and rsd as described here, do not occur in neurotypical people? I do relate to the first one – interest based nervous system, but not entirely. I do find that I can do SOME tasks based on the fear of consequences, usually related to my job, because I don’t want my boss mad at me, and I don’t want to get fired.

    So I ask, where would you categorize someone who fully experiences 2 and 3, but not necessarily 1?

  17. On RSD (Which I did not know about until today, despite having been diagnosed with ADHD at the age of six eighteen years ago): “Some people avoid rejection by becoming people pleasers. /Others just opt out altogether, and choose not to try because making any effort is so anxiety-provoking./”
    So what exactly is a person supposed to do when they’ve ‘opted out’ and what’s left of the part of them that cares about this would like to stop doing that?

    1. Here’s what’s helped me:
      1.) a therapist with a thorough understanding of adult adhd. My therapist helped me establish new thought patterns and behavior patterns. She taught me to combat the negative thoughts about myself or the activity (whatever activity I was avoiding in my life, including interacting with new people) that caused me to just not even try and that helped me reframe my mind.

      2.) I’ve become almost obsessively mindful of my behavior and thoughts. By habit, I ask myself what I’m feeling, why I’m feeling that way, and if my thoughts are logical and if not, I think about the reality of the situation and I turn to the strategies I learned about in therapy, to help me reframe my mind.

      For me, it’s all about analyzing my thoughts, mindfulness, and extensive education on how adhd affects people who have it. It’s also about knowing myself and my reality/perspective and how that differs from the realities/perspectives of others. Feeling like I have a solid view of myself and the entire situation helps me reframe my mind.

  18. I think it’s important to note that “interest” can be a VERY situational thing for people with ADHD.

    Before I was diagnosed, I would get upset because many well-meaning people insisted that the reason I was struggling with my dissertation was that I must not be that interested in the topic. But I was! I really was!

    The problem was a) of course, a dissertation is still a huge project that’s going to be inherently hard for anyone with executive dysfunction to manage and b) not every single task – or even every part of every task – is as interesting as the next. My interest in the topic did not make it any easier to get engaged with individual tasks that were not as interesting as, say, reading an article on the topic or analyzing my data. “I get to do the interesting part next” doesn’t work as a reward in my brain. It only cares about what I’m doing now and why it should care about that one task I’m trying to do now.

    Or there’s the fact that I struggle to stay awake during talks, even if I’m very interested in the topic – my brain just can’t sustain focus on any topic via *that particular medium* for an extended period of time. It’s not the topic, or even that the speaker isn’t engaging or isn’t explaining things well! I just can’t sustain focus on something talking about *anything* for more than 10-15 minutes. I have to play a game or something on my phone so I can switch my focus back and forth just so I can stay awake during a talk that I am really enjoying! I also love audiobooks – but only while I’m driving, so I have other things to focus on. The same audiobook would put me right to sleep if I just sat in my living room listening to it, even though the story isn’t boring.

    I have several other examples, but this is long enough. I’ve just been frustrated lately by seeing several articles with this focus on interest that make it sound like if a person with ADHD has trouble focusing on something, they must think it’s boring. I know that’s not what anyone’s trying to say, but without further clarification that can be the message conveyed.

    1. I had to chuckle at the dissertation-writing reflections. As a nursing student I developed a pattern: find a spot in the newspaper-reading room of our local library (because I love the sound of rustling newsprint!) Then I would lay my head on my pile of books and nap, because it was useless to do anything while tired. Twenty minutes, or so, later I would begin- but not with the assigned texts. I started by flipping through my anatomy book or medical dictionary until something caught my attention. I especially loved the weird stuff, bizarre syndromes, etc. Once I reached “the zone” I would turn to the necessary task. I found that the same attention, once aroused, would transfer to that task. I finished pre-requisites and nursing courses with a 4.00.

    2. I describe that (falling asleep in lectures unless also doing something else is a great example) as “having an 8-track brain”.
      If only one track is being engaged, the rest of my brain keeps looking for something to occupy some of the other tracks, and that gets VERY distracting, but if I give one or more of the other tracks something to do I’m able to pay much closer attention to the more important whatever-it-is occupying the first track.
      What works best for me in academic settings is using really great pens in a variety of colors, and filling the margins of my notes with whatever song lyrics are stuck in my head, or complex swirling doodles inspired by the ink flow of an awesome pen*, making interesting patterns around key points in my notes themselves (which has the added benefit of enhancing my visual recall of the notes when test time comes around).
      Back in the day when we still wrote and mailed letters I’d sometimes start a letter to a friend a little further back in my notebook and keep adding to it during that same class for a few weeks at a time. Given that my ADHD seems to include an allergy to the post office, waiting until I had several pages made it seem worth the effort of getting it in the mail eventually.
      I heartily recommend using art supplies like sketchbooks and fancy fine tip markers instead of basic notebooks and pens/pencils, as the visual stimulation and tactile pleasures (for me at least) keep a few of the other tracks occupied enough to free up my auditory focus, and ability to stay awake. I end up hearing and retaining the lecture content so much better!
      Similarly, highlighting passages in textbooks with the same highlighter defeated the purpose for me, it all just blended together. It worked much better for me to underline in colored pencils and switch the colors regularly.
      *My all-time favorite pen is the Pilot Varsity disposable fountain pen with purple ink!

    3. I concur that being an academic with ADHD is very challenging. When I was struggling through graduate school, I noticed a pattern in my struggle to complete papers; the problem as that as I complete the paper, my understanding of the topic would shift, and in turn, I would adapt my thesis/framing of the topic to this new understanding. Unfortunately, this instinctive tactic does not lend itself to meeting deadlines, nor did I ever feel as if I had a real direction for the paper, until the very end, at which time I was already thoroughly burned out and in no shape to write up the final analysis under the pressure of a looming deadline. When you study the humanities, (French literature, in my case), there are additional challenges like the exactitude required to write well in a foreign language, the ability to synthesize the methodology of your profession, which seemingly is never fully addressed in a direct manner. If I were to do it again, with the understanding that I have ADHD combined type, I believe that it would have helped tremendously to glimpse ahead, and understand that for me, I needed more time, maybe a few years more, to everything to gel. After a long struggle, it is all too clear (one thinks) that they have failed; but, when it does come together finally, we are the real deal, experts. The path to growth is not at all linear, and may require more time for us than for others. For those with ADHD, it is important to pace yourself according to your own needs, and make a strong commitment to keep moving forward at a pace that is reasonable for you.

  19. If by “the bible of psychiatric diagnosis” you mean, “full of misleading and harmful BS,” you’re absolutely right!

  20. I have to say that I disagree with the assertion that hypersensitivity can only be managed via medication. As a therapist and a person who experiences ADHD, I have found that somatic psychotherapy and mindfulness have been highly effective in helping with hypersensitivity, especially as it relates to rejection and relational challenges.

  21. This article is extraordinary! I always thought I was “thin-skinned” and take things too personally. Having never heard of ADD growing up, it has been so helpful as an adult (77 yrs. old now) to understand what makes me literally tick. And now to have a name for my hyper-focus and my sensitivity is healing beyond words. These last 10 years have been like peeling layers off an onion. And now I have a great-grand-daughter with ADD who I can support and encourage as she comes to terms with who she is — an amazing gifted girl with an ability to shoot for the moon if she wants to.

    1. Amen to that from a 73 yr old . I suspect though that you may find some of your other offspring may also be undiagnosed. My son, my grandson , and my great grandDaughter are all ADHD. Grandson is my Daughters son. He and his spouse and Dtr are all ADHD

    1. It is interesting because I do not actually have that feature in my experience of ADHD. I believe, in part, that my mothers emphatic assertion that I be on time and respect other poems time helped to curb some of those tendencies.

      1. It is interesting that this condition is determined not by the severity of the underlying clinical brain injury but by the inadequacy of our adaptation. If this were any other limb or organ, the condition would be the same regardless of our success at adapting to the malady.

  23. Hello!

    Dr. Dodson, could you please further clarify the question that your premise is based on? “What does everyone with ADHD have in common, that people with ADHD don’t experience?” I’m having trouble understanding the nuance. Thanks!

    1. I don’t know for sure and I can’t speak on behalf of the person who wrote the article, but I got the impression that the second “with” might have been supposed to be “without”, since then the sentence would basically be “what do people with ADHD experience that people without ADHD don’t?”, which makes more sense to me.

  24. Ven la Faxine xr prescribed for a major depression has performed admirably for RSD the hyper in my Hypersensitivity although Pthe dose is only 75 mg and unchaned for 5 years the results are excellent..

      1. Do you have any tips on how we can better advocate for ouselves with our clinicians (especially if they are not as well versed about RSD?)

      3. I dont have any. This was the psychiatrists answer to my major depression and it took several months to have total effect. Around that time i read mindfulness for dummies which had a major impact on my interpretation of those around me. Also my working memory started a long term trend upward that is now outstanding by comparison to what it was 5 years. Ago. Now I can walk out of my appartment and seldom return for forgotten items. At my worst i would return three times for hats, gloves, sunglasses, keys, and assorted other items necessary for the outing i was attempting to go on. I rarely leave a tap running or burner on . At least 8 hours and preferrably 9 have become a priority, Convenience food has taken a back seat to a healthy diet heavy in Vegetables and fruits (nad choclate) Pop drinks and alchohol are infrequent indulgencies. Next on my list I hope to add a decent amount of exercise.
        Sweets still play too large a part but i am human (i think).
        As to advising your clinician, i am of no help. Mine confirmed the diagnosis and prescribed concerta but I have chosen not to pursue a stimulant nor do i consume caffeine by the the two liters a day i used to.
        When a medication works as well as mine did, i thank my lucky stars and God, and read as much as I can and attend any group programs i can find.

  25. I’ve never felt so much like someone understands my child (and me)! Thank you for putting these features together with detailed explanations and suggestions for treatment strategies. Now, how can we work to help others see ADHD this way?

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