ADHD is a syndrome, that is a series of symptoms commonly seen together, often inherited and causing difficulties in some or all of the following areas.
But what’s actually wrong in the brain? Truth is all we have at this point is hints and theories and at best a partial picture of what’s going on. There are brain scans that can measure function of brain tissue, as well as general appearance and size. In people with ADHD, parts of the brain are smaller, or don’t light up in functional scans like they should. This includes the prefrontal cortex, the amigdyla and hippocampus. We know that a concussion can lead to a complex of symptoms that can look very like ADHD and respond to ADHD medication. What’s a concussion? Enough brain damage to addle you or knock you unconscious for at least several minutes, while not showing up on currently available scans.
Each time I get a lecture on the neuroanatomy or chemistry of ADHD, it’s entirely different from the last explanation, and described in definitive detail, like it’s the one and only. It never is.
What does ADHD look like?
Now, that’s a loaded question. It can look very different whether you’re the day dreamer or the restless, the inattentive or the impulsive. In adults it can be not listening carefully (some patients say the focus fine, they just can’t remember what was said after). It can make people late, or impatient, or behind in their work or chores. It can make people act without thinking things through. It can cloud executive function so that even when you think about things, you reach the wrong conclusions because you can’t work out the pros and cons of a decision easily. It can impact school and jobs, relationships and parenting. It can be extremely expensive thought impulsive spending (ooh, shiny…). It may take a huge effort to keep the ball rolling, resulting in anxiety, depression and especially fatigue. Many of my patients are good at their job, but have little energy for life outside work.
I like to ask my young female patients – ‘ are you famous for dating BAD boys?’ and the answer is often, oh my god, and it doesn’t go well.
We talk like the typical hyperactive impulsive bad behaviour of kids goes away in adulthood, but I’ve had patients who had to declare bankruptcy multiple times, who are on their fourth marriage, or who have been so soured on relationships they choose to be lonely over having another go. Patients often don’t stick around long enough to get promoted, or don’t think they can be successful at university. Many have screwed up their undergrad degree and that’s if they even complete it – and that’s darn expensive. Parenting is difficult for people with adhd – it’s hard to remember what your promised, or threatened so consequences fall by the side. It’s often very difficult to be consistent about rules and consequences, one day being a pushover, another a martinet, yelling and even hitting.
For a more detailed description of what it’s like to be adhd, check out some of the books I recommend, especially ‘Driven To Distraction’ and ‘Taking Charge Of Adult ADHD’
While adults don’t usually get arrested, they do get:
Fired, Divorced, Bankrupt, Frustrated, Depressed, Anxious, Miss Promotions, Fail at School, Relationships, Parenting, Businesses, Saving.
They can’t: find things, finish a book, remember things, follow a plan, feel good about themselves, succeed with many parts of their life.