So I poured my heart into a 4-page letter to the editor about ADHD, only to discover the journal doesn’t do letters to the editor! Fast forward to nine months later – to now – I’m revisiting the subject on this new blog with a refined perspective. Given the nuanced and complex nature of ADHD, particularly when co-occurring conditions (comorbidities) are present, it’s understandable why misunderstandings often arise.
Just a disclaimer though that the views expressed here are my own which are based on my professional experience, and understanding.
Rethinking ADHD: The Importance of Evidence-Based Understanding
As a psychologist with ADHD and extensive experience in its diagnosis and treatment, I often reflect on the various ways ADHD is portrayed and understood. Discussions within the psychotherapeutic community have prompted me to share some thoughts on the crucial role of evidence-based practices in our approach to this complex condition. This is particularly important when considering the complexities of ADHD and its impact on individuals’ lives. It’s important for clinicians and those working with individuals with ADHD to engage with the most current findings to ensure an accurate understanding of the condition.The landscape of ADHD research has evolved significantly over the past two decades. As Dr Russell Barkley, notes the field has made remarkable progress with over 200,000 papers published on the topic since 2011. Our understanding of ADHD continues to evolve but one consistent finding amidst this progress is the strong genetic component of the condition.
One area that warrants careful consideration is the interplay between early experiences and ADHD. While the impact of attachment and psychodynamic factors on development is undeniable, it’s vital to avoid generalisations and recognise the significant neurobiological underpinnings of ADHD. Research consistently highlights the role of specific brain differences in attention, impulsivity, and executive functions. It’s important to remember that correlation does not equal causation, and not all individuals with ADHD have a history of early trauma, nor does trauma invariably lead to ADHD.
A 2023 Australian Senate inquiry into the Barriers to consistent, timely and best practice assessment of attention deficit hyperactivity disorder (ADHD) and support services for people with ADHD indicated undiagnosed and untreated ADHD carries significant risks. This includes increased suicidal ideation and completion, marginalisation, co-occurring mental health conditions, employment instability or unemployment, and poor educational outcomes. Furthermore inadequate ADHD support services have long-term consequences for individuals, families, and healthcare, education, and justice systems. The senate inquiry further highlighted lived experiences of people living with ADHD where they described how poor therapy experiences that is not culturally appropriate can be traumatic, exacerbating ADHD symptoms. Given this, there is a need for evidenced based, trauma-informed and culturally appropriate practices when addressing ADHD.
A comprehensive understanding of ADHD requires thorough assessment by qualified professionals. Clinician’s relying solely on self-diagnosis of ADHD is problematic as it may not provide effective support. When diagnosing ADHD it’s also important that other potential medical or psychological conditions are ruled out. A formal assessment process typically involves a detailed clinical interview, behavioural rating scales, and may include cognitive or neuropsychological testing to provide a holistic picture. This rigorous approach is crucial for accurate diagnosis and the development of effective treatment plans.
It’s important to avoid generalisations when discussing the psychological experiences of individuals with ADHD. While some individuals may face challenges related to self-perception and a sense of self, many others experience a strong and cohesive sense of self. Attributing specific personality traits or experiences universally to ADHD can perpetuate harmful stereotypes and can lead to shame and blame. There are also broader systemic issues that contribute to stigma and misconceptions making it hard for people to seek help and support.
Unfortunately, ADHD is sometimes portrayed in a solely negative light, leading to misunderstandings about its characteristics. For instance, the intense focus often experienced by individuals with ADHD, known as hyperfocus, can be mistakenly conflated with the experiences of fragmentation or dissociation, which are often linked to traumatic memories and accompanied by negative emotions. It’s important to differentiate these experiences. Hyperfocus is typically driven by a strong interest and can generate positive feelings of engagement and accomplishment. As therapists, and indeed as a society, our focus should shift towards recognising and appreciating the inherent strengths and unique talents of individuals with ADHD. Highlighting these positive attributes can significantly contribute to improved emotional well-being and a stronger sense of self-worth.
Our focus as professionals should be on empowering individuals with ADHD by recognising their strengths alongside any challenges they may face. A multifaceted approach that may include psychoeducation, behavioural strategies, lifestyle adjustments, and medication (when appropriate) can be highly effective in helping individuals manage executive functioning difficulties and lead fulfilling lives. Promoting inclusion and valuing the inherent worth of every individual, regardless of their disability is fundamental to ensuring optimal care for individuals with ADHD.
References
Australian ADHD Professionals Association. (2022). Australian evidence-based clinical practice guideline for attention deficit hyperactivity disorder (ADHD) (1st ed.) [Clinical practice guideline]. https://adhdguideline.aadpa.com.au/wp-content/uploads/2022/10/ADHD-Clinical-Practice-Guide-041022.pdf
Barkley, R. A., & Benton, C. M. (2022). Taking charge of adult ADHD: Proven strategies to succeed at work, at home, and in relationships (2nd ed.). The Guilford Press.
Brown, T. (2017). Outside the Box: A Practical Guide. American Psychiatric Publishing.
Community Affairs References Committee. (2023). Assessment and support services for people with ADHD. Parliament of Australia. https://www.aph.gov.au/Parliamentary_Business/Committees/Senate/Community_Affairs/ADHD/Report
Falk, D. E., Yi, H., & Hiller-Sturmhöfel, S. (2006). An epidemiologic analysis of co-occurring alcohol and tobacco use and disorders: 1 Findings from the National Epidemiologic Survey on Alcohol and Related Conditions. Alcohol Research & Health, 29(3), 162-171.