the promise of these new brain-imaging techniques, we will better understand the great variations in human brains in the future.
The Many Faces of AD/HD
For many years, when people thought of AD/HD, the picture that came to mind was of a hyperactive, troublemaking little boy, running around causing a lot of problems and was identified with these overt behaviors: not being able to pay attention, having an overactive activity level, and impulsively acting out. These disruptive behaviors were impossible to miss. In reality, AD/HD has many more dimensions than this common stereotyped picture.
We used to believe that children with these behaviors outgrew their AD/HD when they became adults. However, we eventually learned that a large percentage of them continued to struggle as adults even though their hyperactivity diminished. Even though their difficulties were often less visible as adults, their poorly regulated attentional system caused them just as many perplexing and frustrating problems. Since the first edition of this book, we have become more aware of another group of adults with AD/HD who never were hyperactive. These people, largely consisting of women, continue to be under identified in childhood and often remain undiagnosed as adults.
AD/HD by Any Other Name . . .
The Names Change, but the Facts Remain the Same
It seems that the official labels used by the professional community to diagnose Attention Deficit Disorder change every few years, thereby confusing many people in the process of attempting to more accurately describe this syndrome and capture its variations, as well as its core characteristics. Individuals in the professional community may differ on the wisdom of some of the nomenclature, but the general characteristics they are trying to describe stay the same.
To confuse matters further, it is common for many people, especially the general population, to use the terms ADD or AD/HD without differentiating types since it is awkward to specify types in normal conversation.
Different Types of AD/HD (as of this writing)
AD/HD Hyperactive/Impulsive Type
These people used to be called AD/HD with hyperactivity and are the speedy, hyper, bounce-off-the-wall children and multi-tasking adults.
AD/HD Inattentive Type
These people used to be called AD/HD without hyperactivity. They can be dreamy and under active and work and move slowly. Much of the focus of this book is women with inattentive AD/HD. Again, there is much variation. Many women who were hyperactive as children have lost the hyperactivity yet still experience the effects of attention problems. Many who are under active on the outside are hyperactive in their thoughts and experience an internal feeling of being driven even if it is not translated to hyperactive physical activity.
There are also combined types of AD/HD who share characteristics of both.
Detailed Breakdown of What AD/HD is and What It’s Not
AD/HD Does NOT = A Deficit of Attention
Instead it means attention irregularity and inconsistency. This includes difficulties with the following:
•Distractibility or excessive shifting of attention.
•Activating, deploying, and directing one’s attention.
•Containing and maintaining one’s attention.
•Screening out unimportant matters from one’s attention.
And contrary to the meaning of deficit, there are many positives attributes that tend to come along with AD/HD, including a surplus of ideas, creativity, excitement, and interest.
AD/HD Does NOT = Hyperactivity
Instead it means a dis-regulation of activity and arousal levels that involves extremes of activity levels from high to low or from hyperactive to “hypoactive,” or what I call overly underactive.
AD/HD Does NOT = Impulsive Troublemaking
Instead it can be a quieter, less obvious kind of impulsivity with excessive shifting of tasks or life directions.
A Deeper Dive into the Complexities of AD/HD
What we call AD/HD is often confusing because AD/HD looks and feels so different for each person. For example, the AD/HD inattentive type presents differently on the outside than does the more commonly understood and more easily recognized AD/HD hyperactive type. It also feels very different on the inside. In fact, women often internalize their difficulties rather than acting them out, which may result in depression or anxiety. Despite the outward appearances, it is by no means a mild case of AD/HD as Thomas Brown, Ph.D. who has written and spoken extensively about this kind of AD/HD emphasizes. Both forms of AD/HD share the same core difficulties and are just as extreme but are experienced and expressed in various ways with different effects in a person’s life. The important thing to remember is that none of us have perfect control of our attention, regulation of our activity, or impulses. However, as you can see from the following spectrum, AD/HD is defined by symptoms that are extreme, chronic, and severe.
Can You Have These Symptoms and Not Have AD/HD?
Yes! Not everyone who has these symptoms has AD/HD. Let’s say you have these problems to a severe level, and you have had them for as long as you can remember (chronic), and even if they weren’t highly visible, they had great impact. Does this mean you have AD/HD? Not necessarily! You can have these difficulties at particular times, even severely, and not have AD/HD.
Other Reasons for Symptoms that Mimic AD/HD
•Perhaps you have just experienced a major change in your life such as a divorce, a move, a loss of a job, or you are under great deal of stress. As a result, you may become very disorganized, depressed, or feel bad about yourself for a while. To have AD/HD these symptoms must have been there most of the time and over a long period of time.
•You may say things like, “I lose my keys all the time,” or “You should see my closets,” or “I procrastinate.” This may be somewhat of a problem, but if it’s not severe enough to be the problem causing tremendous difficulty in all important areas of life, then it isn’t AD/HD.
•Other kinds of neurological, psychological, and physical disorders such as head injuries, thyroid imbalances, post-traumatic stress disorder to name a few can account for the same kinds of symptoms and must be ruled out.
Family or environmental conditions such as growing up with a chaotic family life, an abusive home, a mentally ill parent, or an alcoholic family can all contribute to such intermittent symptoms. Sometimes a person can have had these family backgrounds and also have AD/HD; this takes expert diagnosis. It’s also possible that your parent’s difficulties may have been a result of their undiagnosed AD/HD.
For all of the reasons listed above, it is especially important to get a diagnosis by a mental health professional who understands AD/HD (with and without the symptom of hyperactivity), as well as other conditions
