Here's Why ADHD Patients Have Such Different Experiences
ADHD Is NOT Just The Crazy Little Boy Who Can't Sit Still In Class, And Here's Why
According to a 2016 CDC survey, around 6.1 million or 9.4% of children have been diagnosed with ADHD, which may not seem like much compared to the general population, but is definitely more than we might expect (CDC). Almost everyone knows at least one person with ADHD, and interestingly enough, each of these people has experiences and symptoms that are unique to them. For example, one person with ADHD may struggle with paying attention during class, another person may struggle more with tics and excessive talking, and yet another patient may have issues with all of the above. But why, you might wonder, do these differences occur? Studies have shown that there are many reasons why the ADHD experience may be different for each patient, including the different types of ADHD, a genetic predisposition for certain symptoms, comorbidities that may go along with ADHD, and traumatic events experienced during key times of brain development.
One of the main reasons for differences between ADHD cases is the fact that there are multiple forms of ADHD. There are three different subtypes of ADHD a person can be diagnosed with: Inattentive type, Hyperactive-Impulsive type, and Combined type. While all three forms of ADHD have some things in common, such as difficulty concentrating, each one comes with its own unique set of symptoms and challenges, which is one reason why ADHD is different for every patient. People with the Inattentive type tend to struggle to pay attention for long periods of time, which leads to “difficulty sustaining attention, following detailed instructions, and organizing tasks and activities” (Williams). Patients with the Inattentive type are usually much quieter than their hyperactive counterparts, which is why a lot of people with this type are not diagnosed with ADHD until adolescence or even adulthood. This can also alter the way a patient experiences ADHD, as ADHD is much harder to manage without the right medication, which is extremely hard to get without a proper diagnosis. Additionally, the Inattentive type is usually very forgetful, and these patients often have a tendency to be disorganized and frequently misplace things. On the other end of the spectrum, patients with the Hyperactive-Impulsive type tend to “talk non-stop, interrupt others, blurt out answers, and struggle with self-control” (Williams). These symptoms are typically what come to mind when you think of ADHD. This type is more prevalent in boys than girls, and is usually very noticeable due to the restlessness and noisiness associated with it. Children with this subtype tend to get in trouble frequently at school due to their inability to sit still and pay attention, which can have a very negative impact on the child’s mental health. Additionally, struggling in school can hurt the child academically. This can lead to feelings of worthlessness and the student falsely believing that they are unintelligent. Finally, the Combined type of ADHD incorporates symptoms from the two previous types, and patients “with Combined type ADHD have at least six of the daily characteristics of inattentive and hyperactive types” (Williams). These characteristics and symptoms can include the restlessness and impulsivity associated with the Hyperactive type or the poor listening skills and disorganization common in the Inattentive type. This hodgepodge of symptoms can create a unique experience both similar to and different from both of the subtypes mentioned before. As we can see, the type of ADHD a person is diagnosed with can have a huge impact on the symptoms they experience. However, this, and many other factors that influence symptoms, is greatly influenced by genetics and inheritance.
Most people are familiar with the fact that ADHD is an inherited disorder, which means that it runs in families. It’s so common in families because ADHD is a dominant trait, which means that if one parent has ADHD, it is extremely likely that at least a few of their children will be diagnosed with ADHD as well. However, what most people aren’t aware of is that the symptoms experienced by the affected parent can be passed down genetically to the child in addition to the disorder itself. For example, my father and I have both been diagnosed with ADHD. However, he was diagnosed with the Hyperactive-Impulsive type while I was diagnosed with the Combined type. Yet despite the differences in our diagnoses, we experience many of the same symptoms, such as restlessness, emotional hypersensitivity, hyperactive tics, and difficulty reading social cues, in addition to the typical ADHD symptoms like difficulty paying attention. I assumed this connection was due to the fact that ADHD is an inherited disorder, and studies have “concluded that the covariation among these symptoms is due to common genetic influences” (Tuvblad, et. al). In other words, symptoms as well as the disorder itself can be passed down through families, which means that genetics can have a much greater influence on the ADHD experience than most people are aware of. Additionally, studies have found that “unique environmental influences appear to contribute modestly to symptoms of the disorder, accounting for 22% of variance in ADHD symptoms in one study” (Deault). This goes to show that, while the patient’s environment and experiences do play a role in ADHD symptoms, as they do in most everything else related to life, growth, and development, genetics and inheritance have a much greater impact on ADHD than environmental influences do. Therefore, genetics not only influences who has ADHD, but what symptoms a person will have. This is just another factor that makes ADHD unique for each patient because the traits and symptoms passed down from parents to child usually differ significantly between families. For example, while emotional hypersensitivity is an ADHD symptom that runs in my family, a former friend of mine with ADHD struggled with reading social cues, which lead to her being extremely blunt. I believe this symptom is one that runs in her family because her mother behaves this way as well. It isn’t hard to figure out why our families aren’t friends anymore. In addition to ADHD, many other psychological conditions can be passed down genetically, and these conditions, which exist as comorbidities to ADHD, can be influenced by the patient’s ADHD and have the potential to affect a person’s experience with ADHD.
Another factor that can influence a patient’s experience with ADHD is a diagnosis of a comorbidity, which is a condition that co-occurs with a primary condition\. A lot of ADHD patients are also diagnosed with comorbidities, and while there are a lot of different comorbidities and disabilities a person can have, the most common ones are depression, which is “the most frequently reported comorbid psychiatric disorder in patients with ADHD,” anxiety, and alcohol abuse, which is “more prevalent in patients with ADHD versus those without” (ADHD Institute). Clearly each comorbidity alters a patient’s experience with ADHD in a unique way, but the way a patient copes with their comorbidity or comorbidities can cause even more differences in the ADHD experience between patients. For example, two people with ADHD may also suffer from anxiety. One has developed healthy, effective coping mechanisms while the other hasn't. The one with healthy coping skills is able to manage their anxiety. On the other hand, the one without those skills frequently gets overwhelmed, which leads to executive dysfunction, which makes planning, problem solving, time management, and organization very challenging and makes the person more overwhelmed. This information about comorbidities doesn’t only apply to adult patients, though, as studies have found that “children with ADHD experience significant difficulty with emotional regulation and are at greater risk for depression and anxiety” (Deault). We have already established that depression and anxiety are the most common comorbidities in ADHD patients, but these studies also show that, at least for children, these comorbidities can be a result of a child’s ADHD, which causes emotional regulation difficulty and hyperactivity. These challenges can make a child feel different from their peers, creating loneliness and isolation, which can be very damaging to a child’s developing brain. These studies show that comorbidities can develop for a variety of reasons including past trauma, genetics, or as a direct side effect of ADHD, but regardless of where a comorbid condition comes from, the coexisting psychological conditions experienced by people with ADHD can greatly impact and effect the way these patients experience ADHD, making their experience with ADHD even more unique and different from the experiences of other patients.
A lesser-known fact about ADHD is that traumatic or stressful childhood events can have an impact on how ADHD symptoms are expressed and experienced. This is due to both the development of mental illness and comorbidities as a result of trauma as well as the way trauma can affect brain development. Behavioral genetic research has found that “both abuse and neglect are associated with increased levels of ADHD symptoms” (Humphreys, et. al). This is because ADHD symptoms are linked to certain parts of the brain, so when trauma occurs during times of critical brain development, it can affect the way those parts of the brain grow, thereby affecting the way the ADHD symptoms linked to them are experienced by the patient. For example, “both stress and ADHD have been associated with reduced volumes in the prefrontal cortex (PFC) and basal ganglia, as well as with reductions in cortical thickness across the prefrontal, parietal, and temporal cortices” (Humphreys, et. al). When trauma is experienced during the development of these parts of the brain, the brain’s development may be altered, worsening or increasing the symptoms the patient may already be experiencing. This means that trauma during childhood can have an effect on ADHD in relation to brain development and, actually, the development of comorbidities as well. This ties back into the way comorbidities can impact a patient of ADHD because childhood trauma can cause other mental illnesses such as depression or PTSD, which, as I mentioned before, when coupled with ADHD, creates a unique collection of symptoms, tendencies, struggles, and experiences. Because of how often trauma leads to mental illnesses and comorbidities, it is extremely important to teach trauma victims healthy coping skills so that they can learn how to effectively manage their comorbidities as well as their ADHD. Even though trauma may not have an excessively large impact on a person’s ADHD symptoms, it does help shed some light on why ADHD is experienced differently between patients.
Clearly, the vast majority of ADHD patients do not fit neatly into the metaphorical box that is the stereotype of the crazy little boy who can’t sit still in class. ADHD is an experience that is unique for each and every patient, and it is made so unique and original by the many influential factors that can affect the symptoms that are experienced by an ADHD patient. These factors include, but are certainly not limited to the type of ADHD a patient is diagnosed with, a genetic predisposition to certain symptoms, certain comorbidities, and traumatic events experienced during childhood as well as how the victim copes with them. While these factors do have a very great effect on how ADHD symptoms are expressed and experienced, there are many other factors that influence a patient’s experience with ADHD, and this wide variety of symptoms and experiences is just one thing that makes ADHD such a unique and interesting disorder. Although there is much more research to be done about how and why ADHD is different for each patient, it is important to share what we do know in order to raise awareness for an increasingly prevalent disorder.
CDC. “Data and Statistics About ADHD.” Centers for Disease Control and Prevention, 21 Sept. 2018, www.cdc.gov/ncbddd/adhd/data.html.
Deault, Louise C. “A Systematic Review of Parenting in Relation to the Development of Comorbidities and Functional Impairments in Children with Attention-Deficit/Hyperactivity Disorder (ADHD).” Child Psychiatry & Human Development, vol. 41, no. 2, 19 Sept. 2009, pp. 168–192, 10.1007/s10578-009-0159-4. Accessed 4 May 2020.
Humphreys, Kathryn, et al. “Stressful Life Events, ADHD Symptoms, and Brain Structure in Early Adolescence.” SpringerLink, 21 May 2018, link-springer-com.elib.uah.edu/article/10.1007%2Fs10802-018-0443-5. Accessed 15 Nov. 2020.
“Psychiatric Comorbidities in Patients with ADHD | ADHD Institute.” ADHD Institute, 2016, adhd-institute.com/burden-of-adhd/epidemiology/comorbidities/.
Tuvblad, Catherine, et al. “A Common Genetic Factor Explains the Covariation Among ADHD ODD and CD Symptoms in 9-10 Year Old Boys and Girls.” ProQuest, Feb. 2009, search-proquest-com.elib.uah.edu/docview/205026173?accountid=14476&rfr_id=info%3Axri%2Fsid%3Aprimo. Accessed 15 Nov. 2020.
Williams, Penny. “What Are the 3 Types of ADHD?” ADDitude, 9 Feb. 2017, www.additudemag.com/3-types-of-adhd/. Accessed 15 Nov. 2020.