My brief story
As someone on a multi-year-long-waitlist for an ADHD screening, I wanted to do some research.
Online content is full of misleading information.
TikTok apparently over 50% of videos being misleading, and only 21%, useful.
Combine that with my own experience with coaching, learning, and cognitive science literature...
I decided to do some research myself.
But the approach I take to cognitive science is different from popular perspectives.
We don't have a central executive.
Learning happens in the organism environment relationship, not just the brain.
And there is no best way for everyone.
Identification
At first glance, ADHD has lots of potential labels:
ADHD: Attention deficit hyperactivity disorder.
ADD: Attention deficit disorder.
ODD: Oppositional defiant disorder.
IED: Intermittent explosive disorder.
Adding terms like twice exceptional or 2e, meaning a person that is gifted with a disability.
Which adds confusion.
Disorder v disability for example:
It seems to me that many of these labels can be swapped, intending to mean similar things.
However, comorbidity (presence of more than 1 condition) rates are high, like 80%+ high for those diagnosed with ADHD.
This is complex ADHD.
Conditions like:
Anxiety
Autism
Depression
Epilepsy
Obsessive-compulsive disorder
Tourettes
and the list goes on...
The DSM 5 categorizes ADHD as a neurodevelopmental disorder.
But diagnosing ADHD is far from simple.
Diagnosis
Judy Singer promoted and popularized the term neurodiverse in the 90's.
Coming from her research into spectrum disorders, and social disabilities.
Discussing why and how some people are isolated and categorized as wrong, unhealthy, or have problems.
Fighting against ableism.
Those belittling disabled people.
However, diagnosing disabilities that relate to behaviours and social interactions is not only complex, but arguably over reliant on subjectivity.
All humans are biased.
Science and research is biased.
Therefore, subjective elements of diagnosis are biased.
An unsolvable issue.
Bias can help, or hinder diagnosis.
Current predictions of between 5-8% of adults have ADHD.
But more and more are being diagnosed as time goes on.
Past bias, potentially resulting in under diagnosing the disorder.
Under diagnosing certain groups, more than others.
Our current bias, potentially resulting in over diagnosing the disorder.
Adding complex ADHD.
Adding comorbid conditions, which can hide symptoms.
Adding the various manifestations of ADHD like inattentive, hyperactive, or combined.
Results in a subjective, potentially multi-condition, variable manifestation disorder, relying on different professionals, to maintain the same assessment.
So diagnosing ADHD, or complex ADHD, is far from simple, even for professionals.
Hence, the advice, don't diagnose yourself.
Criteria
Current criteria from the DSM 5 states:
“A persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development,” (“Diagnostic and statistical manual of mental disorders: DSM-5”, 2013, p. 97)
Enforcing that:
“Six (or more) of the following symptoms have persisted for at least 6 months to a degree that is inconsistent with developmental level and that negatively impacts directly on social and academic/occupational activities” (“Diagnostic and statistical manual of mental disorders: DSM-5”, 2013, p. 97)
But also says:
“For older adolescents and adults (age 17 and older), at least five symptoms are required.” (“Diagnostic and statistical manual of mental disorders: DSM-5”, 2013, p. 98)
Simply put.
Have you experienced symptoms that negatively impact your life, for an extended period of time?
Seems vague to me.
Symptoms
The list of symptoms could be discussed for hours, using thousands of words.
For me, they come down to the interpretation of attention and activity.
Being inattentive, hyperactive, or both.
Symptoms measured using behaviour remembered by the individual, and/or others that know/knew them.
However, behaviours are multi-causal.
I would argue, there is also, non-linearity to their causes.
As mentioned in a previous article, "it is easier to say what doesn't cause something, than what does".
This is emphasized by what Judy Singer was originally researching - social disabilities.
The interaction of people in social environments, and their behaviour.
An example symptom, difficulty following instructions, can lead to multiple questions:
What sort of instructions?
How important are the instructions?
Who told you the instructions?
What is your interpretation of the instructions?
Obviously, it all depends.
Diagnosis, is looking for a general trend of behaviour... I think.
Which I would extend to the other symptoms - nuance impacts the answers.
At risk of oversimplifying the diagnosing process, I would argue it looks for trends, or typical behaviour.
But as Judy discusses, and emphasizes in her writing.
Behaviour is socially impacted.
Maybe the trend or typical behaviour is due to the environment?
Begging the question...
Nature or nurture?
Causes
Skipping the philosophy for this article, I think the question is ill formed.
Both nature and nurture play roles in behaviour.
Multi-non-linear causality.
So Biology has some causes.
But so does the environment.
This is where the online explanations frustrate me.
And the research used as evidences, confuses me.
Biology
Popular explanations of ADHD like behaviour are attributed to the brain.
More specifically, the prefrontal cortex.
Where executive functioning is argued to occur.
However, apart from identifying activation differences, I can't find much else on this, apart from lots of speculation.
Some suggest the differences are due to genetics.
However:
More speculation...
The default mode network discussions are interesting but again, only show brain activation differences.
Comparing severe patients with normal people, skew the results.
Short term studies remove developmental factors.
And at risk of sounding like a sciency person here, but, there needs to be more solid research.
Solid referring to causal, not just correlational findings.
One paper emphasizing, a group of people having different brain activation levels than another is significant.
But it doesn't have longitudinal power.
From what I have seen, Andrew Huberman has almost single-handedly pushed the dopamine cause.
One of many potential causes.
But I have only found correlational research.
The issue I see with focusing on correlational research leads to statements like this: "my dopamine levels are the problem"
Mistaking correlation for cause.
Sometimes a lone cause.
There is more to behaviour than the organism...
Sociology
Saying ADHD is a social construct will, understandably, frustrate people.
However, without society, the disability wouldn't emerge, as Judy alludes to - Social disabilities.
Just because something is a social construct, doesn't mean it doesn't exist.
Behavioural experiences, certainly exist.
But within an environment.
Changing environmental constraints can remove disabling behaviours.
They could also add disabling behaviours.
As a half deaf, half blind person, I live with constraints that disable me from participating in some social environments.
By developing skills, and adjusting the environmental constraints, the physical disabilities I have are no longer disabling.
In the new organism environment relationship.
Learning sign language, or sitting on the right side of a room.
New skills enable me to engage in environments like the deaf community.
Which I was, previously, disabled to engage in.
Phones are often related to ADHD behaviours.
But if ADHD is all biological, phones shouldn't make a difference - unless environment plays a role...
Ecological approach
Taking an ecological approach to the research, I got some answers.
How can symptoms be so well hidden?
Environment plays a role in behaviour.
Why is it harder for some people, more than others?
Biology plays a role in behaviour.
Why can't I focus?
The organism environment relationship isn't resonating.
WTF!?
The radical ecological approach challenges popular psychology, philosophy and cognitive science.
And adds new and novel meanings to terms.
Here is an overview article, but some things I would consider:
What affordances does the person perceive?
How does the practice represent the desired goal?
Are the environmental constraints helping or hindering the person?
Instead of working memory capacity, dopamine levels, or brain problems.
The issues go beyond biology, beyond environment, and into their relationship.
All unique to each experience.
So how can each individual find their own unique solution?
Solutions
Blanket advice is common.
Often with a disclaimer saying ‘we are all unique’.
I understand, but get irritated.
Things like:
Planners
Lists
Alarms
Instructions
Breaking up long tasks
Common and popular tools, for everyone.
Loads of people use planners, lists, alarms etc, but all in different ways.
How do I find my way…that works?
How do I practice?
How do I do the thing?
ADHD specific advice I see, is the same advice I see from all other productivity guru’s.
The difference…
Proposed causes for the issues.
ADHD advice
I see/hear things like, ‘people with ADHD struggle with x more because of y’.
x often being an everyday behaviour.
y often being a biologically proposed cause.
Still with the disclaimer, we are all unique.
Neurodiversity was originally coined to help a movement against ableism.
Neurodiversity isn’t a disability.
And in Judy’s own words:
Instead of looking at ADHD as a medical diagnosis.
‘People with ADHD’
In an ideal world.
We can look at people as individuals behaving in dynamically complex environments.
Organismic ADHD can’t be fixed, because nothing is broken.
How we find our own solutions to issues comes down to our own learning experiences and abilities to develop.
How you do that, is intrenched in educational science…