October is ADHD Awareness Month with this year’s theme being ‘Awareness is key’. With Attention Deficit/Hyperactivity Disorder (more commonly referred to as ADHD) affecting approximately 6–10% of Australian children and adolescents and 2–6% of adults, we believe awareness is very much key to understanding and supporting this significant percentage of our population.
Once known as Attention Deficit Disorder (ADD), the diagnostic criteria for ADHD today recognises that the disorder is neurodevelopmental in nature, rather than just a behavioural disorder. Neurodevelopmental disorders are neurologically based conditions that appear in childhood, and often impair development of social, academic, personal and/or occupational functioning.
Diagnosis is made by clinical criteria, this criteria laid out in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR). The DSM-5-TR refers to three types of the disorder:
- Predominantly inattentive
- Predominantly hyperactive/impulsive
- Combined
Inattention symptoms:
- Does not pay attention to details or makes careless mistakes in schoolwork or with other activities
- Has difficulty sustaining attention on tasks at school or during play
- Does not seem to listen when spoken to directly
- Does not follow through on instructions or finish tasks
- Has difficulty organising tasks and activities
- Avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort over a long period of time
- Often loses things necessary for school tasks or activities
- Is easily distracted
- Is forgetful in daily activities
Hyperactivity and impulsivity symptoms:
- Often fidgets with hands or feet or squirms
- Often leaves seat in classroom or elsewhere
- Often runs about or climbs excessively where such activity is inappropriate
- Has difficulty playing quietly
- Often on the go, acting as if driven by a motor
- Often talks excessively
- Often blurts out answers before questions are completed
- Often has difficulty awaiting turn
- Often interrupts or intrudes on others
DSM-5-TR diagnostic criteria require at least six of the nine symptom criteria for either inattentive or hyperactive/impulsive type to be present for at least six months to proceed with diagnosis. The symptoms must also occur and interfere with functioning in at least two settings (e.g. work, school or home), be more pronounced than would be expected for the individual’s development level and be present before the age of twelve. Additionally, the symptoms must not be better explained by the presence of another condition.
Although people living with ADHD may experience a number of challenges, the team at BUSY Health know not just from the evidence and research, but also from our own work with young people at The BUSY School and with adults seeking support for vocational reasons, that ADHD can sometimes also be something of a superpower.
Individuals can sometimes outperform neurotypical peers in particular domains because of their neurological differences. Children with ADHD often have a strong visual memory and can develop a real passion and aptitude for areas of study and sports that they find interesting.
People with ADHD are often highly focused problem solvers and can report ‘hyperfocus”, which can enable them to work tenaciously on a task they are absorbed in. They can also often be innovative and imaginative thinkers, showing significant motivation when driven by competition and creative thought. These can be key strengths in studies and the workplace.
There are, however, challenges that people living with ADHD are more likely to face than neurotypical peers. These can include staying organised, maintaining focus, remembering important information, attending to important details, organising their thoughts into actions and regulating their responses in challenging situations. They may feel uncomfortable at times when under-stimulated, when required to endure monotony or when their movement is restricted by rules and expectations.
Along with dealing with the demands of the condition itself, experiencing ADHD can also come with concurrent emotional challenges; the guilt over not being able to get started on things the individual wants to get done; the shame stemming from condemnation from others or embarrassment about not living up to others’ expectations.
People with ADHD usually don’t chooseto neglect important considerations and let people down. They don’t choose to act hastily and suffer regret, nor do they choose to get so distracted by their own thoughts that they fail to prioritise what others would be able to do with much lesser effort.
Far from intentional, the condition simply makes many tasks more challenging. It needn’t however prevent success.
For each individual, symptoms and challenges can differ and fluctuate, particularly as demands and resources change. When we add demands like pressure, distractions, environmental distractors, unreasonable expectations or other stressors, ADHD symptoms can often be exacerbated.
But with helpful resources, including management strategies, appropriate nutritional or medication options, helpful structure and organisation as well as support from others, quite often the most challenging symptoms of ADHD can be managed in such a way as to pave a path to success.
Treatment for ADHD usually includes pharmacotherapy with stimulant or other medication, behavioural therapy, and educational interventions. BUSY Health’s team is there to help, support and guide people with ADHD toward effective strategies for the management of their condition.
An example of the type of support BUSY Health’s provides*
Duncan (not his real name) is a young professional diagnosed with ADHD. When he was referred to BUSY Health, Duncan’s previously excellent work was being affected by heightening levels of stress and anxiety, and by a conflict situation in the office that he was struggling to navigate.
We provided regular counselling sessions with a therapist familiar with the challenges of neurodiversity. The therapist helped Duncan to explore the impact of stress and anxiety upon his daily life, Duncan identifying his “organisational skills had gone out the window”. Through conversation, the therapist reflected that Duncan repeatedly condemned himself and described himself in negative terms. Further exploration aided Duncan to identifying unreasonable expectations he was placing upon himself that heightened his stress, leading to avoidance behaviours and in turn a neglect of planning and routine in his life.
Duncan expressed that had constantly been feeling ashamed, guilty and anxious about turning up late at work and subsequently found himself excessively defensive towards others whenever his personal performance or commitment was in question. He felt somewhat relieved to hear that he wasn’t alone in facing such challenges and that feeling as he did can be common for those dealing with ADHD and neurodiverse conditions.
Initially the therapist worked with Duncan on de-arousal strategies he could easily implement when confronted by anxiety and stress, enabling him to slow his mind so that he could refocus on a single helpful task upon which to begin. While not eliminating all of Duncan’s anxiety, it enabled him to focus on building a stable routine that reduced his sense of dread about being late at work.
As Duncan’s sessions progressed, further strategies were provided to assist him to integrate mindfulness, effective self-care routines and personal boundaries around responding to others’ demands upon his time.
Duncan’s journey with us illustrates the importance of personalising support for individuals with ADHD. For other people referred to us with ADHD, those support strategies have included trauma-informed grounding techniques to support PTSD symptoms, systems to address task paralysis and distractibility, and techniques to help people with their time-management.
Everybody with ADHD is unique. Everybody’s experience will be their own and the challenges each person faces will be different. But with interventions tailored to the individual, and delivered in the right way, there is a superpower waiting to be released.
This ADHD Awareness Month, let’s spread the awareness and celebrate the superpower qualities people living with ADHD can bring to the workplace and our communities. *Duncan’s case may not be representative of all client intervention strategies or outcomes and is provided as an example only