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As you probably noticed, in my previous post (that was supposed to cover what I’m writing today as well), I went off on a tangent a bit.
But, or maybe because I did that, I missed some things.
So, in the first part of this post, I’ll briefly look at diagnosis once again. Not to long, just to establish the criteria for diagnosis so we can see what they are and how they relate to everything else.
DMS-V and ADHD
To start with we’ll look at what it says about ADHD in the DMS-V.
But before we do that, for those of you that have never heard of it (as I suspect a lot of people reading this never have 😉 ), the DMS-V is pretty much the holy book of psychiatry.
If you’re interested you can get your copy of the DMS-V here.
I have to warn you though; unless you need it to study, it’ll probably end up as a nice, albeit quite pricey, paperweight.
The DMS-V defines, among other things, the criteria for diagnoses of mental disorders.
Btw, the “V” in there is the roman numeral for 5, not the letter V as DMS-V stands for: The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition.
Yes, I would have abbreviated that as well if i were in their shoes.
If we look up ADHD in DMS-V, this is what it says:
“ADHD is the showing of a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development.”
There is an important disclaimer in that sentence. One that is unfortunately often overlooked outside of the medical profession:”that interferes with functioning or development“.
So even if you were to hit all the checkmarks on the questionnaires, in the interviews, etc. etc., you wouldn’t/shouldn’t be diagnosed with ADHD unless it interferes with your functioning or development.
Now I’ll be the first to admit that it’s hard to hit all those checkmarks and have it not interfere with functioning. At least not if you’re an adult in today’s society or a child in school. Then again, I guess that if you’re independently wealthy it doesn’t necessarily have to interfere. You can just go and do your thing.
Then again, I guess that if you’re independently wealthy it doesn’t necessarily have to interfere. You can just go and do your thing. Unfortunately, I’m nowhere near “independently wealthy” (yet. Feel free to help, I’ll be more than happy to accept PayPal and/or other donations).
So for me, like most other people that go through the diagnoses process, it interfered with functioning.
But before I go on about that, let’s first have a look at those diagnostic criteria:
Diagnostic criteria for ADHD:
- Inattention: six (or more) symptoms of inattention for children up to age 16, or five (or more) for adolescents 17 and older and for adults; the symptoms of inattention must have been present for at least 6 months, and they are inappropriate for developmental level:
- Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or with other activities.
- Often has trouble holding attention on tasks or play activities.
- Often does not seem to listen when spoken to directly.
- Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (e.g., loses focus, side-tracked).
- Often has trouble organizing tasks and activities.
- Often avoids, dislikes, or is reluctant to do tasks that require mental effort over a long period of time (such as schoolwork or homework).
- Often loses things necessary for tasks and activities (e.g. school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones).
- Is often easily distracted
- Is often forgetful in daily activities.
2. Hyperactivity and Impulsivity: 6 (or more) symptoms of hyperactivity-impulsivity for children up to age 16, or five (or more) for adolescents 17 and older and for adults; the symptoms of hyperactivity-impulsivity have been present for at least 6 months to an extent that is disruptive and inappropriate for the person’s developmental level:
- Often fidgets with or taps hands or feet, or squirms in seat.
- Often leaves seat in situations when remaining seated is expected.
- Often runs about or climbs in situations where it is not appropriate (adolescents or adults may be limited to feeling restless).
- Often unable to play or take part in leisure activities quietly.
- Is often “on the go” acting as if “driven by a motor”.
- Often talks excessively.
- Often blurts out an answer before a question has been completed.
- Often has trouble waiting his/her turn.
- Often interrupts or intrudes on others (e.g., butts into conversations or games)
In addition, the following conditions must be met:
Several inattentive or hyperactive-impulsive symptoms were present before age 12 years.
- Several symptoms are present in two or more setting, (such as at home, school or work; with friends or relatives; in other activities).
- There is clear evidence that the symptoms interfere with, or reduce the quality of, social, school, or work functioning.
- The symptoms are not better explained by another mental disorder (such as a mood disorder, anxiety disorder, dissociative disorder, or a personality disorder). The symptoms do not happen only during the course of schizophrenia or another psychotic disorder.
As you might have noticed from the criteria, diagnosis is also broken up into 2 separate parts.
The first list of criteria focuses on inattention (ADHD-Predominantly Inattentive) while the second list looks at hyperactivity and impulsiveness (ADHD-Predominantly Hyperactive-Impulsive) instead.
Although the descriptions are clear let’s take a closer look at the different types of ADHD anyway.
3 different types of ADHD
Given that there are 2 different sets of criteria, 3 different types of ADHD can occur:
- ADHD – Predominantly Inattentive
- ADHD – Predominantly Hyperactive-Impulsive
- ADHD – Combined
Let’s take a closer look at these 3.
1. ADHD – Predominantly Inattentive
ADHD Predominantly Inattentive is different from the other two types in that less than six of the hyperactive-impulsive symptoms will be present. You’ll even often see that Hyperactive-Impulsive symptoms are not, or hardly, manifesting at all.
Because these symptoms aren’t showing there is an unfortunate side-effect.
ADHD Predominantly Inattentive is often not noticed at all, especially in children.
These kids are not running around like crazy, they’re not acting out all the time, they’re calm and even may appear to be doing the things they’re supposed to be doing.
Because this is often not diagnosed these kids are regularly labeled as lazy, uncaring and even dumb (or the apparently more politically correct “not smart”).
Up until recently, this was called ADD instead.
2. ADHD – Predominantly Hyperactive-Impulsive
Hyperactive-Impulsive is true to its name.
Hyperactive children always seem to be “on the go”. They run around and touch/play with anything they can find and they have a tendency to talk incessantly.
You probably won’t see them sit still either. And even if they appear to sit still, you’ll often notice them fidgeting or tapping their feet continuously when you pay a bit more attention. They also have a tendency to try to do everything at once.
Impulsive children appear to be unable to control their immediate reactions or to think before they act. They will often blurt out things that come to mind, regardless of whether they’re appropriate or not. They will show their emotions without restraint and they act without thinking of the consequences (see “kid next door” in the previous post ).
Because they are so impulsive they often find it hard to wait for things they want or even to just wait for their turn.
Even in their teens and later in life they will often choose to impulsively do things that have an immediate payoff. Even if other activities will give a much larger, but delayed, reward.
3. ADHD – Combined
There’s not much to say about this one apart from “it’s the most common form of ADHD”. Symptoms will be a combination of the previous two, and the behavior of people in this group will be a combination of the previous 2 as well.
So no running around like a headless chicken all day but no staring off into space, dreaming, all day either.
We’ve just gone over the clinical part of it, although I may have simplified some things a bit. Feel free to get the DMS-V after all if you want to get all nitty-gritty.
But after all of that, let’s have a look at how people with ADHD describe it:
I’ll start by quoting somebody who actually studied for it so who knows the clinical look as well as a lot of the misconceptions surrounding ADHD:
“People who think ADD means having a short attention span misunderstand what ADD is,” says Kathleen Nadeau, Ph.D., a psychologist in Silver Spring, Maryland, and the author of ADD-Friendly Ways to Organize Your Life. “A better way to look at it is that people with ADD have a disregulated attention system.”
So it’s not that people with ADHD don’t/can’t pay attention to anything, they pay attention to the “wrong” things instead.
I’m a good example of that myself.
Ask me anything I learned in school and I’ll probably draw blanks. But play a song from that same period and I’ll likely be able to sing along with all the lyrics, even if I haven’t heard the song for years. Misdirected attention.
Or have a conversation with me and you’ll find my mind will likely wander off at some point. But, put me in the middle of 3 different conversations and I’ll likely keep up with all of them. Again, misdirected attention.
What do I mean by that? Exactly what I said; attention is present, it’s just completely misdirected. And, unfortunately, it’s something that can’t be controlled all the time either. Mainly because it all happens subconsciously.
Let’s have a look at what somebody else has to say about living with ADHD:
Here’s a metaphor: having ADHD/ADD is like having an iPhone loaded with apps and enabling notifications for all of them. If you did this on an iPhone, you’d get overwhelmed with “someone tagged you in X” “So and so checked in at X” “You’ve received a coupon for nearby y” notifications every couple minutes. Only through practice and discipline are you actually able to turn those notifications off and actually get some function out of your tool. In this case it’s my mind.”
Although quite accurate there is one small thing Kyle missed in my opinion.
It’s like having that iPhone but not having been handed a manual.
The settings for all notifications are hidden and new apps with more notifications are automatically installed all the time. These apps don’t come with a manual either so you have to find the settings for all of them yourself. At the same time, notifications for existing apps get randomly turned on again.
Yes, with practice you can learn how to turn off the notifications. But new ones keep coming anyway so it’s not something you will ever master entirely. Instead, it’s something you learn to deal with.
Now to be fair, for some people medication helps just fine. All of a sudden all notifications get turned off and they can lead a “normal” life. But others don’t like the (possible) side effects as it makes them feel like “a different person”. So they either give up or they try to use breathing exercises, meditation and a myriad of other solutions to help keep them on track, with varying levels of success.
If you are diagnosed with ADHD my suggestion is to just try the various types of medication as well as meditation etc. Figure out what works for you and make that part of your routine.
One thing that helps me it’s getting up and talking a walk outside. That often helps get me back on track.
I said often because there are days when my ADHD just takes over completely and everything distracts me. That includes anything in the room. And yes, even the things that aren’t moving.
On days like that, I prefer to either forget about my plans entirely, if I can. I’ll just go out and will do things that don’t require my full attention. . But, like most of us, I can’t always do that.
So if I have to get work done while I really can’t focus, I use medication.
And I could even choose to use medication all the time. I’m lucky in that the side effects are not bad for me. Not to the point where they bother me anyway.
I just don’t like taking medication if I don’t have to. I rarely even take paracetamol and for those of you that have seen me at festivals, you know there are days that could definitely help me 😀
Ok, so a bit of a tangent again but I hope you learned a bit more about ADHD from it anyway.
Stay tuned for the next installment.
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* attribution for the featured image of this post: By Psyc3330 w11