ADHD: Perspectives From A Neurodiversity-Affirming SLP - Part 1
Author: Kendra Wormald, Reg. CASLPO Speech Language Pathologist
Date: Wednesday, July 24, 2024
Table of Contents
What is ADHD
ADHD, also referred to as attention deficit/hyperactivity disorder, is a neurodevelopmental condition which has been a more recent buzz word across various social media platforms and social conversations, the last couple of years. This article aims to educate, clarify and evoke reflection of personal bias and ableist behaviors, as well as address ways ADHD can be limiting.
As you read through this article, reflect on Enright (2023)’s words, “I want to begin by clarifying that absolutely, everyone has some traits in common with neurodivergent people. Why? Because neurodivergent traits are human traits! We’re all human beings.”
Types of ADHD
The name of this condition can be misleading. The word ‘hyperactivity’ often gives the impression that those with ADHD are always ‘bouncing off the walls’, not listening, and can't sit still. In reality, there are different subtypes of ADHD. Thus, signs and symptoms present differently across different age, sex and variant and may be contextually related. No matter the sub-type, almost all people with ADHD struggle with some degree of distractibility, inattention issues and focus which impact different areas of their lives. Many ADHD characteristics are related to executive functioning which refers to mental skills involving working memory, emotional control and problem solving.
(Johns Hopkins, 2024)
1. ADHD, impulsive/hyperactive. This is the least common type of ADHD. A person with this type is often impulsive and hyperactive. But they often don't have trouble paying attention.
People may:
squirm, fidget, or feel restless, may shake their leg, need to get up often, benefit from whole body movement when listening
talk constantly, at a fast rate, telling several stories at once
touch and play/fidget with objects
have trouble engaging in quiet activities
are constantly “on the go”, feeling the need to always be busy
can appear impatient, challenges with delayed gratification
may speak before thinking, leading to communication breakdowns
interrupt others in conversation at times mid-sentence
have challenges with turn taking
act out of turn and don’t consider consequences of actions
blurt out answers and inappropriate comments
2. ADHD, inattentive and distractible. A person with this type is mostly inattentive and easily distracted
People may:
miss details, especially smaller ones
have difficulty organizing thoughts and learning new information
get bored quickly, wanting to shift tasks as attention flows
may have several tasks ‘on the go’ at once
lose common objects such as pencils, papers, phones, keys, remotes
don’t seem to listen, may ask others to repeat frequently
move slowly and appear as if they’re daydreaming or ‘zoned out’
process information more slowly and less accurately than others
have trouble following directions, especially multi-step that are only given verbally
3. ADHD, combined. This is the most common type. A person with this type is impulsive and hyperactive. They also have trouble paying attention and are easily distracted.
People may experience all or some of the previously mentioned challenges in the other two subtypes.
Brain Differences: ADHD vs. Neurotypical Anatomy
The reason ADHD is classified as a neurodevelopmental condition is because it impacts the structures of the brain. Hoogman et al.’s (2017) research, suggests that children with ADHD often have smaller brains, resulting in volume difference which may take more time to develop and mature. Research suggests these areas are the key parts of the brain that are structurally affected in the ADHD brain:
Striatum: The brain’s reward system. It is the link between motivation and movement. It is incharge of reward processing, decision-making, and social interactions. Dopamine is processed here which balances the interaction of motivation, reward and pleasure. The striatum supports processing of thoughts feelings and experiences
In the ADHD brain, the striatum sends several messages to the cortex to think about, instead of one at a time
Amygdala: A major player in motivation, processing emotions, and controlling emotional behavior.
In the ADHD brain, the amygdala has challenges communicating with the prefrontal cortex, leading to difficulty with emotional coping. This may result in feeling overwhelmed with emotions, possibly leading to challenges with managing emotions such as sadness and aggressing, frustrations and ‘overreacting’ which may contribute to social interaction problems.
Hippocampus: Part of the brain responsible for long-term memory, learning, motivation and emotions. It restricts automatically emotional reactions which may lead to challenges with hyperactivity
Parts of the brain such as areas responsible for executive functions, have less blood flow resulting in underactivity. Other areas hav increased blood flow leading to being overactive and contributing to challenges with focus, emotional control and attention.
Chemical Differences
Chemical messengers called neurotransmitters function ineffectively in the ADHD brain. Dopamine is one of the key neurotransmitters impacted (Buzanko, 2019). There is an abundance of transporters without enough receptors which means dopamine moves too quickly for the brain to interpret it. Dopamine helps control the brain’s reward and pleasure center and works in an essential way to sustain attention and motivation (Buzanko, 2019). Consider having to do laundry or cooking. For many, this doesn’t spark a lot of dopamine, which makes it extremely challenging for an ADHD brain to receive the anticipated rewards or pleasure from completing less favored tasks . Because dopamine does not work efficiently in the ADHD brain, routine tasks with little reward are definitely not interesting and are challenging to start. Inefficient dopamine also makes it challenging to wait and anticipating pleasure may seem impossible.
“Their brains do not have the neural organization to self-regulate and to stop automatic responses…their brain is built to respond impulsively to their environment and makes it hard for them to do the things they need to do day in and day out.” (Buzanko, 2019).
ADHD Myths
ADHD only occurs in boys and is always evident: Unfortunately early ADHD data was normed on young males. As a result, a significant amount of females are learning later on in life why their brain functions the way it does or to some, “ why life is so hard”.
Children with ADHD are always hyperactive: As discussed prior, ADHD presents itself differently across different populations and contexts.
ADHD is a learning disability: ADHD can make learning more challenging but it is categorized as a neurodevelopmental disorder not a learning disability
Caffeine makes ADHD ‘worse’: Although it could provide some energy to someone experiencing hyperactivity, often those with ADHD find caffeine to help them focus and for some it even puts them to sleep
ADHD is caused by poor parenting: There is no substantiated evidence to support that ADHD is rooted in parenting style. There is still research to be done to further investigate the cause of ADHD. Currently, research proposes that it is likely related to genetics.
Part 2 will outline the impacts and experiences of those living with ADHD as well as how to support this population. For instance, there are several ways to validate the lived experiences with ADHD, such as:
Avoid overgeneralizing and saying “everyone's a little ADHD” . This is factually not supported by research. It is an often-said phrase that invalidates and dismisses the unique and persistent daily struggles neurodivergence individuals live with.
Don’t give unsolicited advice about improving a friend’s ADHD habits. It’s better to ask permission, then make a suggestion.
Patience and Empathy. You may recognize someone with ADHD loses their train of thought, interrupts you mid-sentence or is often late. Often those with ADHD aren’t intentionally trying to derail a conversation or change event start time.
Avoid phrases like “ You can’t have ADHD, you’re so successful or “ but you’re so smart”. ADHD is NOT related to intelligence. Although it may impact the amount of effort needed to ‘be successful’, it is highly possible and quite common to be both successful and have ADHD.
Limitations in Research
It is becoming more apparent that research lacks assessment of various demographics. Women or people assigned female at birth (AFAB) are just as likely to experience ADHD however, are significantly less likely to be diagnosed and diagnoses are often received later on in life. ADHD is a condition that affects how the brain works that is not dependent on personality, character, sex or gender. Research is beginning to substantiate that many women do experience ‘internal’ hyperactivity and may present with different ADHD characteristics compared to men(Littman, 2024).
A Speech Language Pathologist can helpsupport you with the daily challenges of ADHD, no matter the subtype.
References
Buzanko, 2019.“Normal” brain vs ADHD brain. What’s different and why. https://drcarolinebuzanko.com/normal-brain-vs-adhd-brain-whats-different-and-why/
Colombo-Dougovito A.M., Dillon S.R., Mpofu E. (2020). The Wellbeing of People with Neurodiverse Conditions. In: Mpofu E. (eds) Sustainable Community Health. Palgrave Macmillan. https://doi.org/10.1007/978-3-030-59687-3_15
Hoogman, M., Bralten, J., Hibar, D. P., Mennes, M., Zwiers, M. P., Schweren, L. S. J., van Hulzen, K. J. E., Medland, S. E., Shumskaya, E., Jahanshad, N., Zeeuw, P., Szekely, E., Sudre, G., Wolfers, T., Onnink, A. M. H., Dammers, J. T., Mostert, J. C., Vives-Gilabert, Y., Kohls, G., Oberwelland, E., … Franke, B. (2017). Subcortical brain volume differences in participants with attention deficit hyperactivity disorder in children and adults: a cross-sectional mega-analysis. The lancet. Psychiatry, 4(4), 310–319. https://doi.org/10.1016/S2215-0366(17)30049-4
Hoogman, M., van Rooij, D., Klein, M., Boedhoe, P., Ilioska, I., Li, T., Patel, Y., Postema, M. C., Zhang-James, Y… Franke, B., et al. (2020). Consortium neuroscience of attention-deficit/hyperactivity disorder and autism spectrum disorder: The ENIGMA adventure. Human Brain Mapping. https://doi.org/10.1002/hbm.25029
Johns Hopkins, 2024, Conditions and Diseases. https://www.hopkinsmedicine.org/health/conditions-and-diseases/adhdadd#skip
Jurgens, A. (2020). Neurodiversity in a neurotypical world. In Bertilsdotter Rosqvist, H., Chown, N., & Stenning, A. (Eds). Neurodiversity Studies: A new critical paradigm. Routledge.
Littman, E (2024).Women with ADHD: No More Suffering in Silence. ADDitude. https://www.additudemag.com/gender-differences-in-adhd-women-vs-men/
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