What is ADHD?
What is ADHD?
Wow, what a question. It is THE important question that truthfully doesn’t get asked that much. Let’s examine what it is and what it isn’t.
A good friend of ADHD 360, Professor Tom Brown, gave me an analogy of how to describe ADHD, and I can’t better this great man’s words. Imagine a symphony orchestra. Each musician is at the very top of their game, brilliant musically, talented creatively and so, so tuneful when in harmony with their instrument. What the musicians in the orchestra need is a conductor, someone to be at the front, in control, to lead them all through the piece of music being played, setting the rhythm, the pace, the volume, regulating that component parts of the orchestra to produce beautiful music.
Well, there’s ADHD explained. The musicians are the parts of the brain that control empathy, emotion, regulation of movement, concentration, focus, motor skills etc. The conductor is the prefrontal cortex of the brain, the bit in the forehead, and when the conductor is ‘on it’ the rest of the brain can perform to its capability. In ADHD, we know that there are limitations in the performance of the prefrontal cortex, the conductor, so our ‘orchestra’ is out of sync, and our impulsivity, attention and activity are not as controlled as we would like. In effect, to complete the musical analogy of Tom Brown, we are out of tune, out of rhythm and we don’t sound so good.
Another friend of 360’s, Russ Barkley describes ADHD as not an intelligence issue but a ‘performance issue’. This explanation also fits well with Tom Brown’s analogy, brilliant and capable but just can’t nail performance without help.
In the world of all things ADHD there are two distinct camps, with slightly different ways of examining ADHD: For some it is an impairment which prevents potential being reached, causes frustration and leads to emotional dysregulation for example. For others, the other ‘camp’, it is a blessing; ADHD allows unfettered creativity, allows freedom of expression and provides an energy that others struggle to match or keep up with. This was once debated on a stage at a conference in the US, and what was clear was that to see both aspects is the ‘truth’ but that different people have differing experiences, and both should be respected.
Perhaps we should look at ‘what is ADHD’ from a scientific basis? A colleague of ADHD 360’s once said with absolute clarity: ‘The brain is merely electricity and chemicals held in a muscle’. Wow, simple! Rather hilariously another colleague, himself so intelligent I think he has two brains, was asked ‘why is the brain so complicated?’ and he responded:
‘If it wasn’t, we wouldn’t be clever enough to understand it!’. Returning to the electricity and chemicals, and revisiting the prefrontal cortex, we know that deficits in the chemicals required to pass messages along the synaptic pathways, bring about impairment in the function of that part of the brain. Specifically, the parts that control hyperactivity, impulse and attention. If we adjust the chemicals, with scientific measures of the right medicines, we can adjust those chemical balances and restore a more fully productive, and appropriate pathway. In effect, we nudge the conductor back into full and appropriate control of the orchestra.
Another way of looking at defining ADHD is by looking at outcomes for people with it? Children with ADHD can easily fail to focus at school, not achieve their potential in exams, not have friends and not be part of the naturally forming ‘peer groups’. Those are the easy to define outcomes. The ones often overlooked are the feelings of ‘a lack of self-worth’, anxiety that builds as tasks are failed and deadlines are missed, struggles with emotions and self-expression. It must be difficult to not understand why you can’t get things right, can’t follow the lesson when others around you can, and to not understand why life is so difficult for you compared to your friends. It must also seem very unfair.
When we look at adults with ADHD, we see different outcomes. Failure in relationships, loss of employment, driving issues, criminal behaviour, sadly all of which are preventable with good treatment. As a clinical service it is actually really heartening when we are given the feedback that ‘wow, you truly did save my marriage’, or ‘my supervisor now wants to spend time with me, work has completely improved’.
When looking at defining ADHD, we can and should also make sure we don’t push the messages to the point where people are ‘defined’ by their ADHD. It is a fine balance between acknowledging who we are, asking for and receiving help when we need it, but staying true to our feeling of ‘self’ and not being defined as ‘someone that is ADHD’, when the truth is you may be ‘someone that has ADHD’.
Whether we look at the science, the emotions or the outcomes, the overriding fact is that ADHD is something we can treat, we can make a difference and interventions should be ‘more than a diagnosis’.