Attention Deficit/Hyperactivity Disorder, or ADHD, are behaviors that I, and many other people, struggle with every day. Those with ADHD can have trouble getting work done, staying organized, or being impulsive. Unfortunately, when I was a child, some around me believed this must be caused by laziness, lack of discipline, or both. As a child, it hurt to be accused of lying by people I respected. I was already so frustrated with the confusion of why any effort on my part never made a difference. It was very hard to get the help I needed, but I finally learned that there was hope! Armed with the knowledge about myself and ADHD I could explain to others what problems I faced. Once I could communicate my trouble I was able to get the support and help I needed throughout school to become the successful college graduate I am today. I've learned a lot about ADHD and about myself over the past decade and then some. I hope that this can help a young person with ADHD, or the parent of one, to understand what ADHD is, what ADHD isn't, and how to talk about the frustrations we with ADHD face.
There are two parts to this article: The first deals with what goes on in the brain to cause ADHD, why ADHD affects the behaviors it does, and why certain medicines ease the frustrations of living with ADHD. The second part deals with my personal struggles, and tries to explain why it can be so difficult to explain the problems I faced.
ADHD and the Brain
Although scientists have known about Attention Deficit/Hyperactivity Disorder since the late 1930’s it was not until much more recently that they have learned enough about how the brain works to sketch even a rough picture of why people have ADHD. To understand what they’ve discovered and why we care, we first need to look at what the brain really is. The human brain is made up of tens of millions of microscopic cells called nerves or, more formally, neurons, the word neuron comes from the Greek word neuro which means nerve. Neurons carry the signals that we use to think. A neuron on its own is like a person at one end of a can-and-string telephone with no-one on the other side, but neurons linked together can talk and listen to the neurons around them. All of these neurons are connected together in a big 3D spider web we call the brain.
Of course, there aren’t actual cans and string connecting brain cells to each other. Instead, neurons are connected at a point called a synapse, which means ‘connection’ in Greek. A synapse is the tiny gap where one neuron ends and the next begins. Cells, even ones as important as neurons, can’t speak, so they need to transmit the signal they carry some other way. Neurons talk to each other using special chemicals. Biologists call these chemicals neurotransmitters. A transmitter is something that sends out signals, recalling that neuro means nerve then a neurotransmitter sends signals between nerves. Different parts of the brain use different combinations of the dozens of possible neurotransmitters to do different things. Some of these areas figure out what you’re seeing and hearing, others store your memories, and some choose whether you’re feeling happy, angry, tired, or hungry.
There are two special areas are about an inch above and behind your eyeballs. These areas control a special type of brain work, or cognitive process. These cognitive processes are called executive function and they control what the rest of the brain is doing at any given moment. Some of the cognitive processes controlled by executive function allow you to plan ahead, make decisions, break bad habits, form good habits, and help you resist temptation. Executive function decides how important each of those things is at any moment. For a person with ADHD the executive function system does not work as well as it should. That’s why a person with ADHD will sometimes struggle to stay on task while at other times they will focus strongly on a task for hours at a time and will ignore other needs to continue working on it. These are the result of executive functions deciding that the task isn’t important or that it’s more important than any other task. One of the biggest obstacles I face because of ADHD is changing habits. To change a habit you need to consistently decide to act differently for a long enough time until it becomes second nature. Someone with ADHD is likely too inconsistent to do this without a lot of outside help.
Over the past 60 years doctors have studied ADHD and have found that certain kinds of stimulant drugs, such as amphetamines, have a positive effect on those with ADHD. Amphetamines alter the processing of three neurotransmitters, but only in certain parts of the brain. These neurotransmitters are dopamine, serotonin, and norepinephrine. This happens to be the same part of the brain, and the same neurotransmitters that concern the executive function that is at the core of ADHD.
My Struggles with ADHD
Talking to others about the difficulties caused by ADHD is one of the most difficult things I’ve dealt with over the course of my life. When I was younger I knew that I had problems, but struggle to explain it. A common issue is that of school assignments, ADHD can make it difficult to complete these tasks. Usually, the tasks that were most difficult to complete were easy, or even trivial, only a couple minutes of work. Yet, ADHD can make completing it a long, drawn out exercise in frustration. Any time I failed to complete an assignment I was always asked why I didn’t do it. Time after time I couldn’t offer an answer that wasn’t dismissed as “an excuse” as I attempted to describe the internal conflict that happens every time I sat down and attempted to work. When I tried the honest answer “I don’t know” instead of my own guesses about why I didn’t do the work I was told this was a silly answer. Those who haven’t experienced it themselves may not understand that feeling the want to complete a task and making the conscious decision to do so are not enough because executive function must be active and correct to follow through on the will and choice. For a while I was taken from teacher to specialist to expert to be taught better organization and time management skills. While these are useful skills to have, all the scheduling and organization in the world can do little against that barrier the student hits when he sits down and attempts to work.
It is that barrier that some of those with ADHD struggle to describe, it varies from person to person of course, but from my own experience I can say that barrier describes the effect quite accurately. Neurological problems that cause, or manifest, physical responses are known as psychosomatic symptoms. In my case, any time I sit down to attempt an assignment I can feel pressure in my chest and extremely low level pain or discomfort in my chest and head. The feelings go away the moment I stop trying to push myself to do the assignment. This is very similar to clinical anxiety, though I feel it is distinct. Both the conscious and subconscious desire to avoid that discomfort will slowly affect behavior. They won’t realize it when they make a decision that puts more time between them and the task they need to perform. Outwardly, this is procrastination, of course, everyone procrastinates at one time or another, but for someone with ADHD it is very easy for procrastination to become a long term problem. The usefulness of solutions like scheduling and organization depends entirely on the strength of the subconscious behaviors that have formed to avoid the psychosomatic barrier. Unfortunately, this doesn’t actually fix anything, the best it does is buy the person time as the subconscious behaviors continue to evolve. I have experienced this so often for so long that I am at a point that that barrier will not fall to any amount of willful desire or external motivation, much to my own downfall.
Fortunately, prescription amphetamines like Vyvanse (lisdextroamphetamine), can help me overcome that barrier like it doesn’t even exist. What was once an insurmountable obstacle simply melts away. The constant struggle of the internal conflict disappears and I can sit down and work on whatever I choose to work on, no longer am I at the whim of my own subconscious desires. And quite the struggle it was! To know you have the capability to perform, and even excel at a task, but be held back by some inscrutable neurological phenomenon that many greet with skepticism is frustrating in ways I cannot even begin to describe.
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