Since October 2022, thousands of individuals with ADHD have faced immense difficulty accessing prescribed stimulant medication – the treatment they need to function and lead healthy lives. No relief is in sight.

Make no mistake that the reason for the ongoing stimulant shortage has much to do with how stimulant medication itself is viewed. After all, the Drug Enforcement Administration (DEA) classifies stimulants as Schedule II drugs for their “high potential for abuse” and sets national drug quotas for these substances based on that classification.^{1 2} This drug quota is, arguably, a major factor driving the shortage.³

Like many psychiatrists, I have taken the Schedule II classification of stimulants at face value for most of my career. Prescription stimulants are Schedule II, so they must be very addictive. How do I know? Because they are Schedule II.

This circular thinking has stopped me – and likely others – from noticing the mismatch between this classification and what I observe clinically. And while it may seem like the Schedule II classification is set in stone, it isn’t. In fact, the Controlled Substances Act specifically states that organizations, or even individuals, may petition the DEA to reclassify a substance.⁴ Shouldn’t we at least question whether these medications belong in Schedule II?

Controlled Substances: What We Get Wrong About Stimulants for ADHD

The DEA classifies drugs into five distinct categories depending upon their medical use and potential for abuse or dependency. Schedule V drugs have the lowest potential for abuse, while Schedule I drugs have a high potential for abuse and no current accepted medical use.

[Read: “Stop Treating Us Like We’re Addicts!”]

While working as a community psychiatrist, I used to brace myself for the bad outcomes from prescription stimulants. After all, as Schedule II drugs, they sit way up in the DEA’s scale. But what I found was that carefully prescribed stimulants rarely caused issues, whereas other drugs deemed “safer” often did.

Take benzodiazepines, drugs that are used to treat conditions like anxiety and insomnia. With benzodiazepines, tolerance and dependence are common, the withdrawal syndrome is serious, and overdoses can be lethal, especially when combined with opioids. When used long-term, the taper can be rocky and often requires several months to complete.

Comparatively, standard prescription stimulant treatment has minor problems. Withdrawal syndromes are rare and brief. While I have seen occasional misuse, I haven’t seen prescription stimulant overdoses or use disorders. Rather, I’ve seen people gain control of their lives. They graduate college, they hold jobs, and their relationships improve. Early refill requests are rare.

People who are prescribed scheduled benzodiazepines rarely miss a dose and need no reminders. Most of my patients with ADHD, however, struggle to take medications every day and may forget to fill their medications on time.

[Read: “This Cannot Be the Price We Pay to Function.”]

For All Their Dangers

The stark difference in adherence between benzodiazepines and prescription stimulants likely reflects two things: the symptoms of ADHD itself and the fact that stimulant medications, when taken as prescribed, are much less reinforcing compared to benzodiazepines.

Just ask any child who takes Quillivant, a banana-flavored liquid form of methylphenidate, if they want their morning dose. Many will run, far. Beer and coffee are acquired tastes because the brain pairs their flavors with the good feeling that follows consumption. The ‘drug liking’ effect of alcohol and caffeine reinforces a desire for the taste — a phenomenon that hardly occurs when taking stimulants as prescribed for ADHD. Coffee and alcohol, despite their abuse potential and widespread use, are freely available to most of the public.

Benzodiazepines, for all their dangers, are Schedule IV. Meanwhile, prescription stimulants sit in the Schedule II Hall of Shame, along with fentanyl. Yes, fentanyl – a substance 50 times more potent than heroin and responsible for a majority of the thousands of overdose deaths in the United States in 2023.^{5 6} Surely, there must be a classification error here, right?

National overdose deaths involving prescription stimulants is difficult to track because of a coding issue that lumps prescription stimulants with illicit methamphetamines. Fortunately, one study separated the two by looking at substance-related death certificates from 2010 to 2017. Of the 1.2 million total deaths that involved substances, only 0.7% involved prescription stimulants, often used in combination with other substances. Methylphenidate-related deaths accounted for .02% (295) of all substance use-related deaths, or an average of 37 deaths per year.  Compared to methylphenidate, there were twice as many deaths involving pseudoephedrine (615), which does not require a prescription, and 160 times more illicit methamphetamine-related deaths (49,602).⁷

Stimulants Are Safe – and Life-Saving – When Used as Prescribed

The sparsity of stimulant prescription-related deaths may reflect their essential role in treatment. ADHD is associated with greater risk for accidents, injury, premature death, and suicide.⁸ Multiple studies suggest that treatment with prescription stimulants may lower the risk of these adverse and deadly events.^8-11

Unfortunately, the serious risks of illicit methamphetamine use can drive stigma and fear toward prescription stimulants. Many people with ADHD may be hesitant to start stimulants for concerns about heart problems and addiction. While illicit methamphetamine does cause major heart problems and is highly addictive, appropriate prescription stimulant treatment does not carry this risk.^12, 13 Even in overdose, major cardiovascular events are rare.¹⁴ Multiple studies also show that prescription stimulant treatment for ADHD does not increase the risk of developing a substance use disorder (SUD) and may even have a protective effect.^{15, 16}

Importantly, there are situations, namely non-oral misuse (e.g., snorting, smoking, or injecting), where prescription stimulants do have high potential for abuse. These routes allow stimulants to enter the brain rapidly and cause a rapid spike in dopamine. The faster and bigger the spike, the more intense the “high” or “drug liking” effect that will reinforce use. Oral routes, on the other hand, more slowly deliver drugs to the brain. This is partly why stimulants, when taken as prescribed, hold a much lower addiction potential.¹⁷

Most people with ADHD will never snort or inject their medications. People without ADHD usually won’t, either. Indeed, the Schedule II classification appears to be on behalf of a subset of people, with and without ADHD, who use stimulant medications non-orally. Arguably, a more tailored way to protect this group may lie on the diagnostic side — by taking a careful history, requiring drug screens in adolescents and young adults, and considering non-stimulants when the risks are too high. Many youth will also welcome a matter-of-fact discussion on substance use and harm reduction.

On Stimulant Misuse

A more common issue is oral prescription stimulant misuse — that is, taking someone else’s medication or too much of your own. A 2022 survey showed that 15% of college students reported taking someone else’s prescription stimulant at least once in their lifetime, but most did so less than once a month. Only 0.1% of students reported misusing prescription stimulants more than four times per month.¹⁸

Most college students report misusing prescription stimulants for perceived performance enhancement.¹⁹ The misuse pattern does not tend to escalate and is lower-risk in nature. This is likely because most students who misuse will only do so orally, which is much less addictive, and they are not using to get high. Some of this misuse may also be an effort to self-medicate. A 2010 study showed that prescription stimulant misusers were seven times more likely to screen positive for ADHD compared to non-misusing students.²⁰

To be clear, it is still a bad idea to misuse prescription stimulants. While the health risks do not appear to warrant schedule II classification, that does not mean “risk free.” All prescription medications carry risks, and risks can vary based on factors like dose, route, and the individual. What is safe for one person can be dangerous for another. For instance, someone with bipolar disorder can become manic from a prescription stimulant. Someone who regularly uses illicit methamphetamine may tolerate high doses of prescription stimulants whereas someone else may become agitated, psychotic or go into renal failure at a much lower dose.¹⁴

For those at higher risk for prescription pill misuse, there are also long-acting formulations that were designed to prevent non-oral use. For instance, Concerta (methylphenidate ER) has a hard outer coating that is very difficult to crush.²¹ This will deter most people. In addition, when studied in a group of adolescents with ADHD and an SUD, Concerta rated only one point higher than placebo in “drug-liking” effect.²²

Vyvanse (lisdexamfetamine) is another long-acting formulation that deters abuse. Vyvanse comes as an inactive prodrug and won’t activate until it is converted by an enzyme in the bloodstream. Even if someone snorts or injects it, it will still need to be converted to an active form in the body and will not produce a more rapid effect. Two “drug-liking” studies also suggest lower abuse potential with IV doses not differing from placebo.^{23 24} While a supratherapeutic oral dose had some “liking,” it also measured higher on “drug-disliking.”²⁴

Reclassifying prescription stimulants to a lower tier would more accurately reflect real-world data on addictive potential, health risk, and their public health benefit. Still, any reclassification to a lower tier carries the risk of fueling misconceptions about safety. Some may mistake reclassification as a green light to misuse. Misconceptions on safety may also drive the purchase of counterfeit pills. Make no mistake: Counterfeit prescription stimulants – which can be easily purchased online – kill people. These fake pills are made to look just like real prescription stimulants, but instead contain illicit methamphetamine and/or fentanyl, in unpredictable amounts. Taking even one counterfeit pill can be lethal.²⁵

Prescription stimulant misuse, as a whole, is a problem that deserves our attention. Targeted education needs to occur at the individual, family and school levels. This may include dispelling myths on cognitive enhancement, emphasizing the higher risk with non-oral use, and increasing awareness on counterfeit pills. When young people are taught the actual risks and realities of the current drug landscape, they are given a chance to make safer choices. This strategy is rooted in connecting with at-risk youth and can happen without interfering with the treatment of people with ADHD.

Schedule II Drugs: The Case for Reclassifying Stimulant Medication

Ensuring access to stimulant treatment is essential to the lives of millions of people with ADHD, and it benefits the public at large. While there is widespread oral misuse, the use does not tend to escalate. Non-oral use is higher risk, but less common and rarely fatal, making prescription stimulants an outlier in the Schedule II class.

Prescription stimulants are long overdue for reclassification. For those still on the fence, here is a more conservative approach: Start with rescheduling medications that have abuse-deterring properties, such as Concerta, Vyvanse, and their generic equivalents. By releasing these medications from the chains of Schedule II, more people with ADHD can live their lives.

Do you think prescription stimulants should be reclassified? Share your thoughts in the comments section.

Schedule 2 Drugs and Stimulants: Next Steps

• Read: Who’s Afraid of ADHD Stimulants?
• Read: The Real Reason ADHD Medication Supply Is Lagging Demand
• Read: “The DEA’s Manufactured Crisis”

SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

Sources

¹ Drug Enforcement Administration. Drug Scheduling. DEA.gov. https://www.dea.gov/drug-information/drug-scheduling

² 21 CFR Part 1303. https://www.ecfr.gov/current/title-21/chapter-II/part-1303

³ Committee on Oversight and Accountability. (May 14, 2024) Comer, McClain Probe Shortages of Schedule II Drugs, including Adderall. https://oversight.house.gov/release/comer-mcclain-probe-shortages-of-schedule-ii-drugs-including-adderall%EF%BF%BC/

⁴ Drug Enforcement Administration. The Controlled Substances Act. DEA.gov. https://www.dea.gov/drug-information/csa

⁵ Drug Enforcement Administration. Fentanyl. DEA.gov. https://www.dea.gov/factsheets/fentanyl

⁶ Ahmad FB, Cisewski JA, Rossen LM, Sutton P. Provisional drug overdose death counts. National Center for Health Statistics. 2024. https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm

⁷ Black, J. C., Bau, G. E., Iwanicki, J. L., & Dart, R. C. (2021). Association of medical stimulants with mortality in the US from 2010 to 2017. JAMA Internal Medicine, 181(5), 707–709. https://doi.org/10.1001/jamainternmed.2020.7850

⁸ Li, L., Zhu, N., Zhang, L., Kuja-Halkola, R., D’Onofrio, B. M., Brikell, I., Lichtenstein, P., Cortese, S., Larsson, H., & Chang, Z. (2024). ADHD pharmacotherapy and mortality in individuals with ADHD. JAMA, 331(10), 850–860. https://doi.org/10.1001/jama.2024.0851

⁹ Krinzinger, H., Hall, C. L., Groom, M. J., Ansari, M. T., Banaschewski, T., Buitelaar, J. K., Carucci, S., Coghill, D., Danckaerts, M., Dittmann, R. W., Falissard, B., Garas, P., Inglis, S. K., Kovshoff, H., Kochhar, P., McCarthy, S., Nagy, P., Neubert, A., Roberts, S., Sayal, K., … ADDUCE Consortium (2019). Neurological and psychiatric adverse effects of long-term methylphenidate treatment in ADHD: A map of the current evidence. Neuroscience and Biobehavioral Reviews, 107, 945–968. https://doi.org/10.1016/j.neubiorev.2019.09.023

¹⁰ Chang, Z., Quinn, P. D., O’Reilly, L., Sjölander, A., Hur, K., Gibbons, R., Larsson, H., & D’Onofrio, B. M. (2020). Medication for attention-deficit/hyperactivity disorder and risk for suicide attempts. Biological Psychiatry, 88(6), 452–458. https://doi.org/10.1016/j.biopsych.2019.12.003

¹¹ Chang, Z., Quinn, P. D., Hur, K., Gibbons, R. D., Sjölander, A., Larsson, H., & D’Onofrio, B. M. (2017). Association between medication use for attention-deficit/hyperactivity disorder and risk of motor vehicle crashes. JAMA Psychiatry, 74(6), 597–603. https://doi.org/10.1001/jamapsychiatry.2017.0659

¹² Manja, V., Nrusimha, A., et al. (2023) Methamphetamine-associated heart failure: a systematic review of observational studies. Heart, 109:168-177. https://doi.org/10.1136/heartjnl-2022-321610

¹³ Zhang, L., Yao, H., Li, L., Du Rietz, E., Andell, P., Garcia-Argibay, M., D’Onofrio, B. M., Cortese, S., Larsson, H., & Chang, Z. (2022). Risk of cardiovascular diseases associated with medications used in attention-deficit/hyperactivity disorder: A systematic review and meta-analysis. JAMA Network Open, 5(11), e2243597. https://doi.org/10.1001/jamanetworkopen.2022.43597

¹⁴ Martin, C., Harris, K., Wylie, C., Isoardi, K. (2023). Rising prescription stimulant poisoning in Australia: a retrospective case series. Toxicology Communications, 7(1). https://doi.org/10.1080/24734306.2023.2174689

¹⁵ Quinn, P. D., Chang, Z., Hur, K., Gibbons, R. D., Lahey, B. B., Rickert, M. E., Sjölander, A., Lichtenstein, P., Larsson, H., & D’Onofrio, B. M. (2017). ADHD medication and substance-related problems. The American Journal of Psychiatry, 174(9), 877–885. https://doi.org/10.1176/appi.ajp.2017.16060686

¹⁶ McCabe, S. E., Dickinson, K., West, B. T., & Wilens, T. E. (2016). Age of onset, duration, and type of medication therapy for attention-deficit/hyperactivity disorder and substance use during adolescence: a multi-cohort national study. Journal of the American Academy of Child and Adolescent Psychiatry, 55(6), 479–486. https://doi.org/10.1016/j.jaac.2016.03.011

¹⁷ Manza, P., Tomasi, D., Shokri-Kojori, E., Zhang, R., Kroll, D., Feldman, D., McPherson, K., Biesecker, C., Dennis, E., Johnson, A., Yuan, K., Wang, W. T., Yonga, M. V., Wang, G. J., & Volkow, N. D. (2023). Neural circuit selective for fast but not slow dopamine increases in drug reward. Nature Communications, 14(1), 6408. https://doi.org/10.1038/s41467-023-41972-6

¹⁸ The Ohio State University. (2022). College prescription drug study: Key findings. https://www.campusdrugprevention.gov/sites/default/files/2022-06/CPDS_Multi_Institutional_Key_Findings_2022.pdf

¹⁹ Faraone, S. V., Rostain, A. L., Montano, C. B., Mason, O., Antshel, K. M., & Newcorn, J. H. (2020). Systematic review: nonmedical use of prescription stimulants: risk factors, outcomes, and risk reduction strategies. Journal of the American Academy of Child and Adolescent Psychiatry, 59(1), 100–112. https://doi.org/10.1016/j.jaac.2019.06.012

²⁰ Peterkin, A. L., Crone, C. C., Sheridan, M. J., & Wise, T. N. (2011). Cognitive performance enhancement: misuse or self-treatment? Journal of Attention Disorders, 15(4), 263–268. https://doi.org/10.1177/1087054710365980

²¹ Cone E. J. (2006). Ephemeral profiles of prescription drug and formulation tampering: evolving pseudoscience on the internet. Drug and Alcohol Dependence, 83 Suppl 1, S31–S39. https://doi.org/10.1016/j.drugalcdep.2005.11.027

²² Winhusen, T. M., Lewis, D. F., Riggs, P. D., Davies, R. D., Adler, L. A., Sonne, S., & Somoza, E. C. (2011). Subjective effects, misuse, and adverse effects of osmotic-release methylphenidate treatment in adolescent substance abusers with attention-deficit/hyperactivity disorder. Journal of Child and Adolescent Psychopharmacology, 21(5), 455–463. https://doi.org/10.1089/cap.2011.0014

²³ Jasinski DR, Krishnan S. Human pharmacology of intravenous lisdexamfetamine dimesylate: abuse liability in adult stimulant abusers. Journal of Psychopharmacology. 2009;23(4):410–8
https://citeseerx.ist.psu.edu/document?repid=rep1&type=pdf&doi=8ead4bf37b0e1111a740fe2ce34ebced83085c3c

²⁴ Jasinski DR, Krishnan S. Abuse liability and safety of oral lisdexamfetamine dimesylate in individuals with a history of stimulant abuse. Journal of Psychopharmacology. 2009;23(4):419–27
https://journals.sagepub.com/doi/10.1177/0269881109103113

²⁵ https://www.dea.gov/sites/default/files/2021-05/Counterfeit%20Pills%20fact%20SHEET-5-13-21-FINAL.pdf

Academic achievement is strongly predicted by the presence of certain non-cognitive skills, like persistence and motivation, which are linked to genetic factors and become increasingly important as children age, according to a study published in Nature Human Behaviour.¹

“Children who are emotionally stable, motivated, and capable of regulating their attention and impulses do better in school, independent of their level of cognitive ability,” the researchers wrote.

The study involved a U.K.-based sample of more than 10,000 children aged 7 to 16 that used surveys and multiple genetic methods, including twin models and DNA-based analyses. Data was collected at ages 7, 9, 12, and 16.

Non-Cognitive Skills

Parents, teachers, and twins were asked questions related to the child’s performance at school and non-cognitive skills, including academic interest and self-regulation. After accounting for general cognitive ability, researchers performed multiple regression analyses that revealed an association between non-cognitive skills and academic achievement at all ages studied.

Non-cognitive skills grew more predictive of academic achievement as children approached late adolescence. Self-report surveys revealed the biggest effect sizes (as compared to surveys completed by parents and teachers). The correlation between self-reported, education-specific non-cognitive skills and academic achievement grew significantly over time (from r=0.10 at age 9 to r=0.51 at age 16).

While cognitive skills refer to objective traits, such as memory, reasoning, and IQ, non-cognitive skills refer to more subjective qualities. In this study, non-cognitive skills were broadly classified as:

• Education-specific non-cognitive skills (academic interest, attitudes towards learning, academic self-efficacy)
• Domain-general self-regulation skills (behavioral and emotional regulation that exist outside of school).

“These findings highlight the important role that non-cognitive skills play during primary and secondary education and suggest that fostering such skills might provide an avenue for successful educational strategies and interventions,” the researchers wrote.

Genetic Influence

Similar findings were revealed using polygenic scores, or PGSs, which estimate the effect of multiple genes on a specific trait. Non-cognitive PGS on academic achievement doubled from ages 7 to 16, while cognitive PGS stayed the same. By the end of the study, the variance in academic achievement was equally accounted for by non-cognitive and cognitive skills.

When controlling for shared family environments, as in the case of siblings, the effects of non-cognitive PGS were slightly diminished but still significant. According to the gene-environment correlation theory, or rGe, this can be attributed to genetic control over environmental exposures.² As children grow up, they “evoke and actively select academic environments that correlate with their genetic disposition towards non-cognitive skills,” the researchers wrote. These traits are then reinforced over time. In contrast, cognitive PGS predictions remained the same through development.

Socioeconomic status did not alter the overall findings. Although children from higher socio-economic backgrounds performed better academically, the slope of association between academic achievement and non-cognitive skills did not change from one group to the next.

“Higher PGS, for both cognitive and non-cognitive skills, corresponded to higher academic achievement, and higher SES corresponded to both higher mean PGSs and higher achievement, indicating a correlation rather than an interaction between genetic and environmental influences on academic achievement,” the researchers wrote.

Mental Health & ADHD

The study confirmed strong correlations between cognitive and non-cognitive genetic factors and their links to psychiatric, personality, and socioeconomic traits. But non-cognitive skills played a bigger role in certain outcomes, like mental health. The disparity between genetic factors was more pronounced for certain psychiatric traits, such as autism and ADHD, compared to earlier studies.³

Some studies suggest mental health conditions are influenced by the same genetic factors. A study published in Nature in 2023 and covered by ADDitude found that 84% to 98% of common genetic variants tied to ADHD seemed to influence other psychiatric disorders, including autism, depression, and schizophrenia.⁴ Genetic research has also linked ADHD to emotion regulation and motivation.⁵

“One of the main areas of the brain affected by the genetics of ADHD is the reward center — in particular, the transmission of a chemical called dopamine. The neurons in the brain of a person with ADHD act differently…They need higher levels of stimulation from their environment,” said Maggie Sibley, Ph.D., in her 2022 ADDitude webinar “My Teen with ADHD Lacks All Motivation! How to Build Executive Function Skills and Drive.”

“You can see that translating into prominent motivation difficulties in kids with ADHD,” Sibley said.

Limitations and Future Research

Targeted interventions that build non-cognitive skills could benefit children with relative social and emotional weaknesses, including those with ADHD. But more research is needed to understand how non-cognitive skills develop. Future studies should focus on the association between these and academic achievement.

Sources

¹ Malanchini, M., Allegrini, A.G., Nivard, M.G. et al. (2024). Genetic associations between non-cognitive skills and academic achievement over development. Nat Hum Behav. https://doi.org/10.1038/s41562-024-01967-9

² Jaffee, S., & Price, T. (2007). Gene–environment correlations: a review of the evidence and implications for prevention of mental illness. Mol Psychiatry, 12, 432–442. https://doi.org/10.1038/sj.mp.4001950

³ Demange, P. A. et al. (2021). Investigating the genetic architecture of noncognitive skills using GWAS-by-subtraction. Nat. Genet., 53, 35–44. https://doi.org/10.1038/s41588-020-00754-2

⁴ Demontis, D., Walters, G. B., Athanasiadis, G., Walters, R., Therrien, K., Nielsen, T. T., … Børglum, A. D. (2023). Genome-wide analyses of ADHD identify 27 risk loci, refine the genetic architecture and implicate several cognitive domains. Nature Genetics, 55(2), 198–208. https://doi.org/10.1038/s41588-022-01285-8

⁵ Merwood, A., Chen, W., Rijsdijk, F., Skirrow, C., Larsson, H., Thapar, A., Kuntsi, J., & Asherson, P. (2013). Genetic association between the symptoms of attention‐deficit/hyperactivity disorder and emotional lability in child and adolescent twins. Journal of the American Academy of Child and Adolescent Psychiatry, 53(2), 209‐220. https://doi.org/10.1016/j.jaac.2013.11.006

We hear a lot about the challenges that ADHD dumps on the backs of those who live with it, and how tough it is to bear the weight of these struggles sometimes. Seldom discussed are the strengths and abilities that ADHD brings — like being incredibly resourceful, resilient, and clever problem solvers.

So we asked ADDitude readers to put their creative ADHD brains to work by brainstorming the most important lessons they’ve learned about living well with ADHD. From the pragmatic — set your clock ahead by 10 minutes — to the profound — guidance on fostering self-compassion — readers offer up hard-won wisdom that they’ve found transformative, in the hopes you might benefit from it, too.

“Grace. Give yourself grace. The everyday mistakes you make can distract you from more important things. Know that doing right by the humans around you is far more important than having your laundry done or being all caught up at work.” —Kate, Texas

“It is essential to find a medical professional who you trust and who is an ally. Do not tolerate doctors who don’t listen to your symptoms or concerns.” —Suzanne, Canada

“Like a fingerprint, ADHD is different for each individual. We can learn from doctors’ opinions and others’ experiences, but we must discover for ourselves how to best deal with our own ADHD.” —Philip, Ohio

[Download: Rate Your ADHD Coping Strategies]

“Find your people! There is nothing that helps more than sitting in a room with a group of others saying, ‘Me too!’ You finally feel validated and less alone as well as understood and accepted.” —Nicky, Scotland

“Don’t resist medication if it will help. It’s not a character failing to take it. On the contrary, it shows your bravery in facing your condition.”  —Richard, Maryland

“Actively search for things to celebrate in yourself and others. It’s natural to be critical but noticing what’s good takes intentionality. The fruit of that is peace and joy.” —Shari, Tennessee

[Watch: “ADHD is Awesome – The Holderness Family Guide to Thriving with ADHD”]

“Write everything down.” —Jennifer

“It’s imperative to learn all you can about how ADHD affects the brain, so you can better understand (and be less judgmental) about your thoughts and behaviors.” —Louis, California

“Find help — and don’t settle for the wrong help.” —Dorothy, Ohio

“Do what you need to do to recharge. I take a 15-minute nap at lunch everyday, which brings up my dopamine so that I’m still productive at work in the afternoons.” —An ADDitude Reader

“Find people who can relate to your struggles and, if you feel safe doing so, share stories of successes and failures. You may be pleasantly surprised by the number of people who feel the same way you do, regardless of whether they have ADHD.” —AJ, Minnesota

“Always divide tasks into very small turtle steps — something that you can easily do.” —Marietjie, South Africa

“The brilliance of ADHD is that our minds and talents can be a playground. ‘Not possible’ isn’t a thing if it is something we are interested in. Want to learn how to build furniture? Done. Make macarons? Done. Run a marathon? Got it. We absolutely thrive when we can chase the dopamine high associated with our areas of interest. I may be awful at adulting, but I wouldn’t want to live any other way.” —Suzanne, Tennessee

“The most important thing I’ve learned is to change my inner monologue of ‘I’m lazy’ to ‘This is just extra hard today.’” —Kendel, Indiana

“Finding what you love may be more important to ADHD people than to non-ADHD people. Being quick to boredom and having quick tempers means if you don’t like your job, you won’t be at it very long.” —Tim, North Carolina

“One trick that changed my world was the concept of a ‘catch-all’ area near the door where I put everything I need to leave the house; and where everything will go once I walk in the door. I have saved so much time over the years not constantly looking for my keys, sunglasses, and wallet.”—Dana, Michigan

“You have ADHD; you are not ADHD. It is an attribute you have but it does not have to define who you are.” —Craig, Oklahoma

“I set my clocks forward 10 minutes. Somehow it always tricks my mind and gives me extra time.” —Karen, Virginia

“I have learned that for every storm, there is a rainbow. My ‘problems’ — sensory gifts, ADHD daydreaming, and deep processing abilities — made me an excellent teacher of 38 years. I have learned to embrace my differences and view them as positives that have enriched my life.” —Jane, California

“Many judgmental people just can’t stand that I am hyperactive, talk a lot, and interrupt without meaning to — but judging others is far, far worse than any symptoms ADHD might cause. Try not to let anyone’s attitude make you feel bad about yourself. You are beautiful. You are valuable. You have been born with your own special talents and abilities that will help to advance mankind.” —Janet, Texas

Self Love, Self Acceptance & ADHD: Next Steps

• Read: You Are Not the Sum of Your ADHD Challenges 
• Read: Self-Compassion – The New ADHD Treatment
• Read: ADHD at the Center – A Whole-Life, Whole-Person Condition

SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

This October, ADDitude is shifting the focus from ADHD awareness to empowerment. From educating others to lifting up our own community. From seeking external acceptance to celebrating self-knowledge.

The first-ever ADHD Empowerment Month will kick off October 1 with a live webinar featuring Penn and Kim Holderness of ADHD Is Awesome, who will discuss the new definitions of ADHD proposed by ADDitude community members. The month will continue with exclusive profiles of creative ADHD powerhouses like novelist Rebecca Makkai, stand-up comic Rachel Feinstein, and illustrator Hayley Wall.

Each day in October, ADDitude will highlight a different definition of ADHD brought to life through stories told by our readers, who said ADHD is creativity. ADHD is curiosity. ADHD is solving problems. ADHD is resilience. And so much more. Below are two examples of these powerful community insights.

ADDitude will be sharing messages like these each day in October on social media and at http://additu.de/empowerment, and a free ADHD Empowerment Month calendar is available now at http://additu.de/oct-cal.

“The ADHD community is beyond ready to shift the focus away from dispelling ADHD myths and educating ADHD doubters,” says ADDitude General Manager Anni Rodgers. “Twenty years after the first ADHD Awareness Day, we are deliberately moving from an external focus to an internal one this October, We are shining our spotlight on the incredible stories, reflections, and definitions of ADHD contributed by members of the ADDitude community. Their voices usher in a new era of ADHD empowerment.”

ADDitude Editor-in-Chief Carole Fleck and General Manager Anni Rodgers are available during ADHD Empowerment Month to discuss the important and timely shift from awareness to empowerment, to highlight the insightful reflections from the ADDitude community, and to introduce Penn and Kim Holderness, and other role models profiled on http://additu.de/empowerment

About ADHD Awareness Month

Twenty years ago, the U.S. Senate established a national ADHD Awareness Day to spur greater understanding of the condition that affects an estimated 7 million children (11%) and 8.7 million adults (10%) in America. Over time, ADHD Awareness became a month-long observance with an external mission: dispelling myths, disseminating truths, and advocating for support among neurotypical populations. The campaign was a success. Virtually everyone now knows about ADHD.

About ADDitude magazine:

Since 1998, tens of millions of readers have trusted ADDitude to deliver expert advice and caring support, making it the leading media network for clinicians, educators, parents, and adults living with attention deficit hyperactivity disorder (ADHD). ADDitude is not only the world’s most trusted source of strategies and information about ADHD and related conditions, such as learning disabilities, anxiety, depression, and oppositional defiant disorder. ADDitude is the voice of and advocate for the ADHD community. In 2021, ADDitude joined the WebMD family of health brands.

Here, ADDitude readers share more stories of when they reaped the rewards of spontaneity. Read more.

“If you can tune into your voice and communicate your story, that’s when you’re going to create something nobody’s ever seen before.” — Hayley Wall

“I would not change my son or husband for anything. We’ll bundle up all the positives and challenges, stick them into our family jetpack, and navigate the steps, bounces, stumbles, and freefalls of this shared diagnosis together.” Read more.

“My creativity has blessed me at every stage of my life. My grandkids and I write songs or make videos, and I do sing-a-longs at my mom’s nursing home. Being ADHD is a rollercoaster ride, but I love the thrills along the way!” Read more.

Imaginative, resourceful, and fast-thinking ADHD brains can often solve problems that stump everyone else. Here, readers share their stories of seeing the solution everyone else missed.

Star of the stand-up comedy special “Big Guy,” Rachel Feinstein talks about her ADHD journey, from adrenaline highs to rejection lows (and how she’s always losing her passport). Meet Rachel

“When I get to engage in an adrenaline-filled experience, like jumping off a 40-foot cliff, I take it.” Learn more about the risky, sensation-seeking activities that ADDitude readers crave.

“I sometimes feel frustrated that the things that seem so simple (turning in homework, putting on BOTH shoes, turning off the stove) can be so hard for the ADHD brain. But the things my son’s brain creates leave me in awe.” _ Kim Holderness

Here’s how ADDitude readers answered our question, “How has your (or your child’s) curious ADHD brain fueled innovation, exploration, and/or opportunity?”

“The more I talk to colleagues about my fresh diagnosis (ADHD, inattentive type), the more I see that others grapple daily with different demons. And some of the things that frighten or frustrate them about teaching come as naturally to me as breathing.” Read this blog post.

“You can’t see my constant struggles to stay on top of employment, housework, and personal affairs; you can’t hear my every thought scream for my total attention as I fail to hold onto a single one; you certainly can’t feel the smaller effects of ADHD pile on top of each other to create a web of executive dysfunction.” Read this blog post.

25 positive affirmations to lift up ADHD brains

Rebecca Makkai is a New York Times bestselling author whose books have been translated into more than 20 languages. She is a Pulitzer Prize and a National Book Award finalist. She teaches graduate fiction writing at Northwestern University, among other places, and she has ADHD.

“When your brain feels, sees, and smells everything, it is more likely than the neurotypical brain to notice something no one has ever noticed before. It is more likely to go down a rabbit hole and discover a new path. It’s more likely to see something in a way no one has ever seen it.”

How to live better with ADHD, according to the experts.

ADDitude readers describe the undeniable signs, symptoms, and strengths of ADHD that may be invisible to others. Read more.

“These mottos have helped me practice self-compassion and affirm my own neurodiversity.” Read more.

From the pragmatic to the profound, readers offer up hard-won wisdom that they’ve found transformative, in the hopes you might benefit from it, too. Read more.

“What if my intense drive is because of — not in spite of — my ADHD?” asks Tracy Otsuka, JD

If you could pay a visit to your childhood self, what words of affirmation, advice, or messages of self-love would you impart? ADDitude readers respond here.

These insights on living and (mostly) thriving with ADHD from the Holderness Family will make you laugh, nod in agreement, and feel a little more understood.

Disorder. Condition. Impairment. These are the words commonly used to describe ADHD. Their accuracy is debatable. What’s for certain: they’re insufficient on their own.

What does ADHD mean to you? Adventure. Gift. Advantage. Creative engine. Superpower and kryptonite, all rolled into one. According to ADDitude readers, this is the essence of ADHD.

This October, we move beyond awareness and acceptance. As we step into ADHD empowerment, ADDitude will amplify the myriad voices comprising our community and share their powerful, telling stories.

What is ADHD? It’s whatever you say it is.

ADHD Is . . .

“. . . a kaleidoscope. I see, hear and think in stereo. The beauty of ADHD is how my mind endlessly sees and hears things others around me can’t.” — Jon, United Kingdom

. . .a different gameplay mode, enabled on some brains.” — Mia, New York

“. . . eye-opening.” — Zak, Florida

“. . . like a powerful wild horse — beautiful and strong but untamed. Imagine what it’s like to ride on its back and be taken where it wants to go. You just need to train your horse, and to develop your strength and agility and learn to hold on.” — Giedre, United Kingdom

“. . . complicated.” — Ava, Canada

[Read: Holderness Family Values – 9 ADHD Truths (with a Side of Laughter)]

“. . . an adventure. ADHD is curious. ADHD is playful. ADHD is a roller coaster.” — Emma, Scotland

“. . . exhilarating. There is always something new to learn.” — Erin, Missouri

“. . .wonderfully maddening. Wonderful because of the ability to focus intently on things that interest you and maddening because you’ll need to develop ways to complete tasks that don’t interest you. You have awareness, perspectives and abilities that are likely different from your peers and those skills make you exceptional.” —Becky, Indiana

[Read: 17 Things to Love About Your ADHD!]

ADHD Is . . .

“. . . hopeful. People with ADHD can help create a future that has justice, empathy, curiosity, and creativity as the guiding principles.” — Sara, Canada

“. . . liberating.” — Noreen, Oregon

“. . .an uphill and downhill battle.” —An ADDitude Reader

“. . .a horse without blinders. Someone with ADHD can see so many things at once.” —John, Illinois

“. . .both a superpower and kryptonite.” — Tyra, Arizona

“. . . a channel to dream big dreams.” — Tara, Canada

“. . . is the key that unlocks universes. Wanting to know more about topics I’m interested in is a gift.” — Nicole, Ohio

“. . . a hurdle — one that makes you more resilient.”  — An ADDitude Reader

ADHD Is . . .

“. . .being upside down in a neuro-normative world which is ‘right way up.’” — Rachel, United Kingdom

“. . . a new day every day, sometimes every hour.” — Jana, Tennessee

“. . . differently powerful.” — Betsy, New York

“. . . hyper-focusing.” — An ADDitude Reader

“. . . magical.” — Sam, United Kingdom

“. . . misunderstood.” — Jamie, Tennessee

“. . . multi-faceted and pervasive, affecting all aspects of one’s life.” — Kathryn, Michigan

“. . . something that gives you the energy to accomplish great things. It may be hard to sit in a class, but you are one of the greatest builders of society.” — An ADDitude Reader

ADHD Is . . .

“. . .a mixed bag. At times it really does feel like a superpower, like when I’m writing for fun; the metaphors and creativity flow like water. At other times, it really does feel like a curse, like when I lose what feels like the 50th pair of prescription sunglasses. My biggest asset is simultaneously my biggest struggle.” — David, Oregon

“. . . determination, focus, tenacity, and courage.” — Heather, Alabama

“. . . balance.” — Maggie, Michigan

“. . . a beautiful brain in a challenging environment.” — Dee, Canada

“. . . overwhelming — and empowering.” — Ariel, Wisconsin

“. . . something that can both control you, and be controlled.” — Andrew, New York

“. . . not good and not bad. It just is.”  — An ADDitude Reader

What Does ADHD Mean?: Next Steps

• Read: “ADHD Is Hard, But…” Crowdsourced Advice for the Newly Diagnosed
• Watch: “ADHD is Awesome: The Holderness Family Guide to Thriving with ADHD”
• Read: “The ADHD Characteristics I’m Most Thankful for Are…”

SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

Wisdom is the hard-won result of experience; there are no shortcuts. But if you could time travel back to speak with your childhood self, what advice would you offer that tiny, still unformed version of yourself? What lessons about living and thriving with ADHD — school, work, relationships, self-love — would you impart? What words do you most wish you’d heard to avoid some headache and heartbreak, and to find more fulfillment and acceptance?

Here, ADDitude readers reflect on ADHD life lessons learned and offer everything from practical hacks to tender compassion. Threaded together, these words form a brilliant tapestry of self-advocacy, self-empowerment, and, above all, self-love.

“Oh, love, hi there! It’s me, your 34-year-old self. I just want you to know that you are wonderful. Absolutely wonderful! I know you feel like people don’t get you and that you have to be perfect to be liked. But, cute one, you are not weird, your brain is just different and you have something we call ADHD. It’s why you sometimes lash out and why you dream for hours. It’s also why you love so many different things. I know it feels safer to hide these things with your fears, but you are hurting yourself by doing that.” — An ADDitude Reader, Netherlands

“Be kind, be kind, be kind. Especially to yourself. It will feel rebellious, maybe even dangerous, to be kind to yourself, but you must try.” — Laura, Louisiana

“You are not lazy. You are not flawed. The world is just not ready for you yet.” — Adrienne, Virginia

[Read: Birds of a Feather – The Joy of Neurodivergent Friendships]

“Take notes, drink coffee.” — Courty, Pennsylvania

“You’re not crazy — you are different. There’s this thing called rejection sensitive dysphoria. It’s real, it explains a lot of what you feel all the time, and it really freaking sucks.” — Chiara, Oregon

“Post-It notes are your friend! Write things down so you remember to do stuff!” — Lisa, Ohio

[Read: Everyday ADHD – Quirky Productivity Hacks for Easily Bored Brains]

“Tell those you trust about how you feel. The sooner you tell someone, the sooner someone can help.” — Sarah, United Kingdom

“Honey, yes, you are different, but it’s a beautiful kind of different. Nothing great was ever accomplished under the umbrella of normalcy.” — Michelle, California

“Get diagnosed now.” — Karon, Colorado

“Never be quiet, keep taking up space until you get the help and support you deserve. It will be better when you’re allowed to make your own decisions.” — Mariah, Illinois

“You are irreplaceable.” — Remy, California

“Keep taking the next right step.” — Anne, Wisconsin

“You will be a great adult. Hold on until you get there.” — Michele, Texas

“Find whatever sparks joy and live your dreams as fully you possibly can.” — Deniz, Massachusetts

“Learn how to apologize.” —Paul, California

“Connect with those who thrill and want to be thrilled … then go home to calm. I have found that people like me are not the ones I like to live with.” — An ADDitude reader in New Zealand

“Don’t drink or do drugs to soothe, it makes things worse.” — An ADDitude Reader

“Choose a trade. You’re creative, enjoy working with your hands, and find satisfaction seeing the end product of your efforts.” — Matt, Canada

“There’s a reason why things that are supposed to be simple feel like they’re written in a foreign language. There are others out there who can understand, appreciate, and see the value in your own unique language.” — Jessica, Texas

“Don’t worry so much about fitting in with others. You will find your tribe along the way.” — Noreen, Oregon

“Bring a fidget everywhere.” — M., Virginia

“Become comfortable with being uncomfortable.” — Jamie, United Kingdom

“Oh, sweetheart, it’s not your fault. Your brain is built a bit differently from other people, and that’s okay. It doesn’t mean you’re a bad student, or a bad person. It doesn’t mean that you’re a weirdo, or unlovable, or a problem.” — Peyton, Oregon

“It’s not you, it’s the world. Keep doing your thing. It’s going to get complicated and confusing but you will develop some amazing strategies and skills to manage it, without even realizing.” — Lucy, Australia

“Learn about your brain. Teach others!” — Wendy, Canada

“Trust your gut. Pay attention to your needs; they’re not lying to you.” — An ADDitude Reader

“God has a plan for you, sweetheart. You are teary-eyed and alone right now, but I promise a whole world of amazing, creative, heart-centered people across the globe will be at a finger tip’s distance from you in the future.” — Erin, Canada

“Work hard at making nutrition, exercise, and sleep as routine and automatic as possible, to serve as a good foundation.” —Beth, Texas

“Figure out what works and what doesn’t, and then design your life around your strengths. Find a job that fires your passions, which means you’ll work hard at it. Find friends who appreciate your spontaneity without punishing you for poor planning and communication. Find a spouse who pushes you to grow as a person and loves you for your good qualities.” — Josh, Utah

Words of Affirmation and ADHD: Next Steps

• Watch: “How to ADHD – An Insider’s Guide to Working with Your ADHD Brain“
• Read: You Are Not the Sum of Your ADHD Challenges 
• Read: ADHD at the Center – A Whole-Life, Whole-Person Condition
• Download: Rate Your ADHD Coping Strategies

Episode Description

To kick off ADHD Empowerment Month, ADDitude asked you (our readers) to tell us how you define ADHD and its impact. More specifically, we asked: “If you were describing ADHD to a newly diagnosed child, how would you portray it in a way that builds self-esteem, hope, and resolve?”

In this webinar, we will share your responses and explore core ADHD strengths such as creativity, curiosity, problem-solving skills, and resilience with Penn and Kim Holderness, authors of the book ADHD Is Awesome: A Guide To (Mostly) Thriving With ADHD. Along the way, we will also celebrate some of the ways our ADHD brains make us undeniably awesome and essentially irreplaceable.

We know having ADHD is sometimes stressful , but the Holderness Family is very good at showing us how to shift our mindset and lean into the aspects of ADHD that make us unique and wonderful. In this webinar, we will discuss…

• Names that better describe ADHD
• Ways to reframe ADHD through a lens of strength to bolster a child’s or adult’s self-esteem
• Real-world examples of ADHD creativity and curiosity
• Favorite stories of ADHD problem-solving acumen from ADDitude readers
• The ADHD ability to bounce back and keep learning in the face of challenges
• How ADHD can help you win “The Amazing Race” (just kidding, but they actually did win!)
• And much more

Watch the Video Replay

Enter your email address in the box above labeled “Video Replay + Slide Access” to watch the video replay (closed captions available) and download the slide presentation.

ADHD Empowerment: More Resources

• Free Download: All the Best Parts of ADHD
  
• Replay: ADHD is Awesome — The Holderness Family Guide to Thriving with ADHD
  
• Read: “How My ADHD Makes Me a More Dynamic, Resourceful, Passionate Leader”
  
• eBook: Inattentive ADHD in Adults — An Essential Guide to the Underdiagnosed, Undertreated Subtype

Obtain a Certificate of Attendance

If you attended the live webinar on October 1, 2024, watched the video replay, or listened to the podcast, you may purchase a certificate of attendance option (cost: $10). Note: ADDitude does not offer CEU credits. Click here to purchase the certificate of attendance option »

Meet the Expert Speaker

Penn & Kim Holderness are authors of The New York Times Bestselling Book, ADHD Is Awesome: A Guide To (Mostly) Thriving With ADHD. (#CommissionsEarned) They are award-winning online content creators known for their original music, song parodies, comedy sketches, and weekly podcast. Their videos have resulted in over two billion views and over nine million followers. Penn and Kim have been married for 19 years and were also winners of The Amazing Race (Season 33) on CBS.

Throughout all their endeavors, Penn and Kim have never shied away from tackling topics like living with ADHD and anxiety. The overwhelming positive feedback and support from their online community was a major motivation behind their ADHD book. Penn and Kim live in Raleigh, North Carolina, with their children, Lola and Penn Charles, and their dog, Sunny.

For more on The Holderness Family, visit theholdernessfamily.com.

#CommissionsEarned As an Amazon Associate, ADDitude earns a commission from qualifying purchases made by ADDitude readers on the affiliate links we share. However, all products linked in the ADDitude Store have been independently selected by our editors and/or recommended by our readers. Prices are accurate and items in stock as of time of publication.

Listener Testimonials

“Penn and Kim are great, and the webinar was indeed empowering. Thank you so much!”

“Thank you. I liked the added feature (video) to today’s webinar. Great addition!”

“Such encouraging and enlightening information from Penn, but also from the comments sent by participants. Thank you!”

Follow ADDitude’s full ADHD Experts Podcast in your podcasts app:
Apple Podcasts | Spotify | Google Play | Amazon Music | RadioPublic | Pocket Casts | iHeartRADIO | Audacy

This quote perfectly sums up the pervasive fear among adults and caregivers of children diagnosed with ADHD. And it remains as detrimental now as it was when authors Edward Hallowell, M.D., and John Ratey, M.D., first published it in their book ADHD 2.0 (#CommissionsEarned).

The first-line medications for ADHD are some of the most effective, best studied, most scrutinized, longest known, and safest drugs in all of medicine. They have been safely prescribed to children for decades. Nonetheless, no other class of medications in virtually all of medicine inspires more baseless fears, intentional disinformation, and wild beliefs as do the stimulants used to treat ADHD. Interestingly, these fears are almost entirely an American phenomenon that hardly exists elsewhere in the world.

ADHD and Stimulants: A Disinformation Campaign Begins

In the late 1970s, a public backlash against treating ADHD with stimulant medication began after groups launched nationally organized, and extraordinarily effective, disinformation campaigns. This instilled a climate of fear among physicians, parents, and educators, and sowed anxiety and confusion among the public. Moreover, it planted in the minds of Americans the otherwise nonsensical idea that it was the treatment of ADHD that was dangerous — not the untreated medical condition itself.

It is also important to make a distinction between side effects due to stimulant medications and those unpleasant experiences caused by poor clinician training and experience. Finding a good clinician is much more difficult than it should be. Establishment medical education has failed miserably to prepare clinicians to diagnose and treat ADHD at all ages.

[Free Download: The Caregiver’s Guide to ADHD Treatment]

The goals of medication treatment include:

• Rule #1: The right medication and dosage matched to the right person should be dramatically beneficial and have virtually no side effects.
• Rule #2: Finely tuned ADHD medication should help you be “the best version of you.”

The Dangers of Untreated ADHD

Clinical neuropsychologist Russell Barkley, Ph.D., has demonstrated that untreated ADHD is not just highly impairing, it can be deadly. In fact, having ADHD lowers a person’s estimated life expectancy by 12.7 years.¹ Barkley has noted that most of the contributors to this mortality are lifestyle-related and can be reversed with treatment.

Research shows that untreated ADHD, with its impulsivity and inattention, raises the risks for serious traffic accidents, addiction, unsafe sexual practices, and self-harm, as well as challenges with academic performance, relationship difficulties, financial struggles, and chronic stress for children, teens, and adults.

ADHD and Stimulants: Facts Over Fears

Baseless fears about stimulant medication have scared caregivers away from seeking proper treatment for their children diagnosed with ADHD. The benefits of ADHD medication, based on decades of research and medical practice, used in conjunction with cognitive behavioral therapy, are profound for many people. The risks stemming from untreated ADHD are equally profound.

[Read: What Are the Long-Term Effects of ADHD Medication on the Brain?]

These are the fears I hear most from caregivers about ADHD medication, and my responses:

Fear #1: Will medication change my child’s personality?

The first-line stimulant medications affect a person with ADHD differently than they do a neurotypical person. Stimulant medications calm and soothe the hyperarousal and loss of emotional control associated with ADHD. A neurotypical person on an ADHD stimulant, by contrast, becomes more agitated, jittery, irritable, and unable to slow down.

Fear #2: Are stimulants addictive?

Having ADHD increases a person’s risk of substance use disorder, regardless of whether they take medication. However, one large study of adolescents found that “current pharmacotherapy for ADHD is associated with lower risk for substance use problems as long as medication treatment is maintained, indicating that pharmacotherapy is likely to be a key part of efforts to reduce substance use risk in those with ADHD.²

Fear #3: What if my child loses weight on a stimulant and doesn’t grow?

Appetite suppression is a common side effect of stimulant medications that goes away when the medicine is taken consistently enough to develop a tolerance to it. Most children ultimately gain weight and grow just as they did before taking medication.

For a small portion of elementary school-age children, most of whom were already picky eaters, the side effect of appetite suppression does create a problem. If a child is losing weight, or just not gaining weight for more than one month, the protocol for reversing this is to:

• Lower the dose of stimulant.
• If that does not work, switch stimulant molecules
• If this is ineffective, use the lowest dose of a gentle antihistamine that is FDA-approved for children 3 years of age and older. While this is an off-label use, it often helps to maintain a very beneficial ADHD treatment until the child becomes tolerant of the medication. Antihistamines like cyproheptadine, for example, return appetite to previous levels for about six hours. They are usually taken 30 minutes before lunch and dinner.

Fear #4: What if a stimulant worsens my child’s anxiety?

ADHD shares a high comorbidity with anxiety disorder. Researchers conducted a meta-analysis of 23 studies of children diagnosed with anxiety who had started on ADHD stimulants and found that anxiety decreased significantly in almost all cases.³

Arm yourself with knowledge. Read about the findings from research studies that have investigated ADHD medication. Then you can make a rational, informed decision about what is best for your child and/or yourself.

ADHD and Stimulants: Next Steps

• Free Download: Reader Scorecard of ADHD Treatments
• Read: Treating a Child with ADHD Medication Diminishes His Future Risk of Substance Abuse
• Read: ADHD Medication Side Effects No One Should Tolerate

William W. Dodson, M.D., is a board-certified adult psychiatrist. He was named a Life Fellow of the American Psychiatric Association in 2012 in recognition of his contributions to the field of adult ADHD.

SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

#CommissionsEarned As an Amazon Associate, ADDitude earns a commission from qualifying purchases made by ADDitude readers on the affiliate links we share. However, all products linked in the ADDitude Store have been independently selected by our editors and/or recommended by our readers. Prices are accurate and items in stock as of time of publication.

Sources

¹ Barkley, R. A., & Fischer, M. (2019). Hyperactive child syndrome and estimated life expectancy at young adult follow-up: the role of ADHD persistence and other potential predictors. Journal of Attention Disorders, 23(9), 907–923. https://doi.org/10.1177/1087054718816164

² Schepis, T. S., Werner, K. S., Figueroa, O., McCabe, V. V., Schulenberg, J. E., Veliz, P. T., Wilens, T. E., & McCabe, S. E. (2023). Type of medication therapy for ADHD and stimulant misuse during adolescence: a cross-sectional multi-cohort national study. EClinicalMedicine, 58, 101902. https://doi.org/10.1016/j.eclinm.2023.101902

³ Coughlin, C. G., Cohen, S. C., Mulqueen, J. M., Ferracioli-Oda, E., Stuckelman, Z. D., & Bloch, M. H. (2015). Meta-Analysis: Reduced risk of anxiety with psychostimulant treatment in children with attention-deficit/hyperactivity disorder. Journal of Child and Adolescent Psychopharmacology, 25(8), 611–617. https://doi.org/10.1089/cap.2015.0075

Still, clinicians have the power to improve care for Black patients by taking the time to understand and mitigate barriers. Education and action are the foundation.

ADHD in Context: Unseen Factors in the Room

No two patients, even from the same cultural background, are alike in their medical needs. That said, Black patients are disproportionately impacted by the following factors and contributing health issues, which often go unnoticed or ignored but greatly impact outcomes.

Trauma and Poverty

Black individuals are more likely than white individuals to experience childhood adversity, and children who have these experiences are more likely to struggle in school and have emotional and behavioral challenges.¹ Black children are more likely to live in poverty and in disadvantaged neighborhoods, where poor access to quality foods and close proximity to facilities that produce hazardous waste increase health risks.^{2 3} Poor sleep quality is also linked to poverty.⁴ A patient who has experienced or is experiencing one or many of these factors can absolutely have issues with focus, attention, behavior, and learning — issues that mimic, aggravate, and/or overlap with ADHD.

ADHD Stigma

Negative attitudes toward mental health conditions and their treatment are prevalent in Black communities.⁵ Some individuals believe, for example, that ADHD isn’t a real diagnosis — that it’s been made up by white people to get Black children in trouble. This is a belief I’ve seen in my own practice.

[Read: Evaluating and Treating ADHD in African American Children — Guidance for Clinicians]

I was performing an ADHD evaluation on a young Black child whose teachers and school counselor — all white — suspected that he was showing symptoms. His rating scales indeed indicated that he had ADHD. The patient’s mother told me, a Black clinician, “You think like those white folk.” These negative attitudes can erect barriers around somebody who needs help — even if the news is coming from a clinician of the same racial or ethnic background as the patient. Some communities, in addition, may look to faith instead of the medical system to address and overcome mental health concerns.

Medical Mistrust and Misinformation

Black communities may fear the medical system — and with good reason. Their fears are the lasting legacy of past abuses by the medical system (the Tuskegee Study is a harrowing example) and ongoing medical racism that leaves Black patients with worse health outcomes than patients from other groups.⁶ One of the most common and pervasive myths I have to dispel for my patients is that ADHD medication causes children to become addicts. I’ve also heard families express fears that medication is a mind-control tactic.

Fear of Labels

Many Black individuals and families regard the ADHD label and other mental health diagnoses as the start of the end. Parents fear that their newly diagnosed child will be held back and targeted academically — beliefs that must be viewed from the context of the school-to-prison pipeline, which impacts Black students with disabilities more than other students.^{7 8}

Clinician Bias

Clinician bias can skew evaluation and treatment outcomes. Black youth, for example, are more likely to be diagnosed with disruptive behavior disorders like oppositional defiant disorder (ODD) and conduct disorder (CD) and are less likely to be diagnosed with ADHD.⁹ In my experience, I’ve seen these diagnoses given when ADHD doesn’t respond to medication as expected and when emotional dysregulation, including anger, is present. In other words, many clinicians think, “If we can’t get it right, then it must be ODD or CD.” Sadly, many patients spend years with inadequately treated ADHD when success is simply a matter of increasing, adjusting, or changing the medication for better symptom control.

[Read: Why We Need Clinicians of Color to Normalize ADHD in BIPOC Communities]

Clinician bias also affects how much a doctor invests in treating a patient, an issue that impacts Black patients the most, as doctors are more likely to describe Black patients with negative descriptors (e.g., “difficult,” “not compliant,” “agitated”).¹⁰ When this is the case, patients are cut off from options that can better treat symptoms and improve functioning and wellbeing.

Communication Styles

Some patients and families may communicate issues using a certain vernacular, colloquialisms, verbiage, and/or a dialect that clinicians may misunderstand or misinterpret. Without any clarifying follow-up, there could be a missed diagnosis or misdiagnosis.

Racial Disparities in Health Care: How Clinicians Can Improve ADHD Care

1. Identify your blind spots. We all have them, and it’s our responsibility as physicians to go out of our way to check them regularly in order to better address our patients’ needs. Implicit bias training can help you identify your blind spots. Take the free Implicit Association Test (IAT) to learn about your hidden attitudes and beliefs. As you learn about and acknowledge your blind spots, tell yourself before you start your workday, “I know I have biases, but I am going to go above and beyond for my patients to make sure I do my job correctly.”

2. Don’t be afraid to ask questions. Questions communicate interest, not ignorance. When you ask a patient about themselves, and how their identity and intersects with their health and wellbeing, it shows that you are paying attention to who they are and it builds trust.

3. It’s your duty to get information out of your patient. Recognize that patients may express health concerns in ways you’re not accustomed to hearing. A comprehensive clinical interview is vital for understanding and clarifying your patient’s concerns, including issues that may mimic or co-occur with ADHD. Rating scales alone won’t cut it. Also remember that patients often have to jump through several hoops to make medical appointments; no one shows up to an appointment (a costly one at that if they don’t have insurance or full coverage) because they feel like it. Think twice before you deem patients “noncompliant” or judge their motivations for being there. There are real concerns to be addressed, and it’s your job to uncover those needs.

4. Ensure all medical decision makers are in the room. In some families, a child’s grandparents — not their parents — may be the ones who ultimately decide on treatment. Take time to understand a patient’s family dynamics.

5. Help patients and families understand the benefits of an ADHD diagnosis. Parents should understand that ADHD is treatable, and that a diagnosis will allow their child to get the services to which they are entitled. Families should run to, not away from, special education services and their tailored resources. Explain to concerned parents that all educational services requiring funding — from gifted and talented programs to resources for students with disabilities — go through special education.

6. Obtain consent and ensure transparency. If you believe a patient will benefit from additional medical and wellbeing services, inform them and only put in an order after obtaining their approval.

7. Understand a patient’s circumstances and expectations. Do not assume that your approach, model, or ideas are the best fit. Really listen to what your patient identifies as their top issues, what they expect out of treatment, and what circumstances will allow them to pursue. Then devise a comprehensive treatment plan that covers those needs. Behavior parent training, for example, may necessitate an alternative approach if caregiver schedules and stressors interfere with the consistent application of positive reinforcement and discipline. No matter the plan, ensure that you, your patient, and other decisionmakers are on the same page.

8. Empower patients to advocate for their health. Most ADHD cases are treated by primary care physicians, but there are a host of providers — from nurse practitioners to psychiatrists — who can help. While insurance plans and financial circumstances may limit where patients choose to go, they should still be aware of these options. Comfort and compatibility are key when choosing professionals, so remind patients that there is nothing wrong with seeking second opinions. Often, the best way to find doctors — especially culturally competent providers — is by asking friends, relatives, faith and community leaders, and other trusted individuals for recommendations. BlackPsychiatryDirectory.com is a helpful resource.

9. Commit to ongoing education. As a psychiatrist, I consider myself a social scientist, and I invite all clinicians to take this approach. Be interested in people and cultures outside of your own. Books, news, films, television shows, and podcasts are all great ways to gain exposure to different cultures and identities.

Racial Disparities in Health Care: Next Steps

• Read: Why ADHD Is Different for People of Color
• Read: ADHD Clinicians Must Consider Racial Bias in Evaluation and Treatment of Black Children
• Read: We Need to Talk About ADHD Stigma in BIPOC Communities

The content for this article was derived from the ADDitude ADHD Experts webinar titled, “Health Equity in ADHD: Addressing Racial Disparities in Diagnosis & Treatment” [Video Replay & Podcast #495] with Napoleon B. Higgins, Jr., MD, which was broadcast on March 7, 2024.

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Sources

¹ Bethell, C. D., Davis, MB, Gombojav, N, Stumbo, S, Powers, K. (2017). A national and across state profile on adverse childhood experiences among children and possibilities to heal and thrive. Retrieved from http://www.cahmi.org/projects/adverse-childhood-experiences-aces/.

² Shrider, E., Creamer, J. (2023). Poverty in the united states: 2022. U.S. Census Bureau. Retrieved from https://www.census.gov/content/dam/Census/library/publications/2023/demo/p60-280.pdf

³ Fleischman, L, Franklin, M. (2017). Fumes across the fence-line: the health impacts of air pollution from oil & gas facilities on african american communities. NAACP and CATF. Retrieved from http://www.catf.us/wp-content/uploads/2017/11/CATF_Pub_FumesAcrossTheFenceLine.pdf

⁴ Jehan, S., Myers, A. K., Zizi, F., Pandi-Perumal, S. R., Jean-Louis, G., Singh, N., Ray, J., & McFarlane, S. I. (2018). Sleep health disparity: the putative role of race, ethnicity and socioeconomic status. Sleep medicine and disorders : international journal, 2(5), 127–133.

⁵ Buser, J. K. (2009). Treatment-seeking disparity between African Americans and Whites: Attitudes toward treatment, coping resources, and racism. Journal of Multicultural Counseling and Development, 37(2), 94–104. https://doi.org/10.1002/j.2161-1912.2009.tb00094.x

⁶ Macias-Konstantopoulos, W. L., Collins, K. A., Diaz, R., Duber, H. C., Edwards, C. D., Hsu, A. P., Ranney, M. L., Riviello, R. J., Wettstein, Z. S., & Sachs, C. J. (2023). Race, Healthcare, and Health Disparities: A Critical Review and Recommendations for Advancing Health Equity. The western journal of emergency medicine, 24(5), 906–918. https://doi.org/10.5811/westjem.58408

⁷ U.S. Commission on Civil Rights. (2019). Beyond Suspensions: Examining School Discipline Policies and
Connections to the School-to-Prison Pipeline for Students of Color with Disabilities. Retrieved from https://www.usccr.gov/files/pubs/2019/07-23-Beyond-Suspensions.pdf

⁸ Center for Civil Rights Remedies of the Civil Rights Project at UCLA. https://civilrightsproject.ucla.edu/resources/projects/center-for-civil-rights-remedies

⁹ Fadus, M. C., Ginsburg, K. R., Sobowale, K., Halliday-Boykins, C. A., Bryant, B. E., Gray, K. M., & Squeglia, L. M. (2020). Unconscious Bias and the Diagnosis of Disruptive Behavior Disorders and ADHD in African American and Hispanic Youth. Academic psychiatry : the journal of the American Association of Directors of Psychiatric Residency Training and the Association for Academic Psychiatry, 44(1), 95–102. https://doi.org/10.1007/s40596-019-01127-6

¹⁰ Sun, M., Oliwa, T., Peek, M. E., & Tung, E. L. (2022). Negative Patient Descriptors: Documenting Racial Bias In The Electronic Health Record. Health affairs (Project Hope), 41(2), 203–211. https://doi.org/10.1377/hlthaff.2021.01423

First, ADHD is a complex condition comprising genetic, environmental, and neurobiological factors. This intricate relationship makes it challenging to pinpoint specific brain patterns or abnormalities that definitively indicate ADHD. Unlike some neurological conditions in which a distinct physical anomaly (e.g., tumor, stroke, etc.) or clear activity pattern (e.g., seizure) can be observed, ADHD presents a more nuanced picture.

Second, the symptoms of ADHD can vary widely among individuals. While difficulties with attention, motivation, and impulsivity are hallmark features, these symptoms present differently from person to person. Some may primarily struggle with attention and focus, while others exhibit more impulsive behaviors. This variability makes it difficult to identify a universal brain signature for ADHD across all affected individuals. In addition, claims of certain types of ADHD based on particular brain patterns go way beyond what the research supports. This is why using brain scans to diagnose ADHD is not supported by any of the professional organizations, including the American Medical Association.

Brain scans, such as functional MRI (fMRI) or PET scans, measure brain activity by detecting changes in blood flow or metabolic activity. These techniques provide valuable insights into brain function and can help detect certain kinds of neurological problems. Unfortunately, they don’t sufficiently capture the more subtle underlying neurochemical processes associated with ADHD. The brain’s intricate network of neurotransmitters, like dopamine, norepinephrine, and serotonin, are involved in ADHD. But their levels and interactions cannot be assessed through conventional brain imaging alone.

Clinical Assessments Are the Gold Standard for ADHD Diagnosis

ADHD is best diagnosed through comprehensive clinical assessments that consider a range of factors. These assessments typically include interviews with the individual, observation of behavior, reports from family members, and standardized rating scales. These methods provide a holistic view of a person’s symptoms, functioning, and history under real-life conditions and across time and circumstances. By contrast, brain scans capture a snapshot in time, sitting still in a scanning device. To put it bluntly, ADHD should be diagnosed based on an evaluation of real-life functioning, not test results.

[Get This Expert Resource: Unraveling the Mysteries of the ADHD Brain]

It’s essential to recognize that brain scans do contribute to our understanding of ADHD in meaningful ways. Research using neuroimaging techniques has identified differences in ADHD brain structure and connectivity, specifically in the regions involved in attention, executive function, and impulse control. While such findings are valuable for scientific knowledge, they are not yet precise or consistent enough to serve as diagnostic markers for individuals in clinical settings.

The interpretation of brain scan results requires expertise and context. It’s not possible to equate a particular brain pattern or system observed in an MRI or PET scan to ADHD. Many other factors can influence brain activity, function, and structure, including mood, medication effects, substance abuse, sleep deprivation, and co-occurring conditions such as anxiety or depression. Failing to consider all these variables and relying solely on brain scans for ADHD diagnosis can lead to misinterpretation or misdiagnosis.

ADHD Assessment Requires a Holistic View

Advances in technology and methodology may eventually lead to more refined ways of using brain imaging for ADHD diagnosis, such as incorporating machine learning algorithms to analyze complex brain patterns. In the meantime, a comprehensive and individualized approach remains the gold standard for ADHD assessment. This approach considers not only brain function, but also the psychological, behavioral, and environmental factors that contribute to an individual’s experience of ADHD. It emphasizes the importance of tailored interventions, including behavioral therapies, educational support, and medication management.

While brain scans offer valuable insights into the complexities of brain function, they currently don’t add much as diagnostic tools for ADHD. The disorder’s multifaceted nature, variability in symptoms, and the need for comprehensive assessment underscore the limitations of relying on neuroimaging. Understanding ADHD requires a holistic perspective, including clinical expertise, thorough evaluation, and ongoing research into its biological underpinnings.

Functional MRI (fMRI) for ADHD? Next Steps for Parents of ADHD Teens

• Self-Test: Do I Have ADHD? Symptom Test for Adults
• Download:What Every Thorough ADHD Diagnosis Should Include
• Read:Mapping the ADHD Brain: MRI Scans May Unlock Better Treatment and Even Symptom Prevention
• Watch: How Brain Imaging Helps Us Understand and Treat Attention Deficit

This personal essay reflects the opinions of the authors.

Stephanie Sarkis, Ph.D., is an author, mediator, and therapist.

Ari Tuckman, Psy.D., is a psychologist and the author of More Attention, Less Deficit: Success strategies for Adults with ADHD (#CommissionsEarned)

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A few years ago, Michael, a nine-year-old boy, was brought to my office by his parents. Mom and Dad seemed comfortable when I greeted them in the waiting room, and they easily conversed as they followed me back to my office. They joked with Michael, and he appeared at ease.

After talking for a few minutes, I asked them, “So, why did you bring Michael to see me?

“The teachers say that he has a lot of trouble staying focused in the classroom,” his mom responded. “They say that he is very bright but doesn’t do well on tests because he rushes, doesn’t check his answers, and seems to stare off. Often, he only completes half of his tests. While he answers questions correctly, he fails the test because he does not complete it.”

At this point, Dad spoke up. “Wait a minute, Gayle. You know my mother told you I had the same trouble in school, but I turned out fine.”

I would have missed it had I not been sitting directly across from her, but it was at this moment that Michael’s mom rolled her eyes.

[Free Guide: What Every Thorough ADHD Diagnosis Includes]

After some testing and discussions with the teacher, Michael was diagnosed with ADHD. However, over the next five years, his father resisted the idea of treating Michael with ADHD medication, even though he responded extremely well to it, with minimal, non-serious side effects.

Dad also frequently “forgot” to give Michael his ADHD medication. If I had missed this earlier warning, I am sure I would have eventually picked up on Dad’s resistance. But the point of this story is not that Michael’s medical care would have been compromised had I missed the eye-rolling. It is that every person emits hundreds of these small, non-verbal communications every hour. And all of us, including physicians, unconsciously interpret these communications, usually accurately. Telehealth interferes with those subtle cues, which may result in a patient’s misdiagnosis or inappropriate treatment decisions.

Pros & Cons of Telehealth Evaluations for ADHD

There are certainly advantages to telehealth medical evaluations for ADHD. For one, they are relatively easy to set up. They eliminate the need to travel from home to a clinic or office, which can be problematic for some. For patients who do not have a steady income source, these evaluations also may be less expensive than in-person evaluations.

Regardless, there are serious concerns about the accuracy of telehealth evaluations. Since there are no blood tests, specific laboratory findings, X-ray findings, or diagnostic findings on a patient’s physical or neurological evaluations, the diagnosis of ADHD usually depends on a patient’s (or their parent’s) self-reporting.

[Free Directory: ADHD Specialists Serving Patients Near You]

This has proven problematic — and, in some cases, fraudulent. In June, the Justice Department charged two executives at the telehealth company Done Global with allegedly distributing Adderall and other stimulants for ADHD to patients without a proper diagnosis. Done reportedly made ADHD diagnoses based on a patient’s minute-long self-assessment and a 30-minute or less virtual evaluation with a provider.

A Better Way to Evaluate ADHD

Most pediatricians will evaluate their young patients with one parent in the room. I strongly encourage both parents to come to the initial evaluations and follow-up visits.

During the 40 years that I have evaluated patients for ADHD, I have noticed that subtle non-verbal facial expressions and messages reveal much more about how each parent feels about their child’s diagnosis or treatment than what they say. These cues could be easily missed during a telehealth evaluation.

For example, I met Danny several years ago. His mother sat in front of my desk, with Danny to her right. He appeared uninterested in our conversation but was in a good mood and smiled occasionally. While his mother spoke, Danny fidgeted, looked out the window, moved around in his seat, and interrupted occasionally.

When I asked Danny’s mom what her biggest concern was, she said, “Well, he is highly intelligent, but he has a tough time staying focused and quiet in school. As a result, he has a difficult time learning. He is very scattered.”

So, I asked my usual questions: When did this start? How was he doing in school? How were his grades? How did he get along with other kids?

[Free Series: The Caregiver’s Guide to ADHD Diagnosis]

She tried to answer each question but became visibly frustrated. Her voice quivered, and she seemed on the brink of crying. Then, she stopped talking and reached into her bag. She pulled out a brightly colored, ragged spiral notebook and handed it to me.

“Danny’s teacher uses this calendar notebook to communicate with her students’ parents,” she explained. “The teacher will write a short note about how Danny did that day. I can write a response or ask a question. The notebook goes from home to school and back again daily.”

Later that day, I started reading the notebook. But by the time I got to the third page, I felt tears in my eyes.

I didn’t need to continue reading to know what was in the rest of the notebook. I was so used to treating children with behavior and learning problems like a detective, objectively analyzing the facts, that I had forgotten what it felt like to a child and their parents. Suddenly, reading this notebook, I could tell exactly how Danny and his mother felt.

If I had used telehealth, I might have received the notebook eventually, but I would have missed how Danny’s behavior affected their lives. I might also have seen Danny’s mother’s tears on the computer monitor. However, my bigger concern was what I may have missed and how that could have affected Danny’s diagnosis and treatment.

Telehealth ADHD Evaluations: Next Steps

• Special Report: ADHD Telehealth Patients Report Rushed Diagnoses, Medication Prescriptions
• Read: Your Complete ADHD Diagnosis and Testing Guide
• Watch: Virtual Mental Health Providers – How to Get Quality ADHD Care Online
• Download: Free Guide: Does My Child Have ADHD? 

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For decades, ADHD was thought to begin in childhood with many people outgrowing symptoms by adulthood. However, new scientific insights reveal findings that have reshaped the ADHD community’s understanding of how ADHD symptoms evolve, fluctuate, wax, and wane over the lifespan. 

We now know that ADHD may emerge later in life in some individuals, and we have insight into factors that impact earlier versus later onset presentations. We also understand that very few people experience a form of ADHD that is always severe and debilitating. Instead, most people appear to experience a fluctuating course through adulthood in which certain situations may be associated with the flare up or down of ADHD symptoms. 

In this webinar, you will learn:

• About the latest science behind our modern conceptualization of ADHD across the lifespan
• About the difference between late-onset and late-identified ADHD, and whether people can develop ADHD for the first time as adults 
• Whether people can be considered “recovered” from ADHD if symptoms have been at bay for a long time
• About the situations that can trigger flare-ups or lead to an abatement of ADHD symptoms 
• How to decide if a person with mild ADHD-like traits qualifies for a clinical diagnosis, and what happens if they do not meet ADHD criteria but still want help 
• About the implications for diagnosis and treatment, as well as how loved ones can best support individuals with ADHD through ups and downs — and what individuals with ADHD can do to live happy and healthy lives

Watch the Video Replay

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ADHD in Adults: More Resources

• Download: How Common Is ADHD in Adults?
  
• Read: Is Adult ADHD Real? Yes — and Still Heavily Stigmatized
  
• Read: Why We Need U.S. Guidelines for Adults with ADHD
  
• eBook: ADHD After 40: A Guide to Symptoms, Diagnosis & Treatment Later in Life
  

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Meet the Expert Speaker

Dr. Margaret Sibley is a Professor of Psychiatry and Behavioral Sciences at the University of Washington School of Medicine and a clinical psychologist at Seattle Children’s Hospital. She has authored over 120 scholarly publications on ADHD in adolescence and adulthood with research funded by the National Institute of Mental Health and the Institute of Education Sciences. She is Secretary of the American Professional Society for ADHD and Related Disorders (APSARD), a Professional Advisory Board Member for Children and Adults with Attention Deficit Hyperactivity Disorder (CHADD), and an Associate Editor of the Journal of Attention Disorders. She is the author of Parent-Teen Therapy for Executive Function Deficits and ADHD: Building Skills and Motivation published by Guilford Press in 2017. (#CommissionsEarned) 

#CommissionsEarned As an Amazon Associate, ADDitude earns a commission from qualifying purchases made by ADDitude readers on the affiliate links we share. However, all products linked in the ADDitude Store have been independently selected by our editors and/or recommended by our readers. Prices are accurate and items in stock as of time of publication.

Listener Testimonials

“The research studies and their outcomes presented were very informative.”

“Got a lot out of today’s presentation. Thank you!”

“This was very helpful to our understanding of late diagnosed ADHD, and to raise the question of other causes of symptoms that may be involved.”

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“I attempted to pick up my son from school to take him to the hospital emergency room. The teacher said he had a seizure-like activity. When I arrived at school, he was restrained by two administrators as they escorted him to my car. He became very aggressive inside my car and hit me in the head so hard that I was bleeding. I attempted to call Crisis Response, but the operator said they weren’t available and dispatched police. Two officers arrived. My son has BFRBs (body-focused repetitive behaviors). One officer yelled at my son, ‘Look at me when I talk to you. You think it’s OK to just sit there and pick your nose and nails? You think it’s alright to hit your mom? Boy, if you were a little older, I’d lock you up right now!‘”

“I was arrested at age 21 for spray painting a small stencil of leaping wildebeests on a concrete overpass in broad daylight. I gave zero thought to the implications of spray painting in a public space. It was impulsive and creative. The consequences were huge. I wish that impulsivity were part of the conversation when educating public safety officials about ADHD.”

[Free Download: Common Signs of a Body-Focused Repetitive Behavior]

“When my son was in high school, he had a giant meltdown after a peer incident. The police were called. He’s a large kid and started sobbing. The police told him to stop crying or he’d be handcuffed. Needless to say, he was handcuffed. I wish the police knew more about the mental health aspects of ADHD. It was a humiliating situation for all involved.”

“Before my diagnosis, I was a chronic speed demon. I would often bump into and scuff other cars… My inattention put me and others at risk for harm. I wish law enforcement knew about health care disparities and the under-diagnosis of ADHD. Criminalizing people for a disease is cruel behavior.”

“I was diagnosed with premenstrual dysphoric disorder (PMDD) and oppositional defiant disorder (ODD) in 1993 and 1994. We now know how PMDD can impact ADHD and how untreated ADHD can look like ODD or be comorbid. None of that was considered 30 years ago for a female. I also masked well and was considered a gifted student. I was very quick to challenge adults who I believed were wrong and I was quick to argue with anyone for anything. I got into trouble a lot. I wish law enforcement knew more about neurodivergent struggles with emotional regulation and utilized calm, compassionate methods before reacting.”

[Self-Test: Premenstrual Dysphoric Disorder Symptoms]

Detained by Police? Follow These Steps

1. First, pause. It’s important to not say the first thought that goes through your mind.
2. Tell the officer you have ADHD. Under the Americans with Disabilities Act, you’re entitled to reasonable accommodations, including modified questioning, fidgets and frequent breaks, and access to your medication.
3. Before you answer questions, make sure to have someone you trust, such as a lawyer or a family member, with you to figure out exactly what happened. You must be truthful and accurate with police, so if you are forgetful and have time-blindness, it’s essential to have a lawyer or trusted person with you for support.

Police Training and ADHD Awareness: Next Steps

• Q&A: ADA Information for the Recently Diagnosed
• Read: Crime, Punishment, and Redemption for My Son with ADHD
• Free Download: An In-Depth Guide to Inattentive ADHD

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At 44, when I was diagnosed with ADHD, my neuropsychologist warned me that telling my family about it, given the personal background I provided, might not be the wisest idea.

Before I brought up ADHD to my family, they never questioned my previous medical diagnoses: migraines, a root canal, COVID-19, two bunionectomies, and two staph infections. My understanding of my health conditions was never challenged until it came to ADHD, when a single family member politely undermined my medical diagnosis, my grasp of reality, and my intelligence.

Why the ADHD denial?

To Deny ADHD Is to Uphold a Fraught Reality

Those who dismiss ADHD, I gather, often do it as an act of self-preservation. To deny ADHD is to avoid uncomfortable truths about opportunity and success.

From the moment small children can comprehend language, adult authority figures tell them that if they follow specific steps, a particular outcome is very likely or guaranteed. “Work hard, and you’ll get good grades.” “Success is no accident.”  “Practice makes perfect.” This rigid, unforgiving logic is the very foundation of the American Dream and a common justification not to help each other. Athletes, actors, musicians, authors, artists, scientists, and other recipients of professional honors, wealth, and prestige will parrot the same talking points.

[Read: Why It Hurts When Neurotypicals Claim an “ADHD Moment”]

My parents and teachers reiterated these adages too. All of my siblings ardently followed this advice, and they were richly rewarded for their legitimate hard work: private boarding schools in England, Ivy League graduate degrees, high incomes, networking with wealthy families, and professional achievements.

Not for me or the other one in 20 children in the 1980s who had ADHD, though.

The people who champion these simplistic platitudes don’t realize or account for the fact that learning isn’t that simple for those of us who are wired differently. If an undetected and untreated developmental disability stymied my academic and professional achievements – instead of my alleged lazy, unmotivated, unintelligent, and scatterbrained behaviors – then the reality for my family and all the other people who genuinely think they worked hard is shattered.

Despite steps to mitigate the effects of disability discrimination, this country still wrestles with the fact that not all opportunities for success are equal, especially in highly competitive, driven environments. Most upsetting is the fact that ADHD runs in families, meaning that “bad” genetics can threaten to upend one’s previously positive self-image and long-held beliefs about intelligence. The inability to accept reality, such as loved ones clinging to stigma over facts, takes hold in families and denies the possibility for compassion, empathy, and proper treatment.

Covert Denial and Faux Concern

I’ll give these skeptics and critics some credit: they know outright denials or rejections of an ADHD diagnosis are no longer socially acceptable. They really don’t want to appear brazenly ignorant by contradicting a widely recognized neurodevelopmental disorder.

[Read: “Is ADHD Really Real?” 6 Ranked Responses to ADD Skeptics]

What’s the “better” response? Very respectful, palatable contradictions that are cloaked in faux concern and passive-aggressive denial. “Being fidgety is normal in children, but now it’s a ‘condition!’” “The inability to focus and concentrate probably isn’t really ADHD.” “All of this ADHD nonsense is only a flashy trend.” “Is the rise in diagnoses social media’s fault?” In my case, I got the question, “Did you take this, um, ADHD test online? Because that’s not how diagnostic testing works.”

ADHD skeptics and critics don’t want to face the fact that one of the driving reasons neurotypical people flourished in life is because academic and workplace environments are mostly set up so only neurotypical people could thrive and prosper.

If there had ever been a proactive, organic nationwide movement to acknowledge and understand disabilities and work to equalize the playing field, then the Americans with Disabilities Act and the Individuals with Disabilities Education Act wouldn’t need to exist. Thankfully, legally mandated disability accommodations expand the chances of success to more people in the workplace, classroom, and other fields. However, with change comes unpredictability. Insecurity and fear drive prejudices and make ADHD accommodations difficult to obtain.

As for my family member who repeatedly attacked the credentials and professional licensure of the neuropsychologist who diagnosed me, I eventually got somewhat of an apology. “I think it’s really good you found ADHD. All of… that seems to be helping you.” I had no idea I had it so good.

ADHD Is Real: Next Steps

• Free Download: How Common Is ADHD in Adults?
• Read: The Definition of ADHD — Myths & Truths
• Read: The Controversy That Was Adult ADHD

Maria Reppas lives with her family on the East Coast. Visit her on Twitter and at mariareppas.com.

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