Introduction
In our last article, we covered several introductory ideas around ADHD, including core symptoms, gender differences, age of onset, causes, and available treatment options. In this article, we will dive deeper into ADHD, exploring what ADHD isn’t, common myths, and how ADHD presents differently in different people.
It’s worth reiterating that ADHD is more than just inattention—it is a neurobiological disorder that significantly affects individuals across multiple areas of life and complicates daily functioning.
The Three Presentations of ADHD (Why We No Longer Call Them “Types”)
In the past, the Diagnostic and Statistical Manual of Mental Disorders (DSM)—often considered the mental health diagnostic “bible”—categorized ADHD into three subtypes:
- ADHD Predominantly Inattentive (ADHD-I)
- ADHD Predominantly Hyperactive-Impulsive (ADHD-H)
- ADHD Combined (ADHD-C)
While we still recognize these variations, the DSM-5 now refers to them as “presentations.” This change reflects the evolving understanding of ADHD as a condition that shifts over time rather than being rigidly categorized. We know that brain structure and function evolve as individuals grow. Consequently, when diagnosing neurodevelopmental disorders like ADHD, we compare an individual’s symptoms to those of their peers rather than to a fixed standard.
For example, let’s consider the basal ganglia, a brain region responsible for regulating voluntary movement. Hyperactivity is a normal part of early childhood development. However, some children with ADHD lag behind in developing self-regulation, leading to excessive movement, restlessness, and difficulty staying seated. If disruptive enough, they may be diagnosed with ADHD, primarily hyperactive-impulsive presentation.
As they enter their teenage years, they may gain better control over their physical movement but struggle more with attention regulation—especially in situations that lack intrinsic interest. If both hyperactivity and inattention persist but are not equally disruptive, they may receive a combined presentation diagnosis.
By adulthood, hyperactivity often shifts to internal restlessness, and difficulty sustaining attention becomes the most prominent struggle, leading to a diagnosis of predominantly inattentive ADHD. This fluidity in ADHD presentation over time explains why we moved away from the concept of fixed subtypes.
There is ongoing debate about whether individuals who have always had inattentive ADHD (historically referred to as ADD) might have an entirely separate condition, such as Sluggish Cognitive Tempo (SCT)—but that’s a topic for another day.
Why ADHD Can Look Different in Different People
In our last article, we discussed the disparity in ADHD diagnosis rates between boys and girls. However, gender differences are just one reason ADHD manifests differently across individuals. Other factors include:
1. Internalized vs. Externalized Symptoms
Individuals who exhibit externalized symptoms—such as hyperactivity and impulsivity—are more likely to be noticed and diagnosed. Those who internalize their struggles (e.g., daydreaming, emotional dysregulation) often go undiagnosed for years because their symptoms are less disruptive.
2. Gender Socialization Differences
Social norms influence how ADHD symptoms are expressed. In many cultures, boys are encouraged to be assertive and energetic, making hyperactivity more noticeable and accepted. Girls, on the other hand, are often socialized to be reserved and accommodating, leading them to mask their symptoms or develop coping mechanisms that delay diagnosis.
3. Masking and Compensation Strategies
Masking occurs when individuals consciously or subconsciously suppress their ADHD traits to fit societal expectations. Compensation strategies—such as using excessive organization to counteract forgetfulness—can also make symptoms less visible. While these adaptations may help in the short term, they can lead to burnout and delayed diagnosis.
4. The Impact of Environment, Personality, and Co-Occurring Conditions
ADHD symptoms do not exist in isolation—personality traits, environmental support, and co-existing conditions can all influence how symptoms present. For example, someone with both ADHD and anxiety may appear highly organized and punctual due to their anxiety-driven perfectionism, even though they struggle with executive functioning behind the scenes.
ADHD and Comorbidities
I like to think of ADHD as a social butterfly—it rarely comes alone. Research suggests that as many as 80% of individuals with ADHD may also have at least one other diagnosable condition. These co-occurring conditions, or comorbidities, can complicate both diagnosis and treatment.
Some of the most common ADHD comorbidities include:
- Anxiety and Depression
- Autism Spectrum Disorder (ASD)
- Sleep Disorders
- Learning Disabilities
- Mood Disorders
Some studies indicate that boys with ADHD are more likely to have behavioral comorbidities, while girls are more prone to mood disorders. Regardless, comorbidities make diagnosis and treatment more complex, requiring careful assessment to address each condition properly.
Common Myths About ADHD
There are plenty of misconceptions about ADHD, which can make it even harder for people with ADHD to get the understanding and support they need. Let’s break down some of the most common ones:
- ADHD isn’t real
Some people believe ADHD is just an excuse for laziness or bad behavior. However, decades of research in neuroscience and psychology confirm that ADHD is a neurodevelopmental condition. If you’ve ever struggled to explain your ADHD to others, you’re not alone—here’s how to explain ADHD in a way that makes sense. - ADHD is just a lack of willpower
Many assume that ADHD means you just need to ‘try harder.’ In reality, ADHD affects executive functions—the part of the brain that helps with planning, prioritization, and impulse control. It’s not about effort; it’s about how the brain processes motivation and rewards. ADHD coaching helps people learn strategies to work with their brains rather than against them. - ADHD only affects kids
ADHD is often associated with hyperactive children, but it affects adults too—many of whom weren’t diagnosed until later in life. It also presents differently across individuals. The three presentations of ADHD help explain why it doesn’t look the same for everyone. - ADHD means you can’t focus at all
Many people with ADHD experience hyperfocus—intense, prolonged concentration on a task they find engaging. This can make it seem like they have selective attention rather than a focus deficit. Understanding hyperfocus can help shift the narrative about ADHD—learn more about hyperfocus here.
Clearing up these myths not only helps people with ADHD but also fosters better awareness and support from those around them.
What ADHD Isn’t
- ADHD isn’t laziness, irresponsibility, or a lack of discipline. ADHD brains function differently in terms of structure, development, and networking. These differences create unique challenges but do not equate to laziness.
- ADHD isn’t just anxiety, depression, or trauma. While these conditions can co-occur, ADHD remains a distinct diagnosis with its own treatment strategies.
- ADHD isn’t a fad. Increased awareness and reduced stigma have led to better identification and diagnosis, not an artificial surge in cases.
- ADHD isn’t adult-onset. If someone exhibits ADHD symptoms only in adulthood without a childhood history, another condition may be at play.
Conclusion: What’s Next?
Understanding ADHD goes far beyond knowing its symptoms. The more we learn about ADHD’s complexity, the better we can support ourselves and others. From shifting presentations over time to comorbidities and societal influences, ADHD is a dynamic condition that requires a nuanced approach.
In future articles, we’ll dive deeper into related topics such as time blindness, emotional regulation, and ADHD in relationships. If you have questions or insights, feel free to engage—whether through comments, discussions, or coaching inquiries. The journey to understanding ADHD is ongoing, but with knowledge comes empowerment.
