ADHD (Attention Deficit Hyperactivity Disorder) seemed like a joke to me during my doctoral days. I grew up within a culture where restlessness and being busy (even chaotically so) was the norm, and so every second person would meet the criteria for ADHD. My education and experiences since have taught me much about attentional processes that validate the existence of ADHD as a disorder truly affecting 9% of the world’s population or less. While ADHD continues to be an attention-grabbing label across the internet, I am hoping we can redirect that attention to attention and decide whether this diagnosis is fad or fact.
First, let me walk you through how the brain does attention. By design, the information from the world around and within us is received through our senses, and transmitted to the spinal cord, inner brain, and finally, the “higher order” centers of the brain. The inner brain (our shared asset with the rest of the animal kingdom) is what regulates things like our heartbeat, breathing, sleep cycles, emotions, energy, and attention. When managed effectively, sensory information is distributed to the next layers of brain tissues to produce and direct language, memory, attention, visual-spatial functioning, organization, understanding, etc.; the stuff that sets us apart from your pet dog or the king of the jungle.
All is well with this system…until life happens. Depending on our genes, personality, or environment, we may operate on a different algorithm. This is where the magic (or trauma) of our complex selves unfolds. In cases of stress and trauma, our flight or fight responses flood our sensory experiences that may short-circuit any transmission through our spinal cord and inner brain. It may also happen that certain information may be quarantined in the unconscious recesses of our brains when associated with what we have known to be threatening. In other cases, events may be too underwhelming to allow that information to carry on its journey forward and upward. The potential for these scenarios exists within each of us (haven’t we all scrolled on our phones mid-movie or missed what the teacher said during an 8 am lecture!). However, the tendency of these alternatives to manifest (either exclusively or as one force) is different for everyone.
This is where my expertise come in. In the same way that a fever may be caused by an infection or teething, attentional problems arise for many reasons. ADHD represents a neurodevelopmental problem with regulating attention. The attention centers of an ADHD brain need a different level of stimulation than the neurotypical brain because those neural pathways aren’t well coordinated. Therefore, ADHD is a lifelong disorder experienced to various degrees across one’s lifetime.
In many other cases, the attention pathways in the brain are intact. Yet, that person may experience a lack of focus or impulsivity. Enter subcortical dysregulation. Emotional experiences such as trauma and anxiety can make the inner brain work overtime. In these instances, we do not know how to filter out or process information in a way that is helpful. This leads to over- or under-stimulation. Regardless, information supply is cut off to the rest of the brain. Consequently, attention centers cannot do their thing. This may look like ADHD (especially if this is chronic), but it is not.
Another ADHD imposter lies in giftedness. It is not uncommon for our gifted friends to hear things like, “You are so capable, why can’t you just get the work done?!” Allow me to explain this. Gifted people’s abilities are so keenly developed that normal life experiences fall short in activating brain activity. The lack of stimulation is certainly like that of ADHD, however, not because of any attention deficit but because advanced skills need more stimulation. It’s like making yourself learn one alphabet per day, when you could easily read up on the complexities of attention.
What complicates these distinctions is that, often, two or more problems exist within a person that give rise to these symptoms (and more). This is why neuropsychologists like me offer comprehensive testing to understand what is(/are) causing these problems. This helps 1) streamline interventions and strategies to what we know works best, and 2) prevent any adverse effects from interventions given based on an incorrect diagnosis (e.g. being put on stimulant medication when misdiagnosed with ADHD).
Bottom line: ADHD and related problems are complex, multifaceted phenomena. With the right tools (i.e., a map with a crossroads between personal experience, community input, and professional expertise), it is possible to navigate the attention maze. When in doubt, consult the neuropsychologist!
Dr. Clarice Mendonca is a Clinical Psychologist and Clinical Neuropsychologist at the MapleTree Psychotherapy Center in Dubai. To schedule a consultation with her, please contact +971 50 232 8035
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