Why ADHD Is Often Misunderstood—and What You Need to Know
People think they know what it means to have ADHD, but it’s very commonly misunderstood.
You’ll hear people casually say things like, “Oh, I’m so ADHD,” when they’re feeling distracted—just like people will say, “Oh, I’m so OCD,” when they like to keep things tidy or double-check their work.
These kinds of stereotypes oversimplify what ADHD actually is and can even get in the way of people getting diagnosed and receiving the support they need.
In this post:
The Stereotypes of ADHD
ADHD in Girls and Women
The Impact of Masking
The Emotional Toll of Late Diagnosis
The Power of ADHD Content Creators
The Importance of Social Media in ADHD Diagnosis
ADHD Research and Experts
The Science of ADHD: DSM-5 and Diagnosis
Inattention: The Internal Experience
Hyperactivity and Impulsivity: External Signs of ADHD
The Role of Neurotransmitters in ADHD
Executive Functioning: A Key Challenge in ADHD
Medication: Some Wind in Your Sails
Lifestyle Supports Beyond Medication
The Stereotypes of ADHD
A common stereotype is that only little boys who bounce off the walls, can’t sit still, and yell a lot have ADHD. But that’s only a small fraction of the ADHD population. It’s the stereotype because it’s the most visible part of the spectrum.
And even then, those noisy, hyperactive little boys don’t stay little boys forever. They grow up to become college students, employees, husbands, fathers, grandfathers, etc.
ADHD in Girls and Women
There’s also a misconception that girls and women don’t have ADHD, which just isn’t true. The real issue is that girls face much more social scrutiny from a young age.
There’s often a pipeline for girls that starts with getting criticism for unwanted behaviors (which are usually ADHD symptoms) and leads to them learning to hide those behaviors. This process of hiding ADHD symptoms, called “masking,” helps them avoid negative social feedback.
Over time, they might learn to censor themselves so well that they stop standing out as much.
The Impact of Masking
Masking is a double-edged sword, though.
On one hand, it helps girls and women avoid social stigma. It can also help them develop strategies early on for managing their ADHD symptoms.
But on the other hand, it can prevent their symptoms from being recognized by parents and teachers, leading to a missed diagnosis. In fact, many women don’t get diagnosed until adulthood—sometimes not until their children are diagnosed with ADHD.
A woman might sit in on her child’s evaluation and realize that she has struggled with many of the same issues for her entire life. And if a woman doesn’t have children, or her children don’t inherit her ADHD, she might never receive a diagnosis.
The Emotional Toll of Late Diagnosis
Late diagnosis can feel like a relief, but it often comes with a lot of emotional baggage.
Living with undiagnosed ADHD for years can really take a toll. One part of ADHD that can amplify this toll is rejection sensitivity dysphoria (RSD), which is very common in people with ADHD.
RSD happens when someone develops an intense sensitivity to criticism, often because they’ve grown up hearing more negative feedback than their peers. In fact, ADHD expert William Dodson estimates that by the time kids with ADHD reach 10 years old, they’ve received about 20,000 negative messages about their behavior.
This constant stream of judgment can make a person hyper-aware of even perceived criticism. Over time, this can lead to emotional overwhelm and a deep fear of failure.
The Power of ADHD Content Creators
If you watch videos on TikTok made by ADHD content creators, one of the most painful and debilitating aspects of having ADHD is often considered to be RSD. This leads to an important point, as well.
Reading research written about ADHD individuals can be helpful, but often the best understanding comes from listening to ADHD people themselves talk about their experiences. Especially because much of the research is based on children.
An adult's experience of having ADHD is very different from a child’s experience of having it. Plus, adults can usually more accurately and comprehensively describe their experiences.
Some of the most prominent content creators in the ADHD space are Richard and Roxanne Pink from @ADHD_Love, Eugene Yao from @ADHDFounder, and Elyse Meyers (@ElyseMeyers). There are many wonderful accounts, but these three have some of the most followers.
Elyse Meyers has been open about having ADHD, and she went viral for sharing zany stories from her life, using humor to humanize the often chaotic, awkward, and painful scenarios from her life.
Eugene Yao also uses humor to shed light on many common experiences for adults with ADHD.
And Roxanne and Richard Pink have a unique angle of centering the topics for their videos on how Roxanne’s ADHD symptoms affect her relationship with her husband Richard.
Richard and Roxanne Pink from ADHD_Love
Viewers feel deeply seen, understood, and validated by these creator’s videos.
The Importance of Social Media in ADHD Diagnosis
In fact, the partner of one of my clients realized he had ADHD after going online to understand my client better, and then reading a Twitter thread by an ADHD content creator and resonating with the entire thing.
He soon received an official diagnosis at the age of 35.
The rise of neurodivergent people being able to share and amplify their voices on social media has led to a much-needed increase in diagnoses.
This is particularly true among historically under-diagnosed populations like women and people of color, who carry a heavier expectation from society to hide and suppress their ADHD symptoms for the convenience of others.
ADHD Research and Experts
If you are looking to dive into the research side of understanding ADHD, one of the very best researchers is Dr. Russell Barkley. He has a unique gift for presenting his rigorous, evidence-based research in a lively, easy-to-understand manner.
Dr. Russell Barkley on his YouTube channel
Dr. Barkley has authored several books about understanding ADHD and there are many YouTube clips of his lectures available online. Other top ADHD researchers/authors are Dr. Stephen V. Faraone, Dr. Margaret Sibley, and Dr. Emily Rosenthal.
The Science of ADHD: DSM-5 and Diagnosis
Let’s break down the science of ADHD to further expand our understanding.
The DSM-5 is a diagnostic and statistical manual that gives clinicians information for diagnosing various disorders, including ADHD. It describes ADHD as having three subtypes based on which symptoms are the most prominent for an individual.
For a diagnosis, the symptoms also need to be disruptive enough to be negatively affecting a person’s life–at school, home, work, etc.
Here are descriptions of the three subtypes:
Inattentive Presentation: Symptoms include difficulty sustaining attention, frequent forgetfulness, disorganization, and a tendency to lose focus.
Hyperactive-Impulsive Presentation: Symptoms include restlessness, excessive talking, fidgeting, and acting without considering consequences.
Combined Presentation: Individuals show significant symptoms of both inattention and hyperactivity-impulsivity.
Inattention: The Internal Experience
Inattention can be a little harder for people to fully understand because it often presents as more of an internal experience.
You can think of inattention as that fuzzy, dreamy, head-in-the-clouds phenomenon where you’re stuck staring out the window when you’re supposed to get work done, or you’re frozen on the couch when you want to be getting up to do the dishes or take a shower or take the dog out.
Oftentimes this looks to others like tiredness or laziness, since from the outside, it can look like someone is just laying on the couch, or staring out the window, or scrolling on their phone when they’re supposed to be getting work or chores done.
What you can’t see from the outside is the internal experience of someone with ADHD in these situations. There is often endless agonizing about how their brain and body feel frozen.
And it’s because their brain isn’t getting enough of the chemicals it needs to enable the person to get off the couch and start the laundry, or to break their gaze away from the window and back to their laptop and get working (more on this chemical aspect later).
There is usually a large amount of guilt and self-recrimination involved in these scenarios. People know how it looks from the outside, they’ve been told time and time again that they should stop being lazy and start applying themselves.
What’s invisible is the internal experience of frustration and paralysis.
Hyperactivity and Impulsivity: External Signs of ADHD
Hyperactivity and impulsivity can be easier to understand and to recognize.
They often play into the stereotype of ADHD–being loud, unable to sit still, saying every thought that comes into your head regardless of how it makes others feel. Spending money recklessly or making life decisions on the spur of the moment without thinking through the consequences.
So while people might think that ADHD only presents as hyperactivity/impulsivity, it can be much more nuanced for many individuals.
They might have only the inattentive symptoms, or they might have both inattention and hyperactivity/impulsivity. It’s important to understand and accept the wide breadth of experiences of people with ADHD to help dismantle stereotypes and help more people get the diagnoses and support they need.
The Role of Neurotransmitters in ADHD
Now for the chemical explanation I promised earlier. There are two neurotransmitters affected by ADHD – dopamine and norepinephrine. Both of these are crucial for regulating your attention and motivation, and for powering your executive functioning.
Executive Functioning: A Key Challenge in ADHD
Executive functioning is exactly like it sounds – almost as if there’s an executive sitting up in your brain and managing you.
The executive tells you to do what’s good for you: to go to bed early instead of staying up all night watching Netflix, to stay focused at work so you can meet your deadlines, to eat healthy and brush your teeth twice a day.
With ADHD and other neurodevelopmental disorders, the orders from the executive in your brain get garbled and muffled, so they don’t translate into action very well.
Let’s say it takes 10 units of mental energy for someone without ADHD to manage themselves during the process of waking up, getting ready for the day, and getting to work on time.
For someone with ADHD, it might take 100 units of mental energy to get to work on time.
So that seemingly simple task of getting to work on time can be ten times harder for someone with ADHD! Now apply that same principle to every single task throughout the day. No wonder people with ADHD have a hard time managing all of life’s responsibilities.
People with ADHD often feel like they’re working twice as hard as other people to only get half of the results.
Research shows that people with ADHD tend to have lower levels of dopamine activity in specific areas of the brain like the prefrontal cortex. This area is responsible for tasks like planning, decision-making, and impulse control.
It also helps regulate the brain’s reward system, which explains why people with ADHD often struggle with delayed gratification.
If your executive functioning doesn’t work properly, you have to put huge amounts of effort and energy into doing the same tasks that are easy-breezy for other people.
Medication: Some Wind in Your Sails
This is where medication can be a big game-changer.
By boosting your dopamine and norepinephrine, your executive functioning is built back up so it can help you take the actions that are in your best interests (without expending devastating amounts of cognitive energy while still falling short).
The two main types of medication are:
Stimulants (e.g., Adderall, Ritalin): These are the most commonly prescribed and have a long history of effectiveness. They work by increasing the availability of dopamine and norepinephrine, helping to improve focus and reduce impulsivity.
Non-Stimulants (e.g., Strattera, Intuniv): These are often used for individuals who don’t respond well to stimulants or experience unwanted side effects. Non-stimulants regulate norepinephrine and can provide a steadier effect over time.
While medication isn’t a cure, it can make a night-and-day difference for some people.
It can help improve focus, reduce hyperactivity, regulate emotions, sleep better, and overall just generally have an easier time managing themselves moment-to-moment.
In short, it can help close the gap between the life someone with ADHD envisions for themselves and the reality they experience.
Lifestyle Supports Beyond Medication
But medication is not the only tool for people with ADHD to get help improving their functioning, and therefore their quality of life. Building a supportive lifestyle can provide essential scaffolding to help manage symptoms.
Here are a few strategies that can make a difference:
Structured routines
Support from loved ones
Visual organization
Mindfulness and self-compassion
Exercise and movement
Working with a therapist
Working with an ADHD coach
These lifestyle adjustments, combined with medication and self-education, can create a more holistic approach to managing ADHD.
This helps people not only survive, but also learn to thrive. Life is precious, and people with ADHD deserve to enjoy it fully, reach their goals, and feel good along the way.
Citations:
Barkley, R. A. (2012). Taking charge of ADHD: The complete, authoritative guide for parents (3rd ed.). Guilford Press.
Hinshaw, S. P., & Scheffler, R. M. (2014). The ADHD explosion: Myths, medication, money, and today's push for performance. Oxford University Press.
Hinshaw, S. P., et al. (2022). Annual research review: ADHD in girls and women: Underrepresentation, longitudinal processes, and key directions. Journal of Child Psychology and Psychiatry, 63(4), 484–496.
Sibley, M. H., & Yeguez, C. E. (2016). Evaluating the predictive validity of ADHD diagnosis in adulthood: A systematic review of longitudinal studies. Clinical Psychology Review, 49, 31–43.
Tuckman, B. W., & Hinkle, J. S. (2020). The impact of emotional dysregulation and rejection sensitivity in adults with ADHD. Journal of Attention Disorders.
