Conflicts of Interest: ADHD

In elementary school, I had a Native Alaskan friend named Sam Schimmel. We both have Attention Deficit Hyperactivity Disorder, we used to go mushroom hunting and pheasant hunting together, we both went to the same school, both of us had many of the same teachers. Yet we both had vastly different experiences at school. While I was a kid who talked too much and couldn’t focus in class, Sam was the loud hyperactive kid who pried his braces off with a fork because they bothered him. Sam was in and out of the principal’s office for disrupting class or acting out. While I could sometimes manage to at least keep quiet in class, I struggled to stay organized, often forgot to turn completed assignments in and quietly goofed off.

I was told I was lazy and unmotivated and had trouble paying attention and keeping quiet. Sam and his parents on the other hand, despite his mother teaching at our school, were told, “You need to go back to Alaska. Go back to the village.³” One of his teachers told him he wouldn’t go to college. The same kid who released a pigeon he caught into his middle school’s teacher’s lounge, the same kid who was told he wouldn’t go to college, is now attending Stanford University on a full ride scholarship. The same kid who was told to go back to Alaska is now advocating for Alaskan Native rights and recognition nationally through Alaska’s congressional delegation. He is an Alaska Climate Action Leadership Team Member, is a youth delegate for the Tribal Nations Conference, and was one of five people to be named by the Center for Native American Youth’s 2017 Class of Champions for Change.³

ADHD, while a common learning disability, is still misrepresented and misunderstood. Education systems are often ill equipped to assist the learning and behavioral difficulties that challenge ADHD afflicted children and young adults. The severity of the effects of ADHD on learning, mental health, and self esteem are greatly downplayed and cast off by those that do not have to struggle just to finish a single page article that does not engage our curiosity and interests. Treatment options for ADHD are wildly misunderstood and over exaggerated as dangerous and unnecessary, or conversely, as a “cure all.” Most importantly, ADHD affects every person differently, and even those with the same illness, at the same school, with the same teachers, can have polar opposite experiences with staff and support. ADHD is not a one dimensional illness, it does not affect anyone the same way, it’s symptoms are misunderstood and joked about and ADHD treatment is sorely misreported in its efficacy, while support for students that need it is often sorely lacking.

“Squirrel!” shouts a group member in a partner project while pointing out the window after I explain that I have ADHD. I have been told to just try harder to focus. I have been told to sit down and be quiet, stop being so restless, stop spinning your pencil, stop tapping your fingers, stop interrupting class. I have been told that ADHD is not so bad, all you need to do is try harder, just sit down and get your homework done. Friends have come up to me to say they think they have ADHD because they get distracted by their phone while doing homework. However the perceptions that are the most damaging to how ADHD is represented and recognized; “ADHD is just a personal failing,” or “You’re just being lazy, suck it up and get it done, just sit down and focus.” What this is demonstrating is ignorance of this learning disability, not of individuals, but society as a whole. It demonstrates a misunderstanding and downplaying of the impact and significance of the symptoms and effects of ADHD.

ADHD is not a lack of focus or concentration. It is a difficulty or inability to regulate compulsive desires between what is interesting or intriguing and what is required to be completed. ADHD is the result of chemical imbalances and structural differences in the brain. There is an underproduction of dopamine, and structural deficiencies on the frontal lobe, which makes unengaging material impossible to sit through, and engaging material all the more irresistible. This can lead to a spiral of starting a project, essay, or homework and getting interested and mired in the details like quicksand, being entirely unable to divert that focus back into the project. This is an example of ADHD manifesting as a hyperfocus, a laser tight tunnel vision unto which only abates with the perfection of every minute detail. The problem is that the hyperfocus usually only manifests while completing a small subsection of little relevance to the greater whole of a project. The symptoms can also manifest as the inability to begin, the mind racing everywhere at once, overwhelmed and unable to decide where or how to start.

The compulsive drive of a mind that is always running also leads to a necessity for instant gratification that completely overrides rational decision making. There will always be something else clawing at our minds trying to rip our attention away from whatever we are doing. It’s not a choice to interrupt in class, it’s not a choice to leave a large project or assignment until the night before it is due. ADHD is interrupting the professor or friends mid sentence before we even think about what we are saying or doing. ADHD is the inability to start a project or complete an essay because there are too many details or distractions that scatter cohesive thoughts like a shotgun. Every day can be a struggle just to go to class and to remember what is due. Even a brief trip to the grocery store is overridden by an overwhelming need to be doing something else. Telling somebody with ADHD to try harder to focus, or to just sit down and work is the equivalent of a person with 20/20 vision telling someone with poor eyesight to try harder to see well.

For an example of hyperfocus, while taking a Science Fiction literature class we were required to construct our own plot summary for a science fiction novel or movie. For that assignment, I spent approximately eleven hours straight in a hyperfocus, not on my plot summary, but the minute details of every problem I could foresee with an intergalactic generation ship. I did hours of research on magnetoplasmadynamic thrusters being developed by NASA and the best fuel for them. As the ship was also a solar sail, I calculated the force exerted by photons emitted from the sun across the surface area of a 3km wide fictional ship I had dreamt up.

I calculated the mass of the semi-spherical starship, created pages and pages of diagrams for the internal layout; from the propulsion systems, housing and population density, required internal volume, oxygen and food requirements and production needed for 100,000 people and much more. All those eleven hours of meticulous note taking, pages and pages of drawings, calculations, diagrams and details eventually boiled down to just one short paragraph in the intro to my essay, which took only three hours to finish. It wasn’t that I did not want to start on the summary, It was one of the extraordinarily few writing assignments I was excited about. What occurred that led to eleven hours of tangential laser focus was being unable to pry myself away from the details and focus on the bigger project at hand, It was like a mental supermagnet that kept irresistibly drawing my mind in.

The previous description of hyperfocusing is contrary to the views and depictions of ADHD, as well as the name of the disorder; Attention Deficit Hyperactivity Disorder. Take a moment to reflect; how many media portrayals of people or characters with ADHD are depicted in a hyperfocus at any time? One TV character may come to mind, Bart Simpson from The Simpsons. Surprisingly, Bart Simpson is fairly accurate depiction of some of the challenges, treatments, and albeit, over exaggerated symptoms of ADHD. What falls short however, is that in nearly all depictions of ADHD in media shows the rambunctious and loud character who can never sit still. The issue with these depictions is that ADHD is often portrayed as manifesting very similarly throughout every character, leading many to believe that ADHD presents as just those symptoms.

The reality differs from that portrayal however, as the learning disability is classified under three different diagnoses: Inattentive type, Hyperactive/Impulsive type, and Combined type.⁶

Each of these diagnoses have separate criteria for behaviors and symptoms, which can present across a broad spectrum of behaviors and expressions from person to person. Someone with Inattentive may have little to no hyperactivity and impulsiveness, while another with Hyperactive type may have great focus, but is unable to sit still. Combined type on the other hand, presents with criteria from both of the latter types. Every person with ADHD will have a different experience, with unique challenges and issues that they will have to overcome. The path and treatment for overcoming these challenges however, will also be unique, with varying degrees of effectiveness and success from person to person.

Treatment for ADHD is misunderstood as well. I have been told to just take ADHD medication and you will be fine. I have been told I need to develop self-discipline in order to overcome ADHD. I have read news reports that demonize ADHD medication as dangerous, toxic, and addictive medications that are unnecessarily prescribed, with no benefit to the consumer. There are news reports paint ADHD medications as easy “cure-all” treatments, and that ADHD is no big deal that is easily overcome with medication.

The prescription of the correct ADHD medication often takes many different attempts, as different classes of ADHD medication can have vastly different effects on different people. For each of those drugs, it is required to try several different dosages to the same medication, ranging from minimum dosage, to far exceeding what is necessary. These drugs can have an astounding impact on the quality of work and ability to initiate tasks and stay on topic. They can help restore normal executive function and increase attention span. however, they can also have undesirable side effects. The minor side effects are tolerable, decrease of appetite, insomnia, twitching. The side effect that has the most impact however, is not being yourself. The medications can trigger social withdrawal, aggravation, and dissociative, an almost third person perspective like you’re watching yourself move through life. This can be emotionally damaging to the students who need to take the medication in order to succeed in school, and can have a lasting impression on self esteem and self worth, and self identity.

Most importantly, however, is that ADHD medications will not work alone, and they do not work for everybody. Medication for ADHD is only part of the constant process of trying to control the symptoms, many people afflicted with learning disability also need counseling, tutors, 504 plans for academic assistance, or an outlet to help with excess energy. In addition to medication, the outlet that works best for me is playing classical music on the double-bass, as classical music stimulates the production of dopamine, which is deficient in the ADHD brain, which helps me regulate focus. All of this work and effort is put in not to cure ADHD, but to try and control the symptoms, to be more normal.We often have to put in hours of additional time and effort to complete mundane assignments, only to be called out as lazy and unmotivated because sometimes our hardest efforts look like we tossed our work together in fifteen minutes before class despite the hours of extra work needed just to finish what we started.

ADHD is perceived as being both hyperactive and lazy or unmotivated, unfocused, or not caring about consequences of our actions. ADHD manifests as the compulsive inability to regulate actions and attention. We cannot just “try harder” to focus and ADHD medication and treatment can only help so much. While ADHD medication, classical music, and support from my parents worked well for me, that is not always the case. Sam Schimmel, with a full ride to Stanford and incredible service to the native Alaskan community would not have gotten where he is today had he gone to a public middle school and high school.

Our public elementary school, Bryant Elementary, ranked highest overall in Seattle, demonstrates that even with some of the best resources, students with ADHD are often left unaccommodated and unsupported, sometimes, even ridiculed. it will always be a struggle just to meet expectations for kids with ADHD. Sam was able to succeed because the private school he attended went out of their way to understand and accommodate his learning disability, and with that support, along with the support from his native Alaskan community and finding an outlet for his hyperactivity, Sam was able to achieve great success that he otherwise may not have been able to. ADHD is not choosing to be lazy, unmotivated and unfocused, or hyperactive and compulsive, it is physiologic differences in brain structure and chemistry. Without understanding, motivation, and support from the surrounding community, ADHD can make starting and completing even insignificant events or tasks a constant and persistent struggle.