Attention deficit hyperactivity disorder
An unstructured collection of my thoughts about ADHD
Last year I was diagnosed with ADHD at age 20, and prescribed daily Adderall. I was a bit unnerved by how easy it was to get the diagnosis. I walked in to the doctor’s office, smalltalked for a brief moment, and then:
ME: Hi, I’m not trying to self-diagnose or anything, but after giving it a lot of thought I think I might have ADHD. I have struggled with severe procrastination issues as long as I can remember, I talk too much and dominate conversations, and I obsessively collect and discard hobbies and skills.
DOCTOR: Well, I think you’re clearly smart enough that you know all the “right answers” to the DSM-5 diagnostic questions.1 So we’ll just skip that test.
ME: That… makes sense.
DOCTOR: I believe what you’ve told me. I have ADHD myself, and I think it’s pretty obvious you do as well. I’ll just give you a prescription for the lowest dose of Adderall, and I’ll call you in 2 weeks to ask how it’s working out for you.
That was it. I went from meeting this doctor (this was my first doctor’s visit since I moved to Los Angeles) to being diagnosed and prescribed within about 5 minutes.
I’ve been taking Adderall each workday for over a year now. I choose to take weekends and holidays off because I worry about becoming dependent. Even after a year of this, though, I still occasionally feel uneasy about the whole scenario.
It’s harder for most people to get Adderall than it was for me. There’s some evidence to suggest ADHD might overdiagnosed in men, and underdiagnosed in women. I’ve spent a lot of hours wondering if maybe I don’t really have ADHD, if maybe I’m really just lazy; looking for an excuse to hide behind.
It doesn’t help that ADHD is not a well-defined thing. It’s a label placed on a collection of symptoms, but we don’t really understand the actual physical causes of ADHD. You might hear people talk about neurotransmitter concentrations or thalamus morphology or whatever, but none of that actually describes an etiology.
The rate of ADHD diagnoses has skyrocketed in recent years.2 Historically, ADHD was considered to be mainly a childhood diagnosis. Now, more than 1 in 25 American adults are diagnosed with it. Nobody knows why the rate has gone up, though there are plenty of folks who think they do. My own unfounded speculation is that it’s more of a nurture thing than a nature thing. But it is largely heritable and there is a proven genetic factor to it, so who knows?
My grandpa tells me he believes it’s because of glyphosates in our food.3 For all I know, he could be right.
Since I’m already speculating—I suspect ADHD and autism are two sides of the same coin, manifesting in different ways. Around half of autistic people meet the criteria for ADHD, and around a third of ADHD people meet the criteria for autism.4
This doesn’t really tell us all that much though, because like ADHD, Autism Spectrum Disorder does not have an etiology—it’s just a label on a bucket of symptoms. My personal unfounded speculation: the underlying etiologies for both ADHD and autism are the same or closely related.
But I’m not too attached to that theory. It’s probably wrong.
Another thing ADHD and autism have in common is that they appear to be spectral rather than binary. You can have ADHD, but you can also have mild ADHD, severe ADHD, hyperactive-type or inattentive-type ADHD. You can also be anywhere from “mildly on the spectrum” to “high-functioning” to “requires constant care” when it comes to autism.
I have a friend who doesn’t believe in treating ADHD with stimulants. They’re strongly against it. They think Adderall is a crutch. To some degree, I’m inclined to agree—it does feel like a crutch for me sometimes.5 But crutches are great for people whose legs don’t work!
Now that it’s been a year, I sometimes wonder if I still need the crutch—if maybe I’ll always need the crutch—or if I’ve simply grown too accustomed to having it. As it stands, I think I still need it, especially so long as I continue to work my current job.6
The thought of taking Adderall for a very long time scares part of me. “What if you permanently damage your neural circuitry by strongly conditioning your brain to expect Adderall-dopamine?” it says. The other part of me says “Well, if it helps you, why not? Besides, you don’t have any real evidence that permanent damage is really a threat here.” Depending on my mood, those voices each take turns being the loud one. My uneasiness is compounded by the fact that there is very little research on the long-term effects of taking dextroamphetamine salts. I’m one of the guinea pigs—me and 4.4% of Americans, anyhow.
I’m not sure what the point of this blog post is. I guess I just have a lot of thoughts about ADHD, and I wanted to write them down and put them into the world somehow. Talking about having ADHD often makes me feel silly, because it’s become such a buzzword recently—it seems like everyone and their dog has it these days.
I’ll end with a few questions that I think about on a regular basis:
What is ADHD, really? What’s the etiology?
Similarly, what’s autism, really? How is ADHD linked to autism?
How much of my own personal failings should I allow myself to attribute to “the way my brain is?”. 100% seems absurd, but so does 0%. After all, everyone has some genetically determined strengths and weaknesses.
During Adderall shortages, is it moral for me to fill my own prescription despite the fact that doing so may deprive someone else of their meds who needs them more than I do?
If I keep taking Adderall responsibly for another 10 years, will I regret it? Should I regret it? Am I exposing myself to real risk? If I am, how does that risk weigh against the present-day advantages of continuing my prescription?
Is my self-talk about all this healthy? Am I too hard on myself? Too easy on myself? Am I overthinking everything?
Is it bad that I hoped my doctor would diagnose me with ADHD? Shouldn’t I have been more apprehensive? Is it possible I tricked myself into believing I was neurodivergent just so I could get attention?7
I don’t know the answers to any of these, and I expect nobody who reads this will know them either. Indeed, several of these questions are highly subjective and probably don’t even have “correct” answers. But they’re questions which constantly bounce around in my skull regardless.
Thanks for reading.
While I did look the DSM-5 criteria up before the appointment, it was mostly because I was afraid I’d forget to mention something relevant. I had every intention of answering all diagnostic questions the doctor asked 100% honestly, even if that meant giving a “wrong” answer.
The rate of debilitating autism (meaning autism severe enough that the person requires constant caretaking) has also risen extremely over the past 50 years.
Considering that the glyphosates he was exposed to as a young man probably contributed to him getting Parkinson’s, I think it’s a reasonable hypothesis. Of course, correlation is not causation, but the correlation does seem to be present.
The exact comorbidity rates vary wildly from study to study, but it’s clear that there is significant overlap between the two conditions. Anecdotally, I’ve found that I naturally tend to surround myself with people who I later discover are diagnosed with either ADHD or autism. It happened in high school, it happened in the gap year I took after high school, and it has happened in online circles since I moved to LA. I’ve always found it fascinating how ADHD and autistic people seem to subconsciously group up like this.
To be clear, I’m talking only about my own experience here. I don’t think it would be wise for me to project my own experiences onto other people.
Again, it’s really a lovely job and my coworkers are lovely people. But I still routinely freeze up and panic at work without my meds.
I think the answer to this is no, but the doubts still arise anyways.