The ADHD Journey: Progress through shame

By: Chellsea Sparks MA, LPC Associate

I think when everyone hears the words ADHD, we assume that it is someone who can’t focus or concentrate.  We might think of someone who talks a lot or doesn’t think before they act. It is so much more than that. Symptoms of ADHD impact multiple areas of functioning. I like to think about it like an onion with lots of layers and impacts on everyday life, including our relationships with other people. ADHD affects attention, inhibition, self-control, and executive functioning (which is that front portion of the brain related to cognitive thinking and decision-making). This can show up as time management, working memory, organization, self-discipline, future planning, the ability to problem-solve, motivation, and emotion regulation skills. A person with ADHD can experience symptoms in a wide variety of life areas and situations.

It is imperative to acknowledge the different layers of the “onion” that are impacted by executive functioning deficits that are present in the brain with someone with ADHD. These different layers not only affect someone’s ability to function but how they view themselves and others. The first thing is to understand the stigma attached to the label of ADHD. Someone with ADHD may be perceived as lazy, unmotivated, and incapable. Rather than a behavioral issue, however, it may be that their brain doesn’t produce enough dopamine to support the executive function (pre-frontal cortex area) of the brain. Mental health disorders, like physical health disorders, are not a matter of will. I could compare this to diabetes or blood sugar issues. If someone’s body does not produce enough insulin, we wouldn’t shame them for passing out when their blood sugar got too low. In the same way, we shouldn’t shame someone with ADHD for a brain that doesn’t produce enough dopamine to regulate themselves. Rather, we should understand that dopamine needs to be regulated (just like insulin). In addition, our mental and physical health are connected. One influences the other. When you don’t feel good mentally, you don’t feel good physically and vice versa.

We also must recognize the gender differences present in the diagnosis of ADHD. Women are often under diagnosed with ADHD because they don’t present with “normal” (stigma) symptoms of ADHD. Women may mask hyperactive symptoms more often. For example, they may experience racing thoughts rather than running around. Although women may receive a diagnosis later in adulthood it is important to acknowledge how gender limits proper and timely diagnosis. Recent studies into ADHD have just started to include women and explore how this presents in the studies of ADHD in both children and adults.

This is even exhibited by the DSM-5 (what is used to diagnosis mental health disorders). The DSM-5 TR requires that several inattentive or hyperactive-impulsive symptoms are present before the age of 12. This eliminates other, less typical presentations of symptoms. Attention-Deficit/Hyperactivity Disorder is a neurodevelopmental disorder. The DSM-5 TR splits ADHD into two different categories. The first is the inattention category and then second is hyperactivity/impulsivity category. Although the DSM-5 TR has improved and helps diagnosis a variety of issues, we must continue to improve our knowledge and understanding of different disorders. We live in a “hustle” culture. If someone isn’t meeting the “work hard play hard” motto, we may assume they must not be trying hard enough. We might assume something is wrong with them rather than understanding that it could be ADHD. This accounts for some of the shame that can occur with ADHD.

ADHD is a self-regulation deficit disorder. Dr. Russell Barkley states, “my theory, therefore, is here called the executive functioning-self regulation (EF-SR) theory. It suggests that ADHD should be renamed executive functioning deficit disorder (EFDD)- or better yet, self-regulation deficit disorder (SRDD). ADHD by its very nature seems to affect virtually all executive functions to varying degrees, so it makes sense that these are the deficits that should be guiding our efforts at differential diagnosis and management. Because these executive function deficits disrupt, account for, and predict the numerous impairments experienced by those with the disorder across their life course, they should also guide treatment planning and provision of the clinical, educational, occupational, health, and related services that those with ADHD need to function optimally throughout life” (p. 1).

Someone with ADHD may experience self-messages and messages from the world that they aren’t good enough. ADHD isn’t just the inability to focus but also feeling isolated and inadequate compared to neurotypical peers. An individual with ADHD may feel shame, experiencing judgement from others or the world. Shame affects not just what someone thinks but who they believe they are as a whole person. Shame may develop from the continual failure to meet expectations from others. This includes expectations from friends, parents, teachers, spouses, bosses, and others. For people with ADHD, corrective or negative messages are being sent constantly because of their inability to self-regulate. ADHD and the Epidemic of Shame reports that “it is estimated that those with ADHD receive 20,000 corrective or negative messages by age 10” (William Dodson, M.D., LF-APA 2022). Someone with ADHD might view themselves as different and not good enough. Many people with ADHD experience low self-esteem and withdraw from others because of the stigma and shame. This reinforces the “not good enough” message.

In conclusion, our words and language matter to our neurodivergent companions. Someone with ADHD internalizes self-talk and talk of others. Progress can happen with the right support to build the skills to improve executive-functioning. We can help people with ADHD progress through the shame and stigma by education, improving our language and words towards neurodivergent individuals, and providing support to others. As a society we can continue to support our neurodivergent people by not using shame as a tool. To my neurodivergent children, thank you for teaching me how to be a more patient and less shame driven.

Click here to learn more about Chellsea’s work or to view her contact information.

References:

Barkley, R. A. (2022). Treating ADHD in children and adolescents: What every clinician needs to know. The Guilford Press.

Dodson, W., Dodson, W., & Verified. (2022, August 24). ADHD and the epidemic of shame. ADDitude. https://www.additudemag.com/slideshows/adhd-and-shame/#:~:text=For%20people%20with%20ADHD%2C%20shame,as%20fundamentally%20different%20and%20flawed.