The Different Faces of ADHD

The Different Faces of ADHD
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The classic signs of ADHD (inattention, hyperactivity, and impulsivity) don’t tell the whole story. Three of ADHD’s most powerful characteristics are less understood: hyperfocus, emotional hyperarousal, and rejection sensitivity.

There are specific criteria psychologists must consider before making an official diagnosis. They are laid out in the DSM-5, the diagnostic manual for psychology and psychiatry. However, out in the world, most people have a common understanding of ADHD. If you ask, they will give you an explanation that includes hyperactivity, restlessness or trouble focusing.

In therapy, there are three other very common characteristics that show up across a wide variety of people: 1) an interest-based nervous system 2) emotional hyperarousal and 3) rejection sensitivity. Let’s look at each of these.

What is an interest-based nervous system?

Attention and concentration that varies over time and that is strongly influenced by the environment and the activity at hand, are core features of ADHD. These features create a lot of inconsistency in a person’s behavior. When you are really interested in something, it helps you hyperfocus. It creates a sense of urgency and hours can go by while you are absorbed in a task. But you’re also the same person that has trouble following through on something that doesn’t feel relevant or is of low interest to you.

Many times, other people can misunderstand or misinterpret this inconsistency. They may feel frustrated and criticize you, saying you’re being selfish or self-absorbed because you are not motivated to act. This can be in response to a teacher’s assignment, a project assignment by a supervisor or a request from a spouse or friend. That’s because the ADHD nervous system is interest-based, rather than importance- or priority-based. Importance, rewards and negative consequences are less effective for people with this type of neurodiversity.

Options to manage an interest-based nervous system

An effective ADHD management plan needs several parts. First, you may seek a medical evaluation for the appropriateness of medication. It can “level the playing field” and help your neurological system keep up with the demands of your daily life. Next, you’ll need a new set of rules that help you get engaged “on demand”. As said in a previous blog post, motivation isn’t coming. Waiting for that spark to happen will be a long wait. That’s because most organization systems rely on that spark of importance or priority. Instead, ADHD neurology needs an environment that sparks interest. Thinking about your positive work experiences from the past, your optimal work conditions, and recreating them to get things done in the present.

What is emotional hyperarousal?

Most people expect ADHD to create hyperactivity that can be observed by others: toe-tapping, hair-twirling, cracking knuckles, and so on. These behaviors only explain 5-25% of the person’s experience. Instead, a lot of the emotional hyperarousal is internal, leading to comments like “I’m always tense.” or “I can’t turn my brain off and relax.”

People with ADHD tend to have higher highs and lower lows than their non-ADHD peers.  This means you may experience both more intense happiness and be more vulnerable to criticism. In childhood, people with ADHD start to know they are “different,” but are not equipped to understand why. This, in turn, can easily lead to feelings of low self-esteem, inadequacy and shame. Going into adolescence and adulthood, these feelings can harden into harsh internal dialogues and rigid, negative thoughts about oneself.

Often, people with ADHD are first misdiagnosed with a mood disorder because of the increased intensity of mood that’s related to ADHD. What’s the difference? Mood disorders are more stable, are separate from the events of the person’s life, and often last for more than two weeks. Moods created by ADHD are intense but are almost always triggered by events or perceptions, and usually resolve very quickly.

Because of this subtle difference, there is a lot of trial and error with medications that can leave someone feeling very frustrated. On average, an adult will see 2-3 clinicians and go through 5-6 medication trials before being diagnosed correctly.

Options to manage emotional hyperarousal

To counteract feelings of shame and low self-esteem, people with ADHD need support from other individuals who believe they are a good or worthwhile person.  Of course, the affirmations should be genuine and sincere. The key is to separate “who they are” from “what they do”. Most children are not able to make this distinction and uncorrected, this misunderstanding can continue into adulthood. ADHD and it’s related issues are not something a person can “power through” or just “tough it out”. Instead, we need to recognize that there’s something else that’s getting in the way and it needs to be understood. Learning how to succeed with their unique nervous system is the true key to reducing feelings of shame and low self-esteem.

What is rejection sensitivity?

Rejection sensitive dysphoria (RSD) is defined as “an intense vulnerability to the perception (not necessarily the reality) of being rejected, teased, or criticized by important people in your life”. RSD causes extreme emotional pain that may also be triggered by feelings of failure to meet either your own high standards or others’ expectations. To others, these strong feelings can look like flashes of rage and can seem irrational and volatile. On the other hand, some people try to minimize the feelings of rejection by working hard to please others. This can happen at the expense of their own well-being. A third option is to avoid others and avoid the risk of getting rejected. This too comes with a huge social and emotional cost.

Options to manage rejection sensitivity

Therapy can address RSD by increasing awareness and adjusting one’s thoughts and feelings using the evidence around us (reducing distortions). In time and with effort, people with RSD report feeling more resilient or able to “bounce back” sooner from a negative experience. While they may still see the same potential triggers, they are less intensely affected by them.  Their reactions are more muted and more in line with the actual situation. People also report that their thoughts aren’t racing, and the pace is more manageable, instead of leaving them feeling overwhelmed.

Dr. Menon helps smart, sassy, successful, and intelligent girls and women to feel more genuine and accepting of themselves so that they can feel comfortable in social situations and enjoy themselves. You can air out those old feelings of social failure in session. Whether you are in a caretaker role, a perfectionistic mom with an overthinking brain or a student feeling the pressure to perform, Dr. Menon helps women who are feeling anxious because they are doing it all and are terrified of failing. She uses the science and practices of ADHD management strategies and executive functioning skills. You can use them in a variety of everyday situations and develop a roadmap to reach any type of goal. Book your free consultation now.

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