ADHD Awareness Month? Are We Too Aware of It or Not Aware Enough?

Erin Cullen is a graduate student in the Neuroscience Ph.D. program at the University of Vermont.

In honor of ADHD Awareness month, she shares her thoughts about attention deficit hyperactivity disorder both as someone who has been diagnosed with it and as a neuroscientist.

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On May 29th, 2020, I attended a virtual seminar.

I listened carefully, took detailed notes, and asked clarifying questions. In short, I learned the information that was being taught.

That seminar was a revelation and something I had never experienced before.

Before that May 29th, I would have tried to listen but within minutes my runaway thoughts would have drowned out the speaker, no matter how interesting I found the material. My notebook would have a few notes but would mostly be filled with scribbles, unrelated ideas, and a set of tally marks (an approach employed to stay on track and pay attention). I wouldn’t ask clarifying questions – I’d just assumed that whatever I didn’t understand was something I’d missed during lapses in attention. I would have considered myself lucky to walk away with even a few coherent fragments of information. If I’d really wanted to learn the material, I would have asked to record the seminar in order to listen to it again later, with multiple breaks and a chance to rewind when my attention drifted.

But, May 29th was different.

May 29 was the first day I took medication to treat my attention deficit hyperactivity disorder (ADHD).

I hope that growing awareness and clever, compassionate research can move society toward addressing ADHD in ways that minimize its difficulties while supporting the strengths individuals build because of it.

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The Neuroscience of ADHD

ADHD is highly heritable and genetically complex [1], requiring a “top-down” approach in studying it – starting with human genomics, behavior, and brain imaging, and moving on to research about what is biologically driving the disorder. One large-scale genome study in the United Kingdom found at least 12 genetic variants associated with ADHD in children. These genetic variants are, unsurprisingly, concentrated in regions of the genome that are known to be active in the brain [2].

Neuroimaging studies have found that children and adults with ADHD have lower levels of activity in certain brain regions associated with inhibitory control (the ability to hold oneself back from taking an action) [3]. This finding explains why stimulant medications, which on the surface seem like a counterintuitive choice for treating a disorder characterized by too much activity, successfully treat symptoms in 80% of cases (a rare success for a psychiatric medication). These medications increase the typically low activity in these regions to normal levels [4].

In early 2020, I stumbled upon a poster at the University of Vermont Neuroscience, Behavior, & Health Forum. The poster presented findings by UVM researchers who, using an fMRI scanner, discovered that children with ADHD symptoms have impaired activation of task-positive brain regions, which facilitate concentration, and impaired deactivation of task-negative brain regions, which activate during introspective moments when the brain is not focused on anything in particular [5]. This result suggests that, to a greater extent than in neurotypical individuals, there is an overlap in activity between task-positive and task-negative regions.

On the poster was an explanation for why I struggled so much to pay attention in lectures – my brain couldn’t properly switch from a state of inattention to a state of attention.

Why Should We Care About ADHD Awareness?

ADHD is not a personality quirk, a consequence of digital technologies or medicalization of childhood, or a ploy by pharmaceutical companies.

ADHD is a well-defined neurodevelopmental disorder that is associated with educational underachievement, traffic accidents, serious injuries, early mortality, substance abuse, psychological disorders, and other adverse life outcomes. Fortunately, these outcomes can be mitigated by medication and other treatment strategies, as has recently been observed by a group of 80 expert authors in the recent World Federation of ADHD International Consensus Statement [6]. Increasing public knowledge of the symptoms, underlying biology, and consequences of ADHD can dissolve myths and social stigma about the disorder and empower individuals with undiagnosed or untreated ADHD to seek help.

ADHD awareness is also an unignorable element in the pursuit of social justice.

ADHD is massively over-represented in prison populations, with an estimated 26% of incarcerated people meeting diagnostic criteria for ADHD, compared with approximately 5% of the general population [7]. At the same time, ADHD is under-diagnosed and under-treated in Black and Latino populations in the United States, the primary victims of mass incarceration [8].

ADHD awareness is an unignorable element in the pursuit of social justice.

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Embracing Neurodiversity

Despite the challenges it can pose, with the right environment, support, and resources, ADHD can facilitate the development of particular strengths.

It has been theorized that traits we now describe as “ADHD” were once selected for in the history of humanity, and a particular genetic variant associated with ADHD may be part of the reason why paleolithic humans eventually explored and populated the whole earth [9, 10]. Even in modern times, some individuals with ADHD see their disorder as a positive force in shaping fulfilling lives and careers.

Traits that are “symptoms” in classrooms may be assets in the fast-paced world of business and fuel the creative inspiration that drives a career in the arts.

Personally, I find that my inattention and distractability are occasionally useful in my work as a researcher – these traits push me to come up with unusual questions and creative solutions to problems.

As a graduate student in neuroscience, I spend all day looking at, talking about, and thinking about brains, and yet writing about my own brain feels terrifyingly intimate.

Unfortunately, in a society not entirely accommodating of neurodiversity, ADHD still often, and in many minds, occupies an awkward space between disability and character flaw.

This stigma around my ADHD symptoms sometimes makes me feel like a lab rat dressing up as a scientist. I don’t expect that this contradiction will ever fully fade, but I’m excited for what the future holds. I hope that growing awareness and clever, compassionate research can move society toward addressing ADHD in ways that minimize its difficulties while supporting the strengths individuals build because of it.

References

1. Grimm, O., T.M. Kranz, and A. Reif, Genetics of ADHD: What Should the Clinician Know? Curr Psychiatry Rep, 2020. 22(4): p. 18.
2. Demontis, D., et al., Discovery of the first genome-wide significant risk loci for attention deficit/hyperactivity disorder. Nat Genet, 2019. 51(1): p. 63-75.
3. Gallo, E.F. and J. Posner, Moving towards causality in attention-deficit hyperactivity disorder: overview of neural and genetic mechanisms. Lancet Psychiatry, 2016. 3(6): p. 555-67.
4. Rubia, K., et al., Effects of stimulants on brain function in attention-deficit/hyperactivity disorder: a systematic review and meta-analysis. Biol Psychiatry, 2014. 76(8): p. 616-28.
5. Owens, M.M., et al., Correction to: Multimethod investigation of the neurobiological basis of ADHD symptomatology in children aged 9-10: baseline data from the ABCD study. Transl Psychiatry, 2021. 11(1): p. 216.
6. Faraone, S.V., et al., The World Federation of ADHD International Consensus Statement: 208 Evidence-based conclusions about the disorder. Neurosci Biobehav Rev, 2021. 128: p. 789-818.
7. Young, S., et al., A meta-analysis of the prevalence of attention deficit hyperactivity disorder in incarcerated populations. Psychol Med, 2015. 45(2): p. 247-58.
8. Coker, T.R., et al., Racial and Ethnic Disparities in ADHD Diagnosis and Treatment. Pediatrics, 2016. 138(3).
9. Matthews, L.J. and P.M. Butler, Novelty-seeking DRD4 polymorphisms are associated with human migration distance out-of-Africa after controlling for neutral population gene structure. Am J Phys Anthropol, 2011. 145(3): p. 382-9.
10. Abed, R., et al., Evolutionary biology: an essential basic science for the training of the next generation of psychiatrists. Br J Psychiatry, 2019. 215(6): p. 699-701.