ADHD, language, and the burden of belief
ADHD is having a moment. The perfect storm of pandemic stress and social media awareness has driven an uptick in ADHD diagnosis — and with it, a blast of skepticism.
This isn’t new.
I have ADHD, or attention-deficit hyperactivity disorder, and I’ve researched and written about the topic for years. During that time, I’ve encountered many people who have debated the legitimacy of ADHD. And I’ve read what feels like a thousand ill-informed think pieces, variously arguing that the disorder is over diagnosed, fake, caused by TikTok, or a ploy to get Adderall or attention.
It’s never pleasant to have people aggressively deny your lived experience. Still, these are not the conversations that give me pause.
Instead, it’s moments like last week at the park when another parent asked what I do for work. When I told her that I specialize in writing about ADHD and learning differences, she gave me a vague look. “Doesn’t everyone kind of have ADHD?” she asked.
Most of us with ADD or ADHD have heard some off-the-cuff version of “I’m so ADD right now” or “Doesn’t everyone have it?” Or had friends who are feeling overwhelmed by their to-do list joke that they might “have it too.”
We’ve made great strides in how we talk about disability and neurodivergence. But ADHD still seems to be fair game. Shorthand for a bad day, a lapse in willpower, or a stupid mistake. A label to claim, and cast off, at will.
And I get it. Everyone has ADHD traits sometimes. That doesn’t mean everyone has ADHD. And when people casually attribute their difficulties to the disorder, it increases the burden of proof – and otherwise – for those of us who really do have it.
When asked about the threshold for diagnosis, most clinicians will use the same word: impairment: When the symptoms of a disorder begin to impact a person’s ability to function.
Someone without ADHD might misplace their shoes occasionally, but not every day. They don’t have to rely on endless strategies just to get out of the house. They’ve probably been late to a few meetings, but not all of them.
Because when you meet that threshold, it’s not a passing frustration or a one-off mistake. It’s your whole life. And for many of us, impairment translates to real-world damage.
And this is where casual language turns toxic.
I spent most of my life undiagnosed and struggling, desperately trying to conceal what I couldn’t understand. The same question echoing in my brain, “What is wrong with me?”
By the time I was diagnosed at 21, I was barely coping. Scraping along from day to day with no expectations, the future a dark blot. Even with the benefit of understanding and support, it’s taken me decades to learn how to manage the disorder.
But even as I failed or got fired or screamed at, my privilege — white, upper middle class — was still there to protect me. But when ADHD interacts with racism, income inequality, sexism, and lack of support, the consequences can be incredibly destructive.
Black and other non-white children are less likely to be diagnosed than their white peers. And without diagnosis or understanding, many kids don’t get the supports they need to thrive — IEP services, academic accommodations, medication, and therapy.
Children of color are significantly more likely to be punished for symptoms that are beyond their control. Black children with ADHD are at greater risk of being held back, suspended, expelled, or incarcerated.
An example of this is the nightmarish case of Grace, which ProPublica reported on in 2020. A 15-year-old Black teenager with ADHD was sentenced to six months in juvenile detention for failing to complete her homework while on probation, despite having an IEP. The publicity around Grace’s detention provoked outrage, but her situation was far from rare.
Women and girls of all races with ADHD are historically underdiagnosed and underserved. In a landmark longitudinal study, researchers at Berkeley followed 190 girls with ADHD as they grew into adulthood. The girls struggled in ways their neurotypical peers did not, reporting lower levels of self-esteem and higher rates of mental health and substance issues.
Among the girls they studied with ADHD-CT (the diagnosis for someone having both hyperactive-impulsive and inattentive traits), 51% reported that they’d intentionally self-harmed by age 17, compared with only 19% of girls without ADHD. And by the time they reached young adulthood, one-fifth of the girls with ADHD-CT had attempted suicide.
School-age kids with ADHD are more likely to struggle academically and socially, and adolescents have significantly higher rates of substance abuse, driving accidents, certain eating disorders, depression, anxiety, and suicidal ideation. And as we age, people with ADHD are more likely to experience mental health issues and relationship troubles and have higher rates of underemployment and lower self-esteem.
Treatment, understanding, and support can make a huge difference. But for that to happen, the disorder needs to be recognized as real and serious.
When the true impact of ADHD is minimized, or when it’s treated as a joke or tossed off to explain away a bad day, it puts people with ADHD in the position of having to justify to the world and to us that our differences — the things that make us who we are — are real at all.
How we talk about ADHD speaks volumes. It communicates how seriously, or not, we take the disorder. And with stakes this high, that’s no laughing matter.