ADHD is widely misunderstood, even by many professionals in healthcare and education

Recently a number of media reports have expressed alarm about the increasing number of children and adults being diagnosed and treated for ADHD.  There have also been news reports about some colleges and universities refusing to provide ADHD assessments or medication for students because of concern about increased use of ADHD medications by students who have not been adequately evaluated or diagnosed with ADHD.

Much of this fear appears to be based on fundamental misunderstandings of ADHD—what it actually is, what causes it, how it can be appropriately assessed, and what medications used to treat it actually do and don’t do.  One reason for this lack of understanding is that most physicians and other health care providers are provided little or no professional education about ADHD. The unfortunate effect of this lack of training is that many medical professionals are unaware of how to provide appropriate assessment and ongoing treatment for ADHD.

Some health care providers attend continuing education courses or workshop sessions to learn about ADHD, but coverage of this very common disorder in the curriculum of most medical and nursing schools is superficial, outdated, and often non-existent.  Similar problems exist in most textbooks and curricula for professional education of teachers and school psychologists

Some common misunderstandings of ADHD include

  • Failure to understand that most persons with ADHD can focus very well on a few specific activities in which they have strong personal interest or when they are afraid that something very unpleasant will happen very quickly if they don’t take care of this task  right now. This leads many to think that persons with ADHD simply lack willpower and could work much more effectively all the time if they really wanted to. It is difficult for many to understand why these shortcomings can’t be fixed simply by more effort. They don’t see that most of these operations are unconsciously determined by automaticity.
  • Failure to understand that ADHD is not an “all-or-nothing” experience like pregnancy where one either is or is not. It is more like depression.  Everyone gets sad and bummed out sometimes, but we don’t diagnose a person as clinically depressed if they are just unhappy once in a while.  All of the symptoms of ADHD are problems everyone has sometimes, but diagnosis of ADHD should be made only when a person is significantly and chronically impaired by those symptoms.
  • Failure to understand that medications for ADHD cure nothing; they do not eradicate ADHD impairments as an antibiotic might cure an infection. For about 80% of those diagnosed with ADHD, prescribed medications can significantly alleviate ADHD symptoms.  However, the benefits of these medications end when the medication wears off each day, just as eyeglasses provide no improvement of vision while they are not being worn.
  • Failure to understand that none of the medications for ADHD work effectively for everyone diagnosed and that the amount and timing of stimulant medication for a given individual has not much to do with age, weight, or severity of symptoms. It depends upon how sensitive that person’s body is to that medication and how quickly they metabolize it. Ongoing fine-tuning of dose and timing is essential for successful treatment.
  • Failure to understand that the risks of not treating ADHD effectively are far greater than the risks of providing appropriate treatment. Any medical treatment carries some risks for some people. These risks are minimal for most persons with ADHD so long as their overall health is adequate and their ADHD treatment is appropriately designed and adequately monitored. Risks of not providing appropriate treatment for ADHD include risks of significant problems with education and learning, employment, driving, family interactions, social relationships, self-management and self-esteem. Inadequate treatment also heightens risk of substance use disorder, depression and anxiety disorders.

There is great need for more adequate science-based coverage about ADHD in the media. There is also urgent need for more adequate science-based information about ADHD in the professional education of all health care providers and educators working with children and adults.

16 Responses to ADHD is widely misunderstood, even by many professionals in healthcare and education

  1. Linda Bojman says:

    I agree that ADHD is misunderstood. People today are looking for simply and quick fixes. They do not understand that when the brain is involved there is no quick fix. There is only constant monitoring.

  2. jeanette pool says:

    Coping with disorders is difficult enough, being singled out by educators to try harder (even with full medical reports)does not feel right.
    Please keep educating and let the facts of science speak truth.

  3. Mary says:

    I am a mother of a teenager with ADHD and GAD, and I have been frustrated for a long time with the fact that so many teacher and coaches(sports)in our school system are so uninformed.My son is very bright and his grades go up and down throughout a semester, but he always manages in the last week of each semester to bring the grades up and makes the honer roll, dispite many missing or late grades figured in! Some teacher follow his 504 plan some do not, conversations I have with some of his,it pretty clear they think he could keep up if he wanted to. It does wonders for me to read things like this, and I am going to suggest to a friend on the school board that it should be past on to the right people!

    • lina says:

      Hi my son has ADHD and OCC. There were times when I could hardly understand this ‘attention deficit’ phenomena myself and I am his mother. My son rose to glory on occasion but missed most of his high school education because, while physically present, his brain just wasn’t there. And while his Australia wide scores put him in the top 3% of students in Australia during that year, his teachers continued to fail him for minor curricula infringements. Frusrrations all round. The school didn’t help, omitting to publish the top scoring students and / or congratulating them on their academic success. I did, rightly so, take it personally. For a school rag that published and congratulated on the minor achievements of favourite students, it seemed a blow struck to the student with ADHD. It only added to attitudes from teachers that my son was lazy and defiant. I sympathise and feel a sense of kinship with you and parents of these kids.

  4. Anna says:

    Thank you Dr. Brown for your work! I remember several years ago being at one of your lectures and thinking to myself “Wow this guy explained my ADD better than I could ever explain it!” You hit the nail on the head and it is soooo refreshing to know thee is some one out there that gets us and is committed to educating the world about ADD/ADHD

  5. Jacinta says:

    Excellent Dr. Brown.

    I am fed up with people, especially the media misunderstanding this condition. Live inside my head before you start judging that I am just making excuses! And the uninformed making judgements about medication. I am also concerned about all those who are undiagnosed and wondering why they are not achieving their potential. With better informed health professionals, people can get the right help.

    Educating the world like you are doing is vital.

  6. Margaret Heckler says:

    This article is so true and this just does not affect children and teenagers! As a matter of fact I am trying to convince my husband to go for evaluation and testing but am finding it more difficult because a neurologist my husband went to told him that “adults don’t have ADHD” and then proceeded to do a 5 minute “test” and told him that he did NOT have ADHD. So now whenever I try to revisit the subject my husband insists that he does not have ADHD because this doctor told him he did not! My brother who has ADHD and my sister-in-law also have tried on numerous occasions to convince him he needs to be tested. In the last few years his attention problems have grown worse – in the last month he has lost his glasses 3 times (had to be totally replaced once), lost his keys 4 times, lost our checkbook twice (thank God I found it once and the Vet’s office call the second instance), lost his watch, lost his sunglasses. I have printed out this material and other material but getting him to sit down and concentrate and read it may be a problem. After 24 years of marriage I am at the point of calling it quits – maybe that will motivate him to get help. Do these health care professions who dismiss adult ADHD even consider how their actions may impact not just the patient but his family?

  7. cam says:

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  8. Linda Brauer says:

    Why is it that the more that is known about AD/HD, the more prejudice people seem to have toward it? I much appreciate the video that Dr. Brown made available several years ago that addressed AD/HD Fears and Prejudices. I shared it with our Community Mental Health Board and a few weeks ago with the director of an organization working to reduce rates of crime, who had expressed interest. I first wanted to prepare her for the inevitable objections she will encounter. I believe there is more stigma with AD/HD, than other diagnoses, even within the mental health community, because it is regarded as “not serious” in public systems, here. Billing clerks tell me AD/HD isn’t covered if its someone’s primary or only diagnosis, that it has to be secondary to another diagnosis. But it may be someone’s first diagnosis, and treatment may prevent someone from becoming anxious and depressed. I am concerned these beliefs are changing the standard of care. Teachers are being told to not mention to a parent that a child might have AD/HD, yet they screen for vision and hearing problems. One man told me that because he admitted to having smoked pot in his youth, that he has not been able to be prescribed a stimulant as an adult, but what if someone were self medicating? I thought that perhaps it’s because AD/HD looks like deliberate misbehavior, and people believe sins must be punished, but our state recently passed bills to address autism. There is compassion for Autism. You would think people would see getting treatment as taking responsibility. I think we have a lot more work to do to help people understand there is help for this, now! It’s good we have Doctor Brown’s book to refer to, but doubt that the people who need to read it most, will, not until they are diagnosed and treated!

  9. Marlene Mauk says:

    Dr. Brown,
    I wish that every psychologist and psychiatrist who works in substance abuse treatment centers were required to read your work. My 21 year son began smoking synthetic marijuana as a teenager. He has been in 2 drug rehab treatment centers, where he was told he had problems with impulse control, had anger issues, difficulty regulating his behaviors and at one center was diagnosed with oppositional defiance disorder and at the other was diagnosed as bipolar. Additionally, our family psychologist diagnosed him with minor depression. We informed both centers that he had been diagnosed with ADHD when he was 7 years old and that it was severe. However, neither facility addressed the ADHD as part of their treatment. The center that treated for dual diagnosis sent him home with 7 different medications, including an anti-seizure drug, an anti-depressant, a mood stabilizer, a sleep aid and God only knows what else. Yet not one medication was prescribed to address the ADHD. Incomprehensible. I asked one of the centers why they did not prescribe something for the ADHD and they replied that they would not because the stimulants are controlled substances. Now my son thinks that he doesn’t need the medication because the good doctors at the centers would not prescribe it. My son was discharged early due to many minor behavior infractions and we are still trying to find a center that understands the role that ADHD plays in his behavior issues. I know from experience that his behavior is like night and day when he is on his ADHD medication. Your work could do so much to help those in the substance abuse centers understand the seriousness of ADHD and its effect on behavior.

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