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What It‘s Like to Have ADHD: Presentations Change Throughout Life



Having ADHD is like being in a room with a 1,000 TV sets turned on, but all on different channels.

“Now try and concentrate on just one TV without getting distracted,” Damian Aird asks the readers of The Mighty, a community platform for people coping with mental health conditions. For him, that is what it is like to have ADHD.

Other people describe their experiences with familiar examples: a browser window with too many open tabs, a cat unsure which red dot to chase, a tornado of thoughts or the constant feeling of forgetting what you went into a another room to get.

For other people, it’s a feeling of needing to be in motion or being surprised by what you just said, because you hadn’t planned on saying that. 

There are three main “presentations” or ways of having ADHD for both adults and childern. Some people will display the behaviors of just one presentation while others will slide among the three presentations at different points during their lives.

One condition, three presentations

Attention-deficit/hyperactive disorder, commonly called ADHD, is a brain-based condition experienced by both children and adults. It’s marked by difficulties with maintaining attention, short-term memory, organizing thoughts and decisions, and often, but not always, accompanied by restlessness, feeling “on the go,” and highly active behaviors and impulsive actions.

The recent revisions in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, (DSM-5), describe three ADHD presentations:

  • Predominantly inattentive presentation
  • Predominantly hyperactive-impulsive presentation
  • Combined presentation
Until the 1990s, ADHD was often considered to be two separate but related disorders: ADHD and attention deficit disorder, or ADD, reflecting the lack of externally hyperactivity. Today, what was referred to as ADD is known as ADHD, predominately inattentive.

Changing from ‘types’ to ‘presentations’

The three ways of having ADHD used to be referred to as subtypes until the DSM-5. Why the change from “types” to “presentations?” The members the American Psychiatric Association’s DSM-5 committee believed it more accurately reflected the lived experience of people affected by ADHD. 

“The change…reflects increasing evidence that symptoms are often fluid within individuals across their lifespan rather than stable traits,” write Jeffery N. Epstein, PhD, and Richard E. A. Loren, PhD. “The ‘presentation’ terminology better reflects that the symptom profile represents the person’s current symptomatology, which may change over time. The ‘type’ terminology implied more stable, trait-like characteristics.”

Dr. Epstein and Dr. Loren give the example of a very busy child, diagnosed with ADHD with hyperactivity. As the child grows, he still experiences difficulties with attention and executive function but the symptoms of hyperactivity seem to fade away or become more internalized. The presentation then changes as the child grows into a teenager or young adult, from predominately hyperactive to predominately inattentive.

What it’s like to have ADHD

The newer presentation description helps to make the diagnosis of ADHD more reliable but it is the day-to-day experiences of those affected by ADHD that help us to best understand what it’s like to have the disorder. CHADD worked with The Mighty to find adults affected by ADHD who wanted to talk about their experiences:

“My mind is in 100 different spots at once,” says Mike Moon. “Each of them seems equally important to get done and it seems like I have to get them done all at once. I bounce from one thing to another. My mind is in a fog that I can’t clear.”

“For me it is a constant struggle to remember,” says Angelique Landy Borgmeyer, “to remember what needs to be done next, what needs to come first, what I need to bring for an appointment, when an appointment is, what time I need to leave, what I have to make dinner with, when I need to pay a bill, and that’s just one day.” 

“Then it’s not being able to ever sit still, shaking yourself to sleep at night with energy, tapping anything (foot, hand, pen, etc.) and being constantly jittery and jumpy,” says  Zoe Klumph.


Researchers are looking at how ADHD appears differently among children than in adults, along with the differences between men and women affected by ADHD, especially since women seem to have the inattention presentation more often and are diagnosed later.

A better understanding of these lived-experiences is needed, researchers say, to help ADHD treatment specialists create more developmentally-informed clinical practices that meet the needs of the person affected by ADHD where he is at that time of life. ADHD symptoms can change, becoming less troublesome in some regards as a person grows, but at other times becoming more aggravated or severe depending on life circumstance (family, career, or major life changes) or normal life changes, including entering puberty for boys and girls and menopause for women.

Where you are at present

Just because your ADHD symptoms have changed, doesn’t mean that your diagnosis will necessarily change. ADHD can continue to present major challenges to executive function and can affect every part of life, including family, school, work and social life. 

In addition to working with your doctor or ADHD specialist, some people opt to work with therapists or coaches as part of their treatment plan. Many children will benefit from an academic accommodations plan at school. Your unique needs as a person affected by ADHD, or the needs of your child, may change over time, but the treatment and resources available for ADHD can support you through those changes and help you be successful, regardless of your previous or current ADHD presentation.

To learn more: 


This article appeared in ADHD Weekly on August 31, 2017.
     


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