Adult ADHD Part One … What is ADHD (and Can You Grow Out of it)?

Growing up, even though I was the oldest, I was more forgetful and disorganized than my siblings. I was (and am) more of a TV junkie. I got lost very easily (still do). I was a bookworm, to the point that I would ignore everything and everybody. I was also more emotionally expressive. This meant that I got angry easily, but it also meant that I wore my heart on my sleeve and couldn’t help sharing whatever was going on with my inner world to any loved ones. As a young teenager, I remember my sister thinking I was weird for telling my mom about my first kiss! Like many adults these days, in looking back I wonder if I had ADHD. And what does that mean today? Do I have adult ADHD?

I still have all these qualities, but to a much lesser extent than when I was young. Everything has gotten way easier as an adult. Don’t get me wrong, I’ve still gotten myself in trouble numerous times. Even today, when travelling with my husband he worries about me taking charge of my own passport!

It never occurred to me or anyone around me that I might have ADHD. Today (in my early fifties), I’m okay with that. But now I have family members who have gotten the diagnosis, and are young adults.

Why Write About Adult ADHD?

In many ways, ADHD is still seen by many people as a problem that only children have. When we grow up, we’re not supposed to struggle with these things anymore. But I want my loved ones to grow up not feeling ashamed of who they are. I want them to be proud, and to have people in their life who don’t judge them or make them feel broken when they forget things or make mistakes. Ideally, my loved ones will understand and accept their whole selves – both the amazing parts and the more challenging parts. I want them to have language to explain themselves to others. This blog series is written for them, as well as all other adults with ADHD on this path to self understanding.

Part two will offer everyday examples of what adult ADHD looks like in real life, and connect those examples to specific brain tasks. Part three will focus on what helps to mitigate the challenging aspects, and share ways to help people with ADHD better understand how to use their unique brains for good.

This blog entry is also for the families. I’ve been there too, feeling frustrated or hurt, not understanding why the same behaviours with my loved ones come up again and again. So, I went on a quest to learn more. Let’s start with some definitions.

What is ADHD?

ADHD is a delay or dysfunction in the part of the brain responsible for “executive functioning“. Most of that responsibility is located in our frontal lobes (or prefrontal cortex). In human history and development, as our brains got bigger over millennia, our frontal lobes developed last. Prehistoric people mostly just had to react to what was in front of them. They didn’t have to plan and organize themselves, monitor and adjust their behaviour!

As an aside, it needs to be mentioned that under current diagnostic criteria, there are three kinds of ADHD: primary hyperactive, primarily inattentive, and combined (struggles with both). There is some research that demonstrates that primarily inattentive ADHD is a completely separate disorder, in a diagnostic category of its own. For example, people who have the primarily inattentive subtype do not necessarily struggle with impulsive behaviours. They might even do the opposite – overthink decisions! But separating out “with hyperactivity” and “without hyperactivity” has not made its way to full medical approval. (Further comment on this is beyond the scope of this series.)  

For those (like me) who might be wondering if they have adult ADHD, note that current diagnostic criteria requires that you had to have experienced symptoms starting before the age of twelve.

What is Executive Functioning?

My husband worked for many years as Executive Director of several different non-profit societies. So, I’ve always explained executive functioning as the “boss of our brain”. It’s the part that tells all the other parts what to do next. When someone’s boss isn’t doing their job, they might “struggle to analyze, plan, organize, schedule, and complete tasks at all — or on deadline. They misplace materials, prioritize the wrong things, and get overwhelmed by big projects” (Barkley, 2022). It’s like the boss stayed home and watched TV all day while the workers couldn’t figure out what they were supposed to be doing!

Who are the workers? They are the core skills that are required of the executive functioning part of our brains. They help the boss gets the job done! According to Dr. Barkley, there are seven:

1. Self-Awareness: recognizing social cues and connecting them to one’s own behaviour
2. Inhibition and Impulse Control: the ability to show self-restraint
3. Non-Verbal Working Memory: the ability to “see” the task as done in your mind, as well as seeing the steps it takes to get there.
4. Verbal Working Memory: our inner monologue or self-talk, remembering instructions
5. Emotional Self-Regulation: the ability to stay (relatively) level in our mood, respond rather than react, and restrain emotional expression when needed
6. Self-Motivation: being a self-starter, even when the task seems a bit boring or is not urgent
7. Planning and problem solving

Remember, the above list is seven different workers running around in your brain. (Still with me? I like to imagine them the way Disney depicted the four primary emotions in the movie “Inside Out”.) Each one has a different job description — but sometimes they have to work on a team. For example, to avoid emotional outbursts, Impulse Control (#2) might have to work together with Self-Regulation (#5).

By the way …

Depending on which expert you are reading, this list often goes by different names. Some sources will say there are eight core skills, or others might say there are twelve. This used to confuse me. For example, instead of “Planning and Problem solving” (#7), Planning and Organizing might be viewed as one core skill, while Adapting and Problem Solving might be another. In the end, it doesn’t really matter. The concept is the same.

Rather than seven, eight or twelve, Dr. Diamond (2012), a neuroscientist from UBC, collapses the skills into three umbrella domains:

1. Inhibition/Interference Control: the ability to restrain oneself and block out distractions,
2. Working Memory: vital for being able to remember, plan and carry out directions, and
3. Cognitive Flexibility: the ability to plan, adapt and problem solve.

*Note in the list of three above that the ability to plan and carry out tasks (what so many struggle with) appear in both #2 and #3. These are complex brain tasks involving several different core executive functioning skills. Yet another area where your “employees” have to work as a team!

Don’t “Try Harder”, Instead Try Differently!

What is the key takeaway? ADHD is an impairment in these core skills. And every single one of these things is wired into our brain! Take a moment and think about what that means. It’s not a matter of trying harder. When you (or your loved one) can’t remember to always put your keys back into the same spot, so you will know where to find them the next day, consider all the different executive functioning skills that are involved to carry this out successfully. Consider that you wouldn’t ask a person with a sight impairment to read something (in print) to you. You wouldn’t tell them to try harder. Instead, you’d find a way of helping them to read differently eg. braille, audio recordings, etc. I’m hoping that understanding how complicated the task is that you are asking your brain to do in finding your keys the next day, will allow you to hold yourself (or a loved one) a little more compassionately than you might otherwise. (More on this in parts two and three of this series.)

Can You Outgrow ADHD?

As a therapist, I am constantly looking for ways to offer to hope to my clients. So this is an important question. The answer is complicated.

On the one hand:

Very broadly speaking, as we grow the above list of seven develops in chronological order in our brains. According to Dr. Barkley, signs of Self-Awareness (#1) develop around age 2, and it’s not until about age 30 that neurotypical adults have attained most of our capacity in Planning and Problem solving (#7). This is mainly true for people with neurotypical brains. (Personally, I didn’t notice a significant improvement in my Working Memory and Self-Regulation sometime after the age of 30! This was the time in my life when I got a lot better at keeping track of my keys, and controlling my temper.)

And if ADHD is defined as a delay (or disorder) in our executive functioning, does that mean you will outgrow it? In other words, everyone else’s brain is fully grown by age 30, so you’ll have caught up by age 35? Well … it’s not that simple. It’s true that symptoms will improve, both because the brain catches up, and because adults have had time to learn needed skills. For some people, especially those where the symptoms are milder, maybe their challenges won’t fall in the “diagnosable” (clinical) level after a certain age. I think I am probably one of those people. In looking at adult diagnostic criteria, these days I don’t meet the cut off to get diagnosed with adult ADHD. I do experience struggles, but nothing I can’t manage or causes any big problems.

On the other hand:

But it’s also true that the world is not made for neurodiverse brains, and those who might experience struggles as children in the moderate range (or higher) will probably continue to experience challenges as adults with ADHD. Several factors may be at play.

1. Years of trying to measure up, blend in and fit in may lead to mental health challenges such as anxiety and/or depression. And sometimes, those symptoms look very much like symptoms of ADHD.
2. To avoid embarrassment, those with adult ADHD may have learned strategies (or hacks) to mask their difficulties and better blend in with neurotypicals. While this works to make life easier, putting on a mask makes it hard to feel authentic, and also comes with hidden stigma.
3. The demands of school are no longer a factor, and adults are (mostly) free to pursue their interests and passions. But new expectations and responsibilities arise, and make new demands on our brains. These might include managing finances, responsibilities at work, or the expectations that come from being in an intimate relationship.

In Conclusion …

So now, if you tell someone that you (or a family member) have adult ADHD, you will know how to explain what that means. It’s a lot more than the kid who struggles to pay attention and keep their body still while sitting in class!

You’ve learned the brain science. What does all this actually mean in real life for adults with ADHD? Learn more about that in part two.

Need more help? Book an appointment with Kirsten today!

Sources

Anon. “Can You Outgrow ADHD?” (medically reviewed August 2021). Retrieved from https://www.healthline.com/health/adhd/can-you-outgrow-adhd

Barkley, R. “What is Executive Function? 7 Deficits Tied to ADHD” (2022). Retrieved from https://www.additudemag.com/7-executive-function-deficits-linked-to-adhd/

Diamond, A. “ADHD (without hyperactivity): A neurologically and behaviourally distinct disorder from ADHD (with hyperactivity)” (2005). Retrieved from https://pubmed.ncbi.nlm.nih.gov/16262993/

Diamond, A. “Executive Function” (2012). Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4084861/

Littman, E. and Kessler, E. “ADHD: Behind the Behaviour” (2017). Retrieved from https://www.smartkidswithld.org/getting-help/adhd/adhd-behind-behavior/