I’ve recently embarked on a Diploma in ‘ADHD coaching’ through the ADHD Foundation Charity, to enhance my existing ‘Executive Coaching Practice’. I thought it might be timely to start to write more about my thoughts, perceptions, and personal lived experiences of ADHD alongside the programme and embed my learning.
I heard this week that as many as 75% of neurodiverse minds, don’t even know they think differently, or experience information from our environments differently. This makes perfect sense, we just know what we know, we can’t experience other people’s thinking.
Latest statistics show that:
- 1 in 10 people have Dyslexia.
- 1 in 60 people have Autism.
- 1 in 20 ADHD – the most common (5% of the population).
- 1 in 10 Dyscalculia
- 1 in 20 Dyspraxia
It’s argued by many that neurodiversity is a result of natural evolution. In his book ‘The Power of Neurodiversity’, Thomas Armstrong, argues early on, for the need to move away from disease-based thinking, and just as we use the terms ‘cultural diversity’ or ‘biodiversity’ to refer to the rich variety of social heritage and biological life, we should appreciate that given 1 in 5 of us are said to be neurodiverse, this is a natural evolutionary process to be progressive as humans. Rather than describing neurodiversity as a deviation of normal, maybe we should start to think about it as a majority and minority approach. I’m quite happy to be in the minority, I’m not happy to be described as ‘not normal’.
In true ADHD style, I’ve been mulling the idea of writing a different themed blog every month for the next 12 months for quite a few weeks now, and I’ve just settled down to begin my first piece titled ‘January’… Only it’s just occurred to me that it’s actually now February! Eeek!
So here I am, (albeit a month late) challenging my ‘challenged executive functioning brain’ to write each month. I hope you enjoy reading them and that they help raise some awareness of neurodiversity and in particular ADHD and help to remove stigma and stereotyping.
There obviously has to be a theme, and as February is the month of love, I’m titling this month – February – For the Love of Dopamine…
‘We’re all a bit ADHD aren’t we’? I hear this a lot when I talk about my own ADHD. Similarly, I guess to, ‘I think we’re all a bit on the spectrum aren’t we’. When I talk about my ADHD traits/experience/symptoms or whatever you want to call it, I get people frequently saying things like ‘Oh yeah I forget all the time’ ‘yes, I zone out all the time’ etc… I think I must have ADHD. This can often undermine the condition and reality for those with ADHD as well as unintentionally proliferate the narrative of this being a fad. I recently made my thoughts clear on this concept of it being a fad here
Everyone will experience some of the common traits of ADHD, at some points in their life, but it is to the extent of which it happens, and frequency as well as the impact it has on your life, which is different for those of us with ADHD. Russell Barkley states in his book ’Taking Charge – Adult ADHD’ that the difference in traits such as distractibility and inability to concentrate, is that it becomes developmentally rare for the age group.
He, alongside colleagues undertook an interesting comparative study to understand the differences in impact of these traits for people with diagnosed ADHD compared to a general community sample. I found this powerful. Using the DSM-5 criteria, the study worked a sample group of people with diagnosed ADHD and a similar size group from the public and asked them if they had experienced the 18, DSM – criteria symptoms ‘often’.
| Symptoms/Traits | Diagnosed ADHD | General Community |
| Inattentive | ||
| Lacking attention to detail: This includes making careless mistakes at school, work, and other activities. | 74% | 3% |
| Difficulty sustaining attention: The person might struggle to pay attention throughout meetings, lectures, or lengthy reading sessions | 97% | 3% |
| Trouble listening: It might seem like the person doesn’t listen and often thinks of unrelated matters during conversations. | 73% | 2% |
| Failing to complete tasks: They might have trouble following instructions, get easily side-tracked, and fail to finish their assignments, tasks, or chores. | 75% | 1% |
| Poor organisational skills: A person may struggle to organize their work documents and belongings, manage sequential tasks, schedule their time, or meet deadlines. | 81% | 5% |
| Avoiding tasks requiring sustained focus: Examples include completing reports and reviewing lengthy papers. | 81 | 2 |
| Losing important items: Constantly misplacing items, such as documents, glasses, wallets, keys, and mobile phones, is another sign of ADHD. | 75% | 11% |
| Distracted easily: An adult ADHDer may often be distracted by unrelated thoughts. | 97% | 2% |
| Forgetfulness: A person with ADHD might forget their bill payments, chores, or appointments. | 78% | 4% |
| Hyperactive/Impulsive | ||
| Fidgeting and tapping hands or feet. | 79% | 4% |
| Leaving their seat when expected to remain seated (e.g., during a meeting or lecture) | 30% | 2% |
| Feeling restless | 77% | 3% |
| Struggling to stay quiet during activities | 38% | 3% |
| Often on the go and unable to sit still | 62% | 12% |
| Talking excessively | 44% | 4% |
| Blurting out answers and completing other people’s sentences | 57% | 7% |
| Trouble waiting their turn. | 67% | 3% |
| Interrupting other people or intruding on their activities | 57% | 3% |
They further asked the two groups about the level of impairment and impact on different domains of their lives by the above symptoms.
| Domain | ADHD | General Community |
| Home | 67% | 2% |
| Work | 75% | 2% |
| Social Interaction | 56% | 1% |
| Community Activities | 44% | 1% |
| Educational | 89% | 1% |
| Dating/Marriage/Relationships | 73% | 1% |
| Money Management | 73% | 1% |
| Driving | 38% | 2% |
| Leisure Activities | 46% | 1% |
| Daily Responsibilities | 88% | 2% |
I think this work really demonstrates the differences experienced by those with ADHD and hopefully serves to aid some understanding of how impactful on our lives they are for us by comparison.
ADHD has a scientific, neurobiological evidence. So, what are some of the actual neurobiological differences for people with ADHD, as often there’s a sense that if we can’t see it, it’s not real.
There are many different parts of the neurobiology, including differences seen on MRIs of the brain. I’m keen to focus upon neurotransmission and the role of Dopamine.
I’m no Neurologist, (and if you are, please feel free to correct me) but what I do understand is that in simple terms our brain in is separated into different areas, each being responsible for different functions of how we operate as a human (vision, hearing, movement, emotion, memory etc). Our brains are also full of millions of nerve cells, these nerve cells need to talk to each other to send messages to different parts of the body to tell it what to do. They are responsible for getting messages from the frontal brain (the boss) to the other areas, (often referred to as ‘wiring’ – ‘my brains wired differently’).
For the messages to transfer from one cell to the next, ‘neurotransmitters’ (also referred to as brain chemicals) are released into a teeny-weeny gap between each cell, called a synapse (like a bridge between the cells for the neurotransmitters to get across to the next cell).
However, in ADHD, three main neurotransmitters (Dopamine, Noradrenaline and Serotonin) are thought to be somewhat dysfunctional. There is an increase in the reuptake of these which means that there is not enough available to get across the bridge and carry the messages. (Here’s a 3-minute video that probably explains it better… https://www.youtube.com/watch?v=1jCeSCo9rsM). As a result of this, it is thought that four main regions of the brain are impacted and therefore responsible for some of the traits and symptoms people with ADHD experience.
- Frontal cortex – Responsible for maintaining attention, organisation, and executive function.
- Limbic system – Regulates our emotions. A deficiency in this region might result in restlessness, inattention, or emotional dysregulation.
- Basal ganglia – Regulates communication within the brain. Similar to a circuit board, information from all brain regions and is ‘sorted’ and directed to the correct area. Impairment of this can result in inattention or impulsivity.
- Reticular activating system – Helps to regulate behaviour and can impact on sleep.
I want to focus on Dopamine particularly, as it’s the one which for people with ADHD is most central to how we feel ‘reward’, which is a fundamental aspect in everyday life, eating and drinking being a simple example, and is also linked to attention.
Dopamine is the ‘feel good’ neurotransmitter, it helps us to feel pleasure and reward. Things that make us feel good can trigger a dopamine release in our brains. If something is rewarding or pleasurable, such as eating a piece of chocolate, or drinking a glass of wine, we will remember it and seek it out again. Whilst chocolate and wine are not the healthiest examples, the point is that dopamine helps us to learn and can reinforce behaviours (positive or negative).
A different example is if we are working on an essay, the dopamine reward helps us to stay motivated for the longer-term goal. There’s an ability to almost see the longer-term reward even if it takes time to get there, because that is what we have learnt from our previous lived experiences through release of dopamine.
For people with ADHD, due to the reduced availability of dopamine (through the neurotransmitters) it’s often more challenging for them to stay on task, do things that don’t interest them and ultimately give them the dopamine rush which people without ADHD receive. This can sometimes lead to the brain of someone with ADHD prioritising shorter term rewards over longer term ones (doing what interests them to get the dopamine reward). This is not a choice behaviour or something people with ADHD can control, it’s the need for dopamine coupled with the dodgy wiring! What we then see, is somebody who struggles to focus, stay on task, lack attention, be impulsive, ‘feels’ enormous amounts and struggles to regulate emotions at times (Ta-Da – I think)!?
This increased reuptake of Dopamine means that the messages are not getting through as effectively, which can lead to people with ADHD seeking out big dopamine hits, things that make us feel good… holidays, shopping, a sense of needing something to look forward to, seeking pleasure and feel-good factors. These big dopamine hits can come in various forms and can have both positive and negative effects.
As humans, who are hard wired for connection (big shout out to Brene Brown), what could be more dopamine fuelled than the feeling of love. When we do fall in love, we can fall hard and fast, because, at its simplest level, we love being loved. And we are great people to love mostly (obviously I can’t speak for everyone). We give love, laughter, fun, and passion in abundance, you will definitely know you have been loved by someone with ADHD, have a read of this if you have time. We can give intense, displays of affection and generosity. However, for many people with ADHD, relationships can be a challenge for many reasons. The dopamine rush may fade quicker, awareness of your ADHD challenges may cause internal anxieties, challenges with executive functioning, can lead to emotional dysregulation and which is why it’s so important to be open about it, and be with somebody who understands you, supports you and doesn’t make you feel bad about your ADHD. A great example of this which I recently discovered was ADHD_love they also wrote a very short, but good book from both views, called ‘Dirty Laundry’ which is funny and heart-warming.
‘Dopamine chasing’, or ‘following the dopamine’ – as it’s been referred to (unsure if helpfully or not) also has a darker side, it can lead to:
- Addiction/Addictive Patterns
- Substance misuse
- Risky behaviours
- Increased risk of early death (higher for women – If her ADHD is severe, it can see a woman’s life expectancy reduced by up to 12.7 years, mainly due to ‘unnatural causes’ such as accidents and suicide)
- Eating disorders
- Low self esteem
- Increased risk of suicide
- Self- Harm
- STIs and teenage pregnancy
Dopamine also plays a crucial role in memory (something which I personally really struggle with). It’s suggested that it plays a role in forming of memories in the prefrontal cortex of the brain, and may also affect working memory, making it difficult to retain, recall and store information.
It can feel like a double-edged sword at times. However, help is at hand… Medication!
I thought I might just finish by saying a little bit about why stimulant medication works in ADHD, and it’s not just that we are all amphetamine junkies! Drugs such as Methylphenidate and Amphetamine are used to help manage symptoms of ADHD, they are classed as dopamine reuptake inhibitors, and work by inhibiting the reuptake of dopamine and therefore enabling more to cross the bridge into the next nerve cell. They essentially increase the availability of the neurotransmitters and have been seen to lessen symptoms in 70%-80% of people who take them.
So, what is the point to my ramblings… I guess I want to challenge thinking that ADHD is a fad, it’s not real, that everyone is a bit ADHD, and demonstrate that there is a science behind it and awareness of its neurobiology. Hoping that by doing so, it may reduce stigma, increase understanding and empathy, and enable more parity of esteem to physical conditions. I also want to embed my learning from my ADHD Coaching Diploma Course, and this is a good way of me testing out what I’m learning.
Ramblings… 
Leave a comment