When you think of ADHD, what do you think of? Who do you think of? For me, the people who immediately spring to mind are Jim Carrey and Bart Simpson (ok, Bart isn’t a real person, but you know what I mean). Think Attention deficit hyperactivity disorder and you are likely to think of the happy-go-lucky scamp. The excitable class clown who won’t sit still, won’t shut up and, occasionally (or frequently), takes the joke a little too far. Forever a child at heart. Where the ADHD person goes, mischief soon follows. They are silly, unpredictable, but more often than not they grow out of it and, often, we suspect that those naughty childlike imps know how to behave and can behave, they just chose not to, right?
But ADHD is a much more serious condition than that, and the mischievous joker or Manic Pixie Dream Girl stereotypes of people with ADHD underplay how destructive this neurodevelopmental condition can be, especially if it goes unrecognised, undiagnosed and untreated.
A couple of years ago I started to suspect I had ADHD. I thought, if I did have it, that would possibly explain why I am messy, often late, a little forgetful, leave important things to the last minute and often find myself overwhelmed by things I thought should be easy. I started looking into the symptoms and sure enough, I felt like they were describing me. I needed to look into it, but I needed to get my PhD out of the way first.
In April, I finally had an assessment over zoom with a psychiatrist, and after a long chat about who I am, what I struggle with and what I was like as a child, he told me I had severe ADHD. I got a little emotional, and I explained that I thought I was, but I was worried I wasn’t, and that I thought maybe I was only just a clinical case, at which point he said to me that “no, your ADHD is so severe, you’re lucky you’re not in prison”. I laughed, as a fan of hyperbole I thought he was making a joke. He looked deadly serious and said “No, people with ADHD this severe often end up in prison.” He went on to tell me that ADHD has a population prevalence of between 3-7%, in prison this shoots up to approximately 25%.
This information was so startling to me that I started to do some research to find out just how serious the potential consequences of ADHD are, and I soon realised that ADHD was a far more serious condition than I had previously thought.
But first, let’s start with the basics – the main symptoms of ADHD include:
- Difficulty Multitasking
- Distractibility
- Forgetfulness
- Impulsiveness
- Low frustration tolerance
- Mood swings
- Poor listening skills
- Poor planning
- Poor time management
- Problems staying on task
- Restlessness
ADHD can typically be subdivided into two types: the Inattentive type, which manifests as mostly distractibility and forgetfulness (this used to be known as ADD); and the Combined type, which has a similar symptom profile as the inattentive type, but also shows hyperactivity or restlessness and impulsivity.
But even looking at that list of symptoms, none of it sounds all that bad. Who isn’t impulsive on occasion? Who isn’t forgetful every now and again? Is that list of symptoms not just a list of common human struggles? What appears to be different in ADHD is the frequency and severity with which these very normal traits appear, and the extent to which these traits impact a person’s ability to meet societal expectations.
I find it can be difficult to explain the ADHD experience and to fully convey the distress the symptoms of ADHD can cause, so instead of trying to explain my subjective experience, I want to take you through some statistics that illustrate the potential consequences of living with an ADHD brain. Although, before I do, it is important to point out that these consequences are not experienced by all people with ADHD and having ADHD does not guarantee that a person will experience many or even any of the following misfortunes. Many people with ADHD have happy and fulfilling lives, and in my opinion, the real tragedy of experiencing negative consequences of ADHD is how incredibly manageable ADHD can be once it is diagnosed. Similarly, none of the experiences I am going to discuss here are unique to people with ADHD, and should not be seen as diagnostic of previously undetected ADHD.
People with ADHD are at higher risk for unwanted pregnancy. Research conducted by Owens et al. in 2017 indicated that the rate of unplanned pregnancy among girls with a childhood diagnosis of ADHD was 42.6%, compared to 10.6% of their peers. Similarly, a large-scale study conducted in Taiwan found that 3.2% of teens with ADHD become pregnant before the age of 20, compared to 1.4% of their non-ADHD peers (Hua et al., 2021). This will likely translate into a higher need for abortions within the ADHD population. Think about this in the context of the overturning of Roe v Wade in the USA earlier this year, which, in all likelihood, is going to disproportionately affect people with ADHD.
People with ADHD are more likely to engage in deliberate self-harm and are more likely to make suicide attempts. One cohort study found the rate of deliberate self-harm among adolescents with a diagnosis of ADHD was 69% compared to 32% among their peers without a diagnosis of ADHD (Hurtig et al., 2012). One longitudinal study following girls with childhood diagnoses of ADHD found that at the 10-year follow up point, 51% of the women and girls who had a childhood diagnosis of ADHD combined type had engaged in deliberate self-harm, compared to 29% of those with a childhood diagnosis of ADHD inattentive subtype and 19% of the control group. This same study found that 22% of girls with combined ADHD had made a suicide attempt, compared to 8% of those with inattentive ADHD and 6% of the control group.
A Canadian study which considered n = 21,744 adults, of whom 529 had ADHD, found that 14% of the sample with an ADHD diagnosis reported having made at least one suicide attempt vs 2.7% of the participants without ADHD (Fuller-Thomson, 2020). And a meta-analysis of 25 studies looking at rates of ADHD in suicidal populations found that ADHD is present at double the rate among individuals reporting suicidal ideation compared to the general population, and 1.5-2 times higher among individuals who have made suicide attempts, some of whom completed (Impey & Heun 2012).
In fact, the link between ADHD and self-harm is so strong that Ward and Curran (2021) argue that all individuals presenting at accident and emergency departments after an incident of self-harm or attempted suicide should be referred to an ADHD clinic for screening. The reason for this association between ADHD and self-harm is likely a combination of emotional dysregulation, social exclusion, low self-esteem, and impulsivity, which are common among individuals with ADHD.
One of the symptoms of ADHD is described as “mood swings”, although a better phrase, which is being used more and more, is “emotional dysregulation”. Put simply, ADHD brains experience very strong emotions. Having very big feelings without being taught the skills to deal with very big feelings can lead to unhealthy coping mechanisms, which is possibly why ADHD isn’t just a risk factor for self-harm and suicide, but also for substance abuse problems. According to one report, 69% of adults age 20 to 39 with ADHD reported experiencing problems with substance abuse compared to 23% of non ADHD young adults (Fuller-Thomson et al., 2021).
People with ADHD are also at a higher risk for eating disorders. While Bulimia is present in approximately 1.5% of the population and Anorexia estimated to be present in 0.9% of the general population, research suggests that between 10 and 16% of ADHD individuals experience eating disorders, most commonly Bulimia, and while approximately 3.5% of the general population have binge eating disorder, the prevalence of this eating disorder is 8.3% for those with ADHD (Palanti & Salerno, 2016).
ADHD is strongly associated with obesity, too, with a meta-analysis finding a 70% increased prevalence of obesity among ADHD adults and a 40% increase in prevalence among children (Cortese, 2019). The reason for this? In extremely basic terms, high levels of impulsivity combined with high dopamine-seeking behaviour can lead to a pretty turbulent relationship with food. This is especially pronounced in cultures which place a high value on low body weight, and heap shame on those of us who dare allow our thighs to touch.
ADHD has been found to have negative associations with nearly every domain of life (Shaw et al., 2012). People with ADHD are less likely to pursue further education, on average have lower educational attainment and show lower lifetime earnings. ADHD is associated with lower relationship satisfaction and is a risk factor for divorce. It is a risk factor for car crashes (Vaa, 2014), divorce (Eakin et al., 2004; Anastopoulos et al., 2009), homelessness, and joblessness. And those with ADHD are four times more likely to have a criminal conviction than individuals without ADHD (Lichtenstein et al., 2012; Polanczyk et al., 2007; Yong & Thome, 2011). Perhaps least surprisingly of all, individuals with ADHD tend to have low self-esteem.
The culmination of all of these risk factors leads to the following startling statistic; individuals who have ADHD that persists into adulthood have 12.7-year reduction in estimated life expectancy (Barkley & Fischer, 2018). This is a similar level of reduced life expectancy as seen in heavy smokers. That said, a disproportionate number of heavy smokers may well also have ADHD.
Despite all of this, not everything is doom and gloom, here, because ADHD is incredibly treatable. According to Dr Berkley, the foremost researcher of ADHD, 90% of those with an ADHD diagnosis respond positively to medication with 40% being “normalised” on ADHD medication, meaning their symptoms are so reduced that they are indistinguishable from their typically developing peers. ADHD medication is available in both stimulant and non-stimulant forms. Furthermore, both children and adults with ADHD appear to respond positively to behavioural therapy.
In fact, Dr Berkley posits that ADHD is one of the most understood, most treatable and one of the most researched neurological conditions, with up to 1,500 and 2,000 academic articles published on ADHD annually.
It is difficult to say for certain if all these potential consequences and psychological comorbidities of ADHD are a direct result of the structural and chemical differences in ADHD brains, or if they are a consequence of how ADHD people are treated by society, or, most likely, a complex interaction between the two. However, one thing is obvious: ADHD is a potentially much more serious condition than our perceptions would indicate.
People with ADHD aren’t just class-clowns, practical jokers, or Manic Pixie Dream Girls. ADHD is not just a childhood condition or an excuse for naughty behaviour. ADHD is a very real condition with potentially life limiting consequences. ADHD is eminently treatable and manageable, but only if we recognise it, take it seriously and treat ADHD folk with the acceptance, compassion and support they need.
