Why ADHD is a Misnomer
For people like me who are deeply invested in helping folks with ADHD live with less chaos and more confidence, this is an exciting time. Public awareness is going up and stigma is going down. Adults are receiving later-in-life diagnoses that change their lives for the better. The Affordable Care Act and mental health parity laws have expanded access to healthcare for so many. The diagnostic criteria (the list of trends and traits that must be present in order to make a diagnosis) have been updated to be more current and inclusive. Doctors, teachers, and other professionals have better screening tools to rely on.
Unfortunately, a weight dragging behind this forward movement is the name itself. Attention Deficit-Hyperactivity Disorder (ADHD) is inaccurate and incomplete, and it doesn’t seem to be going anywhere.
Despite all the progress made by the medical and mental-health communities in recent decades, the legacy of ADHD is rooted in a particular portrait of symptoms. Dating back to 1092, “father of British pediatrics” George Still presented to the Royal College of Physicians about children observed in a clinical setting (3:1 male to female) who were “overactive, inattentive, defiant, and dishonest.”
Almost 125 years later — and with a vast body of research and understanding — we still can’t get those first two out of the name.
Today we have a much better picture of ADHD (or shall I say, “what we call ADHD”) as a challenge with self-regulation:
Regulating the Mind: This is where the “attention deficit” part of ADHD comes from, but instead of a deficit, there is actually an abundance of attention with ADHD — so much attention that it can be difficult to control and direct. Hyperfocus on certain interests or activities is common (again, no deficit here!). Moreover, regulating the mind is not only about attention. Regulation is necessary for all executive functioning: planning, organizing information, and holding onto information (memory).
Regulating the Body: This is where the “hyperactivity” part of ADHD comes from. However, the term “hyperactive” paints difficulty regulating the body with too broad a brush. In some literature it’s referred to as “hyperactive-impulsive,” which is more descriptive but still fails to appropriately capture the sense of restlessness, unease, and anxiety that many ADHDers feel. Further, 33% of adults with ADHD have been diagnosed with the inattentive-only presentation, meaning they display no symptoms of hyperactivity. For those individuals, the “hyperactive” label doesn’t fit at all.
Regulating Emotions: You’ll notice that emotions are not referenced at all in the name “ADHD,” and the average person may not know that regulating emotions is often a central struggle of ADHD. Challenges with emotion regulation may look like sudden or frequent outbursts of anger or sadness, or becoming easily overwhelmed. Another example is Rejection Sensitive Dysphoria (RSD), an intense sensitivity to rejection, accompanied by a range of extremely painful emotions and low self-esteem, that is commonly associated with ADHD.
My purpose here is not to nitpick, because of course no one name can capture all the nuance of any physical or psychological condition. (Although leading ADHD expert Dr. Russell Barkley makes a compelling case for renaming it Self-Regulation Deficit Disorder, or SRDD.) Instead, my intention is to begin exploring how misleading and outdated labels can interfere with access to care. For all the successes in moving ADHD awareness and treatment into the 21st century, how has the portrayal — the brand, if you will — of ADHD as being a problem of “inattentive” and “overactive” boys (hello, 1902 calling!) prevented those who are struggling from getting the help they need? We can never know.
For practical support and compassionate guidance on better managing ADHD, consider reaching out. I’d love to begin that conversation with you.