ADHD; Pathology, Superpower, or Out of Context?
Covering the overdiagnosis, celebration, and challenges of this disorder
Welcome to Polymathic Being, a place to explore counterintuitive insights across multiple domains. These essays explore common topics from different perspectives and disciplines to uncover unique insights and solutions.
Today's topic explores the mess around our understanding of ADHD and how that diagnosis has been misapplied, misused, and misrepresented for a variety of bad reasons. We’ll explore whether it even is a pathology, whether it’s the superpower others claim, and find just how out of context our conversations on the topic are.
Intro
I’ve been torn on the diagnosis of Attention Deficit Hyperactivity Disorder (ADHD) for as long as I knew that term. As a precocious and highly active young boy, many people told me or my mom that I had Attention Deficit Disorder (ADD), the 1990s version. My mom had me tested, and I came back as ‘energetic,’ possibly a bit hyperactive, but not ADD. However, now that they’ve added hyperactivity to ADHD, I’d guarantee that I would have been diagnosed due to that and the shockingly reduced criteria and overdiagnosis of the disorder that has occurred since.
Freddie deBoer recently covered the problems with overdiagnosis in his essay How Should We Feel About the ADHD Epidemic? Here, he discusses that,
These two statements are non-contradictory: ADHD is real and those who have it deserve medical treatment; ADHD is overdiagnosed.
These two statements are also non-contradictory: stimulant medication can be an effective tool for ADHD patients to live productive and minimally-disrupted lives; stimulant medication is overprescribed and poses a potential public health risk given its side effect profile.
This is where it gets messy because we have competing views of the disorder. Sometimes it’s viewed as a pathology, and we treat it with drugs, namely amphetamines, which are basically crystal meth and incredibly addictive. Other times, we have influencers claiming it’s a Superpower and celebrating their ‘neurodivergency.’ Then we have a legitimate question on whether it’s just normal, healthy behavior, but out of context in cultural expectations. Let’s dive into each category, starting with a pathology.
Pathology
The worst part about this entire discussion is that ADHD diagnoses are too often used to excuse poor behaviors. Emotional regulation, deferred rewards, intentional focus, contentiousness, and disciplined execution are all concepts we strive to teach our children to mature them into responsible and capable adults. However, many parents throw these healthy training opportunities out the window when they get the opportunity to diagnose their child and drug them into compliance.
The nuance is important to understand in that ADHD also exists on a spectrum. Yes, there are children who would be unable to regulate themselves in any context and are unable to function without pharmaceuticals. This is certainly a pathology, but these kids are rare. Conversely, the vast majority of diagnoses are normal, healthy kids who are forced into artificial environments where they aren’t allowed to play, adventure, and take risks. Environments where recess has been taken away and sleep schedules are disrupted. Where kids are separated from family, placed in overcrowded classrooms with stressed teachers, and worse.
It’s also essential to recognize that ADHD symptoms overlap considerably with learning disorders, anxiety and mood disorders, ODD/CD, autism, tics, and substance use, which means inattentiveness and impulsivity often reflects something else entirely. Simply put, what we call ADHD, more often than not, is healthy behavior out of context, addressable behavior in general, or masks a real disorder.
challenges how ADHD is even defined as a disorder, let alone the ability to diagnose the symptoms. She highlights that inclinations such as impulsivity, disorderliness, and disagreeableness have a clearer mapping to personality proclivities like the Big Five of Openness, Conscientiousness, Extraversion, Agreeableness, and Neuroticism. ADHD risks diagnosing personality as a disorder, which is troubling. Couple that with the perverse monetary incentives to diagnose from both the psychological and pharmaceutical industries, and you have a recipe for disaster.1
Superpower
This brings us to a conversation I’ve had for over 20 years, where behaviors that look like ADHD are not a problem in many circumstances. Let’s step back to my time in the Army on a Ranger patrol through the mountains: the ability to adapt to new situations, avoid over-focusing on a single thing, and keeping your head ‘on a swivel’ as we liked to say was a critical skill. The research backs this up, where common ADHD traits are important hunter-gatherer skills. It’s the “Hunter in a Farmer’s World” concept coined by
who has both a great Substack and book.
The challenge with viewing it as a superpower is the problematic trend of adults who claim ADHD as an identity and claim ‘neurodivergency’ while denying their own agency to self-regulate. Additional studies back this up, which found that half of popular ADHD influencer videos are misleading, encouraging self-diagnosis, pathologizing common lapses, and misdirecting people away from addressing true behavioral issues.2 I’ve known many people in work environments like this, and I think to myself, “No, you don’t have ADHD, you’re just an inconsiderate, selfish asshole.” That’s certainly not a Superpower.
So we find that these ADHD traits can convey benefits in different circumstances, but out of context for today. It’s like asking a fish to climb a tree when it’s better at other tasks. However, the claim of a superpower also has people clambering to be diagnosed with ADHD to gain status and cover for bad behaviors.
Out of Context
The truth of the matter is that much of what’s claimed as ADHD is a mix of positive behaviors forced into a misaligned cultural setting. The conversation gets muddied because it’s also used as an excuse justifying poor self-agency. Both of these are out of context and need to be addressed.
Our schools and corporate structures, modeled after factory workflows, have created a bias against normal, healthy behaviors that have a long evolutionary advantage, pathologizing them into a disorder. That diagnosis then unlocks a whole host of other terrible outcomes, such as putting children on amphetamines, drugging them into a stupor, excusing bad behavior when better parenting is warranted, and artificially creating a ‘neurodivergent’ identity that attracts the type of person who wants to claim special status as disabled. (or was it a superpower?)
None of this helps anyone thrive, especially when it hides true disorders, results in the medication of healthy behaviors, obscures bad parenting, and invites people to exploit the system for their own gain. Thankfully, it doesn’t have to be this way.
Taking Action
My wife and I agree that we both would be diagnosed as having ADHD, by today’s standards. In fact, the number of people who have tried to convince me to get a diagnosis as an adult is incredible. However, we recognize that we have agency and can take intentional steps to self-regulate, and we both lean into the positive aspects of the behaviors. For example, I have well over 100 tabs open on my computer at all times, and I have almost two dozen draft essays in queue, which I regularly switch between as I build out ideas over time. This leverages the strength of ADD to increase productivity.
We both recognize that our kids are likely to deal with similar behaviors, and we double down in teaching them self-regulation, consideration, intentional action, accountability, and more. We also homeschool, so they have a tailored experience that doesn’t force them into an artificial environment. Our approach to addressing their ADHD tendencies involves teaching them agency while helping them understand their strengths and weaknesses.
It’s not about a superpower or neurodiversity. It’s certainly not a disorder that needs medicalization, nor is it driven by trauma or any other pop-psychology diagnosis that’s trending. We don’t allow our children to behave poorly, and we hold them accountable to high standards of personal and professional conduct. What they have is personality, not pathology, and it can be a superpower when properly leveraged and put in the proper context. The challenge is to strip off all the confounding variables, understand it from a larger systems perspective, and accept it as part of the texture of personality and capabilities that make life fun and different.
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Further Reading from Authors I Appreciate
Further Reading from Authors I Appreciate
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It’s gotten so bad in the influencer community that even personality is pathologized, diagnosed, and drugged as
recently shared in Nobody Has A Personality Anymore. ADHD becomes a tool to claim a mental health diagnosis and associated ‘neurodivergency.’
This is my favorite essay yet. It made me laugh out loud thinking about someone calling out my uncontrolled behavior at work. I think you are a little hard on parents and kids that use ADHD to get accommodations. Without accommodations some kids couldn’t graduate high school. Smart But Scattered is the best book on the topic that I know. Academically coaching a scattered and gifted kid has been the most difficult project I’ve ever managed. Knowing greatness is possible I’ve set my need for a hug aside and been the bad cop. I’m sad and alone but for my daughter I would do it all over again.
I should have been diagnosed in my early teens or pre-teen years. In high school, over 30 years ago, a special superlative in our senior yearbook was given to me: "biggest procrastinator". It was kind of hurtful, but also true. While my grades were exceptional, I often turned work in on the day of assignment, having written it minutes before class started. I have struggled with that, and other traits of ADHD my whole life, until a coworker noticed and asked if I ever had been evaluated. So in my mid-40s, I got evaluated and CLEARLY met the criteria and then some. A whole new world opened for me and it's been amazing ever since I started on focalin. This diagnosis came after my two boys were recommended for diagnosis and treatment by several teachers. They both also CLEARLY have ADHD and function much better with medication and environmental structure. Grades are much better and focus on what's important is much better. They do not take medication over the summer, except for when they might have an athletic or academic "camp", they need to attend. During the summer, their personalities are much the same as when on ADHD meds, but everything about them is messier and less focused. They will go out to play with friends and not come home until well after dark, way past their time to come home. Their rooms are unacceptably messy, rules are not followed, etc All hallmarks of ADHD. We don't medicate these issues in the "off-season", but do discipline them. It can be frustrating but it's necessary to give them breaks. As for me, my work research has picked up, I have published more than ever, and my intraoperative skills are insanely better. Anesthesiologists are multitaskers, and when I'm medicated my focus is laser sharp on what it needs to be. Now, do I see others diagnosed and taking meds that are misdiagnosed? absolutely. But that is between them and their PCP or psychiatrist. My job is to safely get the through surgery. But I notice it.