It was the early nineties when I was first diagnosed as having “ADHD”, Attention Deficet Hyperactive Disorder. Most diagnoses are kept under doctor/patient confidentiality. But this diagnosis was immediately shared with my parents, my teachers, peripherally to other students. No one knew it at the time, but my ADHD was being directly caused by trauma I was experiencing at home. No one believed me when I tried to get help.
I remember at five and six, knowing I was being permantently damaged in someway. Now that damage had a label, one people could use to rationalize why I was some emotionally reactive, withdrawn, uncontrollable, chatty. In my experience, at that time, teachers never asked themselves why I ducked when they walked up behind me, or why I so rountinely got in fights. I think that stems from how we culturally approach people from the binary lens of good and bad.
So these behaviors, blurting out in class, speaking out of turn, drawing when he should be listening, were considered evidence of “hyperactivity”. They had a label and that was all they needed. ADD, or ADHD, was the explanation for all my acting out, while people still failed to hear my direct cries for help. It’s important to discredit victims of abuse, easy to do so to children, and simple enough for a narcissist to justify.
Is ADD still hyperactive?
In the sixth grade, my teacher kicked me out of the Gifted and Talented Education program, or “GATE”. She said she wouldn’t have a child with ADD in her class. This is going to feel like a breakneck turn in a second, but give me a second. I just want to you appreciate how interchangeable these two terms have been in the traumas of my life, so I speak of them personally.
One morning in the seventh grade, we’re playing flag football. This was zero-period PE because my ADHD-diagnosis required I be enrolled in the resource specialist program. This extended my school day one hour so someone could try to teach me to study. I’m trying to get my team into a huddle but Bobby Schueller’s bouncing, as though on a pogo stick. He said he couldn’t huddle up.
“I have ADD, too,” I told him, seeking to creating a kinship.
“Well, I have ADHD,” Bobby said to me. “I’m hyperactive.”
There was something about his swagger, his smirk, how he flaunted what I hid. What tormented me delighted him. But I was working on getting in fewer fights, which was one of the ways my hyperactivity manifested. To my recollection, I kept my hands off him.
I don’t need to describe my futile attempts to explain to another a child that they were the same thing. Bobby was a quarter German, a quarter Swede, and fifty percent human teflon. Nothing stuck to him, and nothing penetrated his mind simply because you were hoping it would. I knew as he hopped about, testing my resolution not to strike him, that he did in fact have ADD.
I could see myself in him.
That frustration made me vow to be more meticulous with how I spoke of it in the future. As I got older, I noticed many people had Bobby’ same confusion. Some actually argued they were two different states, one characterized by hyperactivity, and one without. I didn’t smack them either.
Hyperactivity is simply what neurotypical people can see.
People seeking to understand ADD understandably rely on what they can see. They often focus on a child with a vast assortment bad behaviors. Daydreaming, not doing homework, refusing to sit still, not listening to their teachers. People just want to know why.
They get an “ADHD” diagnosis, and they experience some relief. “My child has ADHD,” they say when feeling confused, or when their frustration boils over, or when they wonder if there’s any point in trying to make the child do their schoolwork. But they don’t see the problem that’s at the root of the behavior.
The diagnosis negates child’s credibility. Their emotions are product of their ADHD, and would go away if they’d just take their medicine forever. Without the ability to feel heard, the child becomes avoidant and withdrawn. The child begins to realize they’re no longer in control of their story, or how the world percieves them. This is the beginning of a lifetime of insecurity. Parents who withhold love, approval, and reinforcement contribute to kids acting on impulsive efforts to seek those things out.
The random and bizarre reinforcements they receive from the age of five to fifteen shape the unique identity. To focus on hyperactivity as an essential characteristic of ADHD neglects the vast neurological experience it really is.
ADHD stems from disregulation
At the core of ADHD is disregulation. The disregulation of emotions oftens appear outwardly as a person who quickly moves from end of the spectrum to other. This person will become entrenched in an emotion that isn’t serving them or appropriate to the circumstances. This looks like losing your temper with the wrong person, crying over a perceived slight, or the everlasting anxiety that drives many to self-medicate.
Cognitive disregulation looks like an inability to focus on tasks, a difficult to process stimulus the same others do, or communication characterized by tangents. The inability to focus on tasks commonly stems from an overly alerted mind, or an understimulated mind, trying to turn it’s attention to a subject that might be more challenging, interesting, or pertinent to survival. The inability to process stimulus as nuerotypical people do may look someone who can’t differentiate one voice or sound apart from others, a handicap for people who work in crowded areas, like restaurants, or who live in societies that so commonly turn to bars for opportunities to meet people.
Cognitive disregulation and sensory disintegration
This disregulation can also take the form of sensory disintegration, a disorder that affects at least 1 in 6 children. Imagine the supreme irritation of your shirt’s tag scratching against the back of your neck or someone brushing their hand over your skin. For those who struggle with cognitive disregulation, small things like these may become a singular focus, causing a build of tension or obsessive focus until the irritance is alleviated.
Both cognitive and emotional disregulation lead to a disregulated output of energy. This where the word “hyperactive” begins to fall dreadfully short.
As much as someone with ADHD, or ADD, may struggle to keep their focus on a Powerpoint presentation, a church sermon, even a one-on-one conversation, their disregulated energy can cause them to “hyperfocus” on certain things for periods lasting hours to months. This focused attention is so supreme, it pushes out nearly everything else, including family, friends, food, hygeine, and sleep. This is the ideal state for someone with ADD or ADHD, when all their minds cogs turn in the same direction, when all their thoughts work in harmony towards a single goal. When their mind is not in this hyper-acute state, it tends to fall into a state of anxiety. It’s pursuit of mental acuity through physical stimulation is what appears outwardly as “restlessness”.
However physical stimulation, or “stimming” can be a very effective means of bringing the brain closer to this idealized state. Small behaviors, like pinching or picking at the skin, pulling at hairs, or biting the inside of your cheeks, may all serve to help the mind focus in one specific stimulii rather than trying to process large pieces of information at once. The more intense or acute the sensation, the more effective. Cleaning under your nails may work, but bouncing your leg is even better. Even better than that is standing up and pacing. Trying yelling, or singing. Pretty soon, you’re bouncing off the walls or in a fight, all because your mind is seeking something it can more effectively focus on that what it’s being presented with.
Stimming can help relieve anxiety. Briefly.
Hyperactivity is an excess of energy compared to the interest level of the provided stimulus.
How much energy the individual has is a product of how much they’ve rested, what their diet is, what their mental state is, what their environment is. It’s a product of so many variables, it feels impossible to predict what those levels will be. But if the individual is put in front of something that doesn’t meet those levels, excess physical or cognitive energy will need to be spent.
Let’s the average energy level of a child is one hundred percent. Every day, they wake up, they go to class. They can tell you what the teacher said, they asked questions, they remember their homework. This child sits still, faces forward, speaks when appropriate, follows the rules at recess. The ideal child, operating at 100% of the average energy level.
A child who experiences disregulated energy levels will sit in front of the same lesson the other child absorbed. This child may be operating at 120% of the average energy level, surpassing the other children around them who are contently paying attention to the teacher. But the ADHD child still needs to use that other 20% of their energy or they fall into anxiety. So they spend that energy chattering, tapping, making noises, and all the other hallmarks of fidgeting. They may suddenly notice somthing in the classroom that’s been there so long the teacher had forgotten about it. Now the other students are distracted, the teacher’s forgotten their place.
This is what hyperactivity looks like, and a fast path to being labeled a “problem child”.
Of course, this is only a brief window because when the energy is spent, the ADHD child may drop into 80% of the capacity of other students. Now the child falls into distress, overstimulated by what other children perceive as a quiet room conducissive to learning. Their body reinforces stimmulating actions, like rubbing their arms or legs, or scratching their skin, playing with their hair.
Hyperactivity manifests in stimming behaviors.
These behaviors, all them of manifestation of “stimming” to escape the anxiety of the under-utilized state, are labeled “hyperactivity”. The problem is, this is only one of many pathways these behaviors go down. Let’s start over. You’re sitting in class, or in a meeting. You’re bored. You’re pinching your forearm over and over again, waiting for the moment to end. You notice a stray, thick hair you’ve not seen before. It will most certainly be noticed, so you pluck it out.
You pluck this hair, and because it’s big and thick, there’s a tiny prick as the root rips out your skin. And that tiny prick is better than simply pinching your skin. Now you’re plucking hairs across your arm. You’re not doing it evenly, not one-for-one on each arm, but one after other of a specific arm, looking for an equally sharp or greater sensation. But most of the hairs on your arm are more fine than the first one, so as you sit in class, or a meeting, or church, or at a traffic light, or even watching TV, your hand moves up to your eyebrow and begins plucking.
At the end of the day, you walk into the bathroom and notice one eyebrow is patchy and bare, noticeably different from the one across from your dominant hand. Hyperactivity can happen in front of a crowd of people and go unseen. If the crowd only sees jumping up and down and getting in fights as “hyperactivity”, many people will go undiagnosed.
The dangers of undiangosed ADHD.
This pathway is every bit as much one stimming takes, but because it is less obvious to others, it’s often overlooked. Further, these pathways, or preferred means of stimming, can be socially influenced. Males are more likely to exhibit the bouncing-off-the-wall/getting-in-fights style of stimming. Meanwhile females may tend towards obsessive grooming, a more personal, less disruptive manifestation of ADHD that teachers and doctors may overlook. This may explain why females are less diagnosed with ADHD than males. Without recognizing stimming behaviors, outward observation of the individual focuses more on inattention, or emotional dysregulation.
This means many girls and women fail to get the emotional and psychological support they need. Failing to diagnose people with ADHD can have tragic consequences. People with ADHD may have their life expectancy reduced by as much as 25 years. Certainly ADHD doesn’t kill people directly, but having ADD or ADHD means struggling with intense, lifelong anxiety, fear, and insecurity. These persistent emotional states not only worsen the severity of ADHD, they lead to risk-taking behaviors, sustance-abuse, and the health consequences of stressed for long periods.
It’s important to recontextualize how we think of hyperactivity, both in how it manifests, and what it reflects about the neurological needs of the indivdual. Recognizing some people struggling with ADD and not others furthers their tragic isolation.