ADHD—Is It a Disability or a Difference?

by Cynthia Hammer, MSW

Children with undiagnosed ADHD usually have no idea how to handle life's challenges; they only know they aren't as skilled and capable as their peers without understanding why. But the parents recognize a problem and reach out for answers.They know something is the matter.

Their child isn't happy. He gets unduly angry and upset and is reluctant to go to school. She is stubborn and won't cooperate. She often plays alone because no one wants to play with her. He only half completes a chore before wandering off to do something more interesting. She loses even her most treasured possessions. She becomes afraid of attempting a new activity, fearful of not doing something perfectly, and being judged "unacceptable."

Once a diagnosis of ADHD is made, the family can move forward. They can explore various treatment options, educate themselves about helpful interventions and strategies, and create the best situation for their child's healthy social, emotional, physical, and mental development.

An adult with undiagnosed ADHD is aware that he is different without being able to define the difference. He feels like the square peg trying to squeeze into the round hole. She knows she is failing at life but has no idea why. He feels overwhelmed and discouraged; he tries hard, but it is to no avail. Maybe she expended her energy unconsciously masking her ADHD symptoms, so no one recognizes something is the matter.

The speed and quality of the ADHD journey after diagnosis—from disability to difference— depend on many variables.

A primary factor for a favorable outcome is a diagnosis early in childhood.

If a child and his parents learn when he is seven that his brain chemistry is faulty and does not produce enough dopamine, they benefit from this knowledge from then on. They know what kinds of behavior to expect and what interventions are helpful.

Early diagnosis of ADHD in a child with a loving, supportive family is ideal, where, hopefully, over time, the child slowly transforms his ADHD from a disability into a difference. He learns to accept his difference and, in many cases, even celebrates being different.

When a child is diagnosed shortly after starting elementary school, she may avoid the fears and worries of less-than-acceptable academic performance. He may avoid hurtful comments made by others about his apparent laziness, restlessness, or inattention. His parents know to bolster the child's self-esteem and they seek out activities where their child can shine. The parents can institute strategies to compensate for his deficient executive function skills. They can advocate for accommodations at school, providing their child with optimal conditions for thriving.

Parents can implement all the interventions known to be helpful.

First, medication which is highly effective in reducing many ADHD symptoms. By educating themselves with information from reputable sources, the parents save valuable years by not pursuing treatments or interventions that research has shown are ineffective. They will focus on finding the medication that makes the most significant difference in their child's functioning. They will supplement medication with regular exercise, time spent outside in nature, a nutritious diet, adequate sleep and maintaining a welcoming and peaceful home.

They will encourage their child to pursue his interests and help him to make the one or two friends that will make all the difference in the world.

The parents learn to value and believe in the worthiness and uniqueness of their child. They must treasure him as a gift to their family while maintaining reasonable expectations, holding the child accountable whenever it is appropriate. They know helping their child to be responsible and resilient will be critical to his future success.

This long list of requirements challenges even the most stable and financially secure families to provide. Imagine the impact on a child when none of these requirements are met because the parents, with their own struggles, don't have the time, energy or knowledge to nurture their child with ADHD. A child diagnosed early in life with ADHD can be a boon, but only if it translates into a difference in how she is perceived and understood.

From a reading posts by adults who were diagnosed during childhood, many of them did not grow up in a warm, loving family, and they are angry their parent or parents were not more kind and understanding.

The childhood of adults diagnosed with ADHD later in life is significantly different.

Their parents and teachers often criticized them for behavior they couldn't help. Other children shunned them and they didn’t understand why. They weren't given special accommodations in school. Often the delay in their diagnosis compounds the disability as the person develops depression and/or anxiety. 

Adults diagnosed with ADHD later in life ponder, with regret, sadness and often anger, not learning about their ADHD sooner. It would have made a significant difference.

After diagnosis, the pathway for an adult from disability to difference can take many twists and turns and is impacted by many factors.

Medication is known to be the most effective treatment for ADHD, although not everyone finds a medicine that helps. But the sooner an effective medication is begun, the more hopeful the future will be for a person with ADHD.

What else are key considerations? How intelligent is the child or adult? Did she come from a stable home environment with routine and structure? Were nutritious meals regularly served? Was there an established bedtime? Was there adequate time for play and exercise? Was the child appreciated and encouraged to pursue his special interests? Were there expectations? Was he given oversight without being smothered? A positive response to these questions benefits a child, even without an ADHD diagnosis.

What kind of experiences did the undiagnosed children or adults have? Were they in situations where they were always put down? Where they were discouraged, instead of encouraged? Did they experience trauma, often a result of undiagnosed ADHD?

As adults, could they afford to get diagnosed and buy the prescribed medications? Did they have access to reliable information about ADHD where they learned about their disability and how to minimize its impacts? Would CBT therapy be helpful and could they afford it? What about ADHD coaching? Did they implement an exercise program? Create structure to their days? Eat nutritious food at established times? What about adequate sleep and reducing stress in their lives?

Did they become aware of their negative self-talk and learn to reduce it? Have they experienced repeated successes in their lives after their diagnosis? Have they developed resilience, good self-confidence and high self-esteem?

Not everyone with ADHD finds contentment and self-acceptance, especially when bogged down by past failures, poor health, a history of substance abuse, non-existent social support, and comorbid conditions.

If ADHD has become a difference in your life and is no longer a disability, that is cause for celebration. But it doesn't mean ADHD becomes a difference for everyone.

For some, particularly those who never learn they have ADHD, it will remain a disability their whole lives.

We need to remember that.