10 Things ADHD Is—and 3 It Isn't

It’s so much more than being distracted.

Attention-Deficit/Hyperactivity Disorder, or ADHD, is one of those mental health conditions that has become cultural shorthand in a pretty inappropriate way. Ignoring the fact that “I’m so ADHD” isn’t even grammatically correct, throwing this acronym around to flippantly explain distraction or disinterest waters down the true meaning of this extremely nuanced disorder. Not only that, it can further isolate those who do have ADHD, since they’re often already misunderstood. To dispel some of the common myths surrounding ADHD, we’ve broken down what the disorder actually is—and a couple things it isn’t, too.

Here are 10 facts about what ADHD really is.

1. ADHD is a disorder of the brain.

ADHD is listed as a neurodevelopmental disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the set of guidelines established by psychiatrists for diagnosing mental illness. Though the exact cause of ADHD isn’t clear, one prevalent theory is that neurotransmitters like dopamine and norepinephrine, which are critical for thinking and attention, are imbalanced in people with this condition.

On top of that, an April 2017 study in The Lancet concluded that people with ADHD have structurally different brains than people without it. The study, which used MRIs to examine brain differences in 1,713 people with ADHD and 1,529 who didn’t have the disorder, found that people with ADHD had smaller volumes in five brain regions that govern things like motivation and emotion. These differences were most obvious in children, but still existed for adults.

2. ADHD is an issue that can affect both children and adults.

ADHD usually evokes images of children with boundless energy. While children can certainly have ADHD, this disorder can last well into adulthood. In some cases, it may not even be diagnosed until adulthood.

Around 11 percent of U.S. children between the ages of 4 and 17 have been diagnosed with ADHD, according to the most recent research available from the Centers for Disease Control and Prevention. That amounts to about 6.4 million kids in this age range.

In addition to that, approximately 10 million people 18 and over in the United States have ADHD, according to Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD), a CDC-sponsored resource. That’s about 4 percent of the U.S. adult population, per 2016 Census data. Clearly, ADHD doesn’t just go away once someone hits adulthood.

3. There are actually three kinds of ADHD that you can be diagnosed with—and they don't all involve hyperactivity.

ADHD and ADD (Attention Deficit Disorder) were once considered two separate issues, as symptoms of hyperactivity weren’t present in all patients. However, doctors now use ADHD to encompass both, Lenard A. Adler, M.D., professor of psychiatry and director of the Adult ADHD Program at the NYU School of Medicine, tells SELF.

Based on your symptoms, you may be diagnosed with one of three types of ADHD:

  • Predominantly Inattentive Presentation

  • Predominantly Hyperactive-Impulsive Presentation

  • Combined Presentation

“In the past, ADD was used as a term for what we now call ADHD, Predominantly Inattentive Presentation, where the inattentive symptoms are more prominent than the hyperactive/impulsive ones,” Dr. Adler explains.

4. But ADHD has so many more symptoms than just inattention and hyperactivity.

If you’ve been feeling particularly unmotivated at work for a few days, odds are it’s not ADHD. An adult would need to experience at least five symptoms of inattention (i.e., problems sustaining focus) and five symptoms of hyperactivity (constant restlessness) and impulsivity (acting without thinking) to be diagnosed with ADHD. (A child would need to experience at least six of each.) You would also need to have experienced the symptoms, which you’ll find below, for at least six months.

Symptoms of inattention:

  • Often fails to give close attention to detail or makes mistakes

  • Often has difficulty sustaining attention in tasks or activities

  • Often does not seem to listen when spoken to directly

  • Often does not follow through on instructions and fails to finish schoolwork or workplace duties

  • Often has difficulty organizing tasks and activities

  • Often loses things necessary for tasks or activities

  • Is easily distracted by extraneous stimuli

  • Is often forgetful in daily activities

Symptoms of hyperactivity and impulsivity:

  • Often fidgets with or taps hands and feet, or squirms in seat

  • Often leaves seat in situations when remaining seated is expected

  • Often runs and climbs in situations where it is inappropriate (in adolescents or adults, may be limited to feeling restless)

  • Often unable to play or engage in leisure activities quietly

  • Is often “on the go,” acting as if “driven by a motor”

  • Often talks excessively

  • Often blurts out answers before a question has been completed

  • Often has difficulty waiting their turn

  • Often interrupts or intrudes on others

“If you just had symptoms and no trouble from the symptoms, it wouldn't be a disorder,” Dr. Adler says. That’s why another part of the diagnostic criteria is that the symptoms need to affect you significantly in at least two domains, like home and work, or school and social settings.

5. ADHD can be hard to diagnose and requires a thorough evaluation, since it can present in so many ways.

People might assume being diagnosed with ADHD is a matter of walking into your primary care physician’s office, complaining of an inability to focus, and leaving with a prescription for Adderall. In reality, being properly diagnosed requires diligent testing that includes an often lengthy evaluation.

Although there’s no specific test for ADHD, diagnosing it in adults can include these assessments, according to the Mayo Clinic:

  • A medical exam to rule out other causes of symptoms

  • Information gathering, including inquiring about other medical issues, family history, and the history of your symptoms

  • ADHD rating scales or psychological tests to help collect and evaluate information about your symptoms

For kids, that assessment could include questionnaires with people like parents, teachers, and coaches, in addition to evaluating school records and using diagnostic criteria from the DSM-5, according to the Mayo Clinic.

6. ADHD can be similar to other mental health conditions, so it’s easy to misdiagnose.

Mental illnesses like depression, anxiety, and bipolar disorder can have some crossover symptoms with ADHD, like inability to focus and impulsivity. So can learning disabilities.

“If you don't take the time to do [a full evaluation], it's too easy to confuse ADHD with a whole lot of other psychiatric diagnoses,” Stephen Hinshaw, Ph.D., professor of psychology at UC Berkeley and professor of psychiatry at UC San Francisco, tells SELF. Or a doctor may see someone sitting still in the waiting room, for example, and be quick to rule out ADHD without properly evaluating the other 23 hours of that person’s day.

7. ADHD begins in childhood, even if you’re not diagnosed until you’re an adult.

Even if you weren’t officially diagnosed with ADHD as a kid, in order to be diagnosed as an adult, you need to have experienced symptoms before the age of 12. “The roots of the disorder have to lie in childhood,” Dr. Adler says. “You don't have to have full childhood criteria, but you have to have some significant symptoms that go back.”

A major issue with hitting that diagnostic criteria, however, is by the time adults seek treatment, they may not remember their childhoods clearly. “It may be that the person who comes in at age 30 for an assessment doesn't really have a good memory about childhood, if he or she wasn’t diagnosed as a kid,” Hinshaw says. “In order to get documentation that some of these symptoms occurred during childhood or adolescence, you often need to get a parent, even though the person's not living at home, or some informant or report cards from school, to corroborate this history.”

8. ADHD can present differently in women and men.

Although the diagnostic criteria for ADHD in the DSM-5 doesn’t distinguish between gender, the disorder tends to show symptoms differently in women and men. This starts in childhood.

Classically, little boys are more likely to exhibit symptoms of hyperactivity and impulsivity, while girls tend to have symptoms of inattention, which can be overlooked because they don’t fit the stereotype of ADHD, Dr. Adler says. This trend can continue into adulthood, too.

9. This disorder tends to run in families, but environmental factors could play a role, too.

Scientists have long known that ADHD has a large genetic component, but they’re still figuring out the role of environmental factors. Genes have a lot to do with it, but you won’t absolutely develop ADHD just because your family members have it, Hinshaw explains. On the flip side, people without much of a strong family history can also have ADHD.

According to the CDC, other ADHD risk factors include:

  • Cigarette smoking or alcohol use during pregnancy

  • Exposure to environmental toxins during pregnancy or at a young age

  • Low birth weight

  • Premature delivery

  • Brain injuries

10. ADHD is treatable, thanks to a mix of medication, therapy, and lifestyle changes.

When people are diagnosed with ADHD, they often feel like it’s a burden that will follow them forever. But there are lots of ways to get a handle on ADHD and live a great life. “There really is good help out there,” Dr. Adler says.

An effective treatment plan may include psychotherapy like cognitive behavioral therapy (CBT), according to the National Institute of Mental Health. CBT involves modifying negative behaviors, emotions, or thoughts. “It can be quite helpful as both a stand-alone treatment or when combined with medication treatment,” Dr. Adler explains.

The gold standard in ADHD medication is drugs like Adderall that include stimulants such as amphetamines. While it may seem counterintuitive to treat ADHD with stimulants, they can increase the neurotransmitters dopamine and norepinephrine to boost cognition and attention, according to the National Institute of Mental Health (NIMH).

Sometimes doctors will prescribe antidepressants alone or in conjunction with stimulants, since they can also treat ADHD symptoms. This can be helpful if stimulants aren’t effective for someone or if they also have a mood disorder like depression, says the NIMH.

There may also be ways to build a life that makes it easier to succeed with ADHD, Hinshaw says. If, along with proper treatment (whatever that means for you), you can learn where your strengths lie and find a job that’s suited to them, or become your own boss so you have more leeway defining success, that may help ADHD symptoms fade into the background.

Now, a few things ADHD is definitely not.

1. ADHD is not just you getting distracted by your phone.

In our technology-obsessed world, it’s easy to lose focus. Maybe you trail off when telling a story because an Instagram notification popped up, or you walk into a room while texting, then promptly forget what you were going in there to do. Living such a screen-dominated life can make anyone a bit less attentive, Hinshaw says, but it doesn’t automatically mean you have ADHD.

With that said, technology can definitely exacerbate ADHD, Dr. Adler says. If you already have a slew of ADHD symptoms and technology just makes it all worse, you’ll want to see a doctor for evaluation.

2. ADHD doesn't mean you have a total lack of focus.

Sure, an inability to focus is often a major marker of ADHD, but that doesn’t mean that people with ADHD can’t ever pay attention to anything. In fact, they can get hyper-focused if they find an activity that really piques their interest, Hinshaw says. That can make it easier to miss the fact that a person has ADHD.

If a kid sits and plays video games for hours, it might seem like they don’t have trouble focusing, but there’s a big difference between immersing yourself in something you like and being able to pay attention, even when you don’t feel like it. “Life is much more complex than doing things that you want,” Dr. Adler says.

3. Finally, ADHD is not just an excuse to be on meds like Adderall.

Drugs like Adderall can truly work for people. For people without it, though, these stimulants act like straight up...well, stimulants. While taking these stimulants is generally considered safe under medical supervision, that completely changes if a person is taking them without a prescription. Possible side effects of taking unnecessary stimulants include increased heart rate, higher blood pressure, and anxiety, according to the NIMH.

Unfortunately, the number of emergency department visits involving misuse of ADHD stimulant medications is on the rise, according to a 2016 Johns Hopkins Bloomberg School of Public Health study published in the Journal of Clinical Psychiatry. The study authors examined data from three national surveys on stimulant prescriptions and stimulant-related emergency room visits. Between 2006 and 2011, nonmedical use of Adderall and its generic versions increased by 67 percent among people 18 and older, and emergency department visits increased by 156 percent, according to the study’s findings.

Any potential payoff isn’t worth the risk, especially because unless you actually need them, these meds probably aren’t effective as you think they are. “If you don't have ADHD, the medicines might keep you up later and help you finish your work, but they don't really help your cognitive powers,” Hinshaw says. “They just make you believe that your cognitive powers are better.”

The takeaway: Misconceptions about ADHD abound, but educating yourself about the condition and showing empathy to those going through it can go a long way.