Perhaps the most over-diagnosed and simultaneously under-diagnosed condition: ADHD.
Who among us does not feel some unease when at a distance from their phone? Who can reliably log off of social for days at a time? Who can successful stay still with their mind’s eye for even 10 minutes?
Call it a combination of modern society and the unique socioeconomic moment, but I think many of us have a form of ‘acquired Attention Deficient and Hyperactivity Disorder’. Of course that’s different from the psychiatric diagnosis ADHD, which requires a persisting - since childhood - pattern of dysfunction in multiple setting of inattention and/or hyperactivity not better explained by another psychiatric diagnosis. Like all diagnoses, dysfunction is the key word - does it disrupt from ‘normal’ function?
When I began my medical residency at McGill University in Montreal, I ruffled some feathers when I identified (and corrected) a significant medical error. The Faculty of Medicine, in its wisdom at that time, figured there must be something wrong with me. They paid for a psychologist to complete full psychometric testing - four hours of cognitive and psychiatric tests. The result? Apparently I too have ADHD (insert shrug emoji).
With this knowledge in hand, I dove deep into the literature. The best I found was the book by Dr. Gabor Maté - a family doctor himself with a diagnosis of ADHD - “Scattered Minds”.
In it, Dr. Maté characteristically cites the genetic aspect - ADHD as perhaps the most heritable condition - ‘At the age of eight or nine, my son said to me, “I always think I should be doing something, but I don’t know what that is.”’
Hilariously, like my own foibles and struggling with punctuality, Dr. Maté recalls his challenges being on time.
“I may have to be somewhere, miles away, at 9:00am, but as long as it is not yet nine, I fully believe I have time enough. I am scheduled to attend ward rounds with nurses and other physicians at Vancouver Hospital. At 8:50 I leap into the shower, still confident: there is space between the big hand of the watch and the hour marker, so I am not late.”
So what does ADHD look like to me? Personally I think I live with ADH - I don’t currently endorse the last D of disorder. To me it means that as I write this column, I have a separate laptop open reviewing lab results of my patients and a browser open to my professional social media page, while also stoking a morning fire and petting my cat. I enjoy the balancing act of simultaneously and specifically managing these various tasks, going to where my mind wants to go in a given moment to apply the characteristic, and perhaps paradoxical, hyper-focus.
I use exercise as my ‘drug’ of choice, a morning run to focus the mind. Earlier during my schooling I was prescribed a stimulant medication for a brief period, but found it unnecessary compared with the efficacy of exercise and meditation.
A brief google search reveals some prominent present day and historical figures with ADHD. To me, when I counsel young patients and their parents, this part is key - ADHD can be a gift, with many ‘superpowers’ that come with it. I try always, when giving a diagnosis, to destigmatize the condition. As doctors, one of the greatest harms we can commit is to make a person feel inferior or even less than human due to a medical condition. We all have our gifts to offer the world, and the beauty of the ‘neurodivergent’ model is to recognize that.
How ordinary would a world be where we were all the same? Grey.
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