Okay, yes, my child seems to have a bit of ADHD but is a diagnosis really needed? Do we really need to label him? This is a sentiment shared with me by many parents and loved ones of someone with or suspected of having ADHD. It’s a fair question, arising naturally as new options and uncharted territory are explored. Many well-meaning parents simply want to avoid pigeon-holing their children, relegating the entirety of their identity to being ‘that kid with ADHD.’ Others worry that their children or loved ones, once diagnosed, will simply stop trying and use ADHD as an excuse for problematic behaviour (“My ADHD made me do it!”). Often there is a worry that people with ADHD will be seen as less competent, disabled, and broken, and treated by others in a corresponding manner – shamed by peers, coddled by teachers, and patronized by society. This sentiment is often also expressed to me by adults who may have ADHD, who worry that a diagnosis will cause them to curl up into a ball, defeated, lamenting the life that they cannot live and the tasks they cannot engage in because they have ADHD (“Sorry, I wish I could help but I have ADHD.”). Others seem somewhat apathetic about the whole thing. Sure, maybe it's ADHD. So what? What's the point of getting an ADHD assessment? It won't change anything other than add some letters and a label. Why bother? These are common questions for people considering getting an ADHD diagnosis. Is there really any value to having the label of ADHD? Does it cause more harm than good? Should you really get an ADHD assessment? Let’s explore these questions.
The Power of Labels
The labels that we apply to ourselves and others do have power. If I think of myself as "untalented" or "annoying," I will consciously or even unconsciously alter my behaviour to fit that self-concept. As an "untalented" person I'm probably not going to sign up for that new martial arts class. After all, being "untalented," I'm not likely to succeed (or so my mind might say). If I consider myself "annoying," well, I might learn to keep silent around other people. Better not annoy them more, right? The power of labels extends to their use with other people as well. If I frequently call my son "rude" after every display of problematic social behaviour, my son learns that he is rude. Hearing this label applied repeatedly he may very well be more likely to continue to act in ways that reinforce this self-concept. Labels affect how we see ourselves. Labels influence how we see, relate, and interact with others. Labels are powerful.
"I Don't Want to Label Him" and Other Tales of Why People with ADHD Don't Get Diagnosed
When we think about the power that labels hold, it makes a lot of sense that people get concerned about the idea of seeking out a diagnosis and being labelled or labelling someone "ADHD." Here are some variations of the common concerns that I have heard from parents and spouses of people with ADHD, as well as adults with ADHD when I've suggested seeking out a diagnosis:
"We don't want others to think less of them."
"So what if she's a bit disorganized? Do we really have to label her?"
"When I was a kid, we didn't call it ADHD... we just called it lazy. He just needs to get his act together - he doesn't need another excuse not to do things."
"He'll just use it as an excuse for everything. I don't think it will be healthy."
"Isn't everyone a bit ADHD these days? I think I'm a bit ADHD too! So what?"
"ADHD has nothing to do with it, she just doesn't care about leaving messes all over the place."
Adults with ADHD
"I'm just making excuses for myself."
"If I get diagnosed with ADHD, what difference will it make?"
"If I get a diagnosis, I'll just curl up into a lazy ball and just give up on trying. I'll become self-indulgent and not do anything."
When we think about the power of labels, it makes sense that people worry that being labelled ADHD will move them in a certain way. More often than not, those concerns involve a loss of functioning and motivation, understandable concerns around individuals who are already experiencing compromised functioning and motivation. The fear of the unknown is also partly at play. We know what life looks like as things currently are. How do things change with a new name, new diagnosis, and new label thrown into the mix? What does life look like for someone who has been diagnosed with ADHD? Given the fears that diagnosis could make things more problematic, hesitancy naturally arises around the topic of assessment for ADHD.
The Benefits of Diagnosis
If labels are problematic, why bother even exploring the possibility of getting a diagnosis? If you suspect that ADHD is at play, there are a few strong reasons to consider seeking out a diagnosis for yourself, your child, or your loved one.
Getting Proper Treatment
The most straightforward reason for seeking out a diagnosis is that it can be an essential step towards getting the right treatment. If someone is suffering from an autoimmune disease, giving them a diagnosis of arthritis or inflammatory bowel disease is not about labelling them for the sake of labelling them. In these cases, the diagnosis helps explain the challenges currently going on. With a diagnosis in place, a treatment plan can be put into motion for these individuals - we know what's causing the problem and here are the different ways to treat the problem. Diagnosis is not about pathologizing people just because we can; it's about figuring out how to make things better.
When it comes to ADHD, with a diagnosis in place, new options open up to us. First, we might start learning more about the disorder. Learning more about what ADHD is and how it shows up can better help us recognize what behaviours and challenges are ADHD related. We can also then learn ways to cope with those challenges. This may involve reading up on some great ADHD books, watching YouTube videos on ADHD, listening to ADHD podcasts, or joining an ADHD group. Knowledge is power - with new knowledge about what ADHD is, we have new options for working with the disorder and its accompanying challenges. Other options for ADHD treatment include starting medication or utilizing evidence-based psychological approaches such as Cognitive Behavioral Therapy for ADHD (CBT for ADHD), Mindfulness for Adult ADHD with the Mindful Awareness Practices (MAPs) ADHD program, psychotherapy for ADHD, ADHD coaching, or skills training for ADHD. There are many effective ways to treat ADHD and reduce the challenges that show up - for the person experiencing ADHD and those living with people with ADHD too. Once you have a diagnosis, finding your way to these treatments and approaches becomes a whole lot easier.
Diagnosis is not about pathologizing people just because we can; it's about figuring out how to make things better.
2) Avoiding Alternative Labels/'Diagnoses'
I have occasionally encountered the following paradox: people tell me that they don't want to seek out an assessment for their child's possible ADHD because they worry about labelling them... instead, they want me to work with their child's laziness and lack of motivation. The unfortunate irony here is that while worrying about labelling their child, they continue to label their child - as 'lazy' or 'unmotivated.' Parents, spouses, and adults with ADHD can worry so much about box-putting, pigeon-holing, and labelling that they miss the fact that these things are actually already happening. Labels allow us to make sense of the world around us. They also allow us to make sense of the behaviour of individuals. Whether someone with ADHD is diagnosed or not, they will display a real-world behavioural difference when compared to others. Parents see their children not doing the things that they are being asked to do. It is understandable that they then look for some sort of explanation for this. Without a clear understanding of the fact that the child has ADHD, the conclusion that the child is simply characterologically lazy might seem the reasonable explanation for why they are not doing the thing that has been asked of them. Spouses see their partners leaving messes around the house, never seeming to take action to improve it despite numerous requests, prompts, and discussions. Without knowing that ADHD is involved, the conclusion that may present itself is that the partner does not care, is 'selfish,' or is 'inconsiderate.' Adults see themselves forgetting to pay bills on time, failing to respond to calls, texts, and emails, or missing important deadlines. Without understanding the role that ADHD plays, they may criticize themselves for being 'careless,' 'irresponsible,' or 'incapable,' or some other version of the 'not good enough' story. We might worry a lot about labelling someone with ADHD but labelling is already happening. The 'alternative' labels used for people with ADHD pre-diagnosis are significantly less helpful, more pathologizing, and more problematic than if we would simply label them with the diagnosis that actually explains their behaviour: Attention Deficit Hyperactivity Disorder.
We might worry a lot about labelling someone with ADHD but labelling is already happening.
Maximizing the Benefits and Minimizing the Harm
Given the potential benefits that come with an accurate ADHD diagnosis, serious consideration should be given to pursuing one for your loved one or yourself if you suspect ADHD is at play. At the same time, we do want to minimize the potential harm that could come with the diagnosis. At a certain level, the harm that we fear will come with a diagnosis is exactly that - simply fear. In actuality, much of what adults and loved ones worry will happen when someone gets diagnosed does not come to pass. The diagnosis of ADHD does not turn people into lazy, immobile, sloth-like beings. Rather, it gives them a way to address the challenges in their lives and see real improvement in the tremendous array of life difficulties associated with ADHD. That being said, the following considerations can be utilized by parents, partners, and people with ADHD to help ensure that an ADHD diagnosis results in maximum benefit and minimal harm.
Appropriately Situating Labels and Identity
One way to help mitigate the potential challenge of label acquisition is to accurately distinguish the person from the label applied to them. For example, rather than saying, "I am ADHD," an adult with ADHD might say, "I am a person with ADHD." Or a parent might tell their child that they are affected by ADHD rather than say that they are ADHD. The difference might seem subtle, but it can help individuals properly relate to their ADHD - as something that affects them, yes, but is not the whole of who they are. ADHD is not a death sentence; nor is it a guarantee of living life a certain way - it is a neurodevelopmental brain difference that impacts our lives but does not dictate our lives or guarantee our life trajectory. We want to appropriately recognize the real impact ADHD has on someone's life while understanding that it is only one influencing factor and one of many factors involved in people's behaviours, choices, and the problems that they experience. As someone who is ADHD, my whole of experience and my interactions with all aspects of life are seen through my ADHD, as part of my ADHD, and as controlled by my ADHD - for better or for worse. As a person with ADHD, I live informed by my experience of ADHD, but not constricted by it. In this case, I benefit from knowing that I have ADHD, but my ADHD diagnosis does not need to unduly constrict my actions or disable me further.
ADHD is a neurodevelopmental brain difference that impacts our lives but does not dictate our lives or guarantee our life trajectory.
Changing Our Relationship to Thoughts
We can extend the above concepts further and connect them to navigating tricky thoughts that can show up post-diagnosis. For example, say that I am a young adult transitioning from high school to university. As I consider choosing my program of study, I find myself interested in some particular paths. Unbidden, a thought arises, "I'd like to take that program, but I have ADHD." I buy into my thoughts, accept them as reality, and choose a different program - less rewarding but safer. My ADHD diagnosis has limited my life and decreased my options. So it would seem. Yet, as above, this is likely more of a problem regarding my relationship to my diagnosis, rather than a problem regarding my actual diagnosis. I could, when that same thought arises, tell myself, "I'd like to take that program AND I have ADHD." Here, a different reality presents itself. I accept the reality that I'd like to take the program and I recognize that I also do have ADHD. By replacing the word 'but' with 'and' the fact that I have ADHD does not become a reason why I cannot do something. I can choose to move towards what is important to me while having ADHD. It is not that my experience of ADHD won't contribute to any challenges I might experience during the program. ADHD is a real disorder and it does contribute to real challenges. However, in the first example, my relationship to my ADHD has me shut down possibilities. In the second example, I recognize that both things are true: I want to do this program and I do have ADHD. In the first example, I see reasons why I cannot do what I want. In the second example, I simply recognize my experience for what it is and avoid adding on unnecessary, unhelpful, and possibly inaccurate predictions ("I can't do X because I have ADHD). Now, I am more oriented to figuring out how I can take the program while also addressing the ADHD-related challenges that can come along. It's important to keep in mind that these 'techniques' (i.e. I am a person with ADHD vs. I am ADHD, and replacing 'but' with 'and') are simply included for illustrative purposes. Walking around and inserting the word 'and' into every sentence is not necessarily going to fix every problem in your life! (Hey, you can try! You do you...). The key is that, in many cases, it is not so much the ADHD diagnosis itself that causes harm; it is the way in which we relate to that diagnosis. If I can hold the diagnosis in my mind lightly, in a way that informs my life but does not dictate my every action, behaviour, and choice, I can experience significant benefits from the ADHD diagnosis while minimizing the potential harm that comes from overidentification, rigid thinking, and behavioural inflexibility.
A note on identity...
Many people with ADHD refer to themselves as ADHDers and strongly value and identify with the label of ADHD. For many people with ADHD, diagnosed later in life, it can feel as if they have finally 'found their tribe.' The label of ADHD is embraced and it becomes a part of their identity. This can be tremendously validating, a source of comfort and reassurance, and promote greater mental health and well-being. There is no problem with identifying with the label of ADHD in this context and it can actually be very beneficial to do so. The key points here are simply that it is valuable to be able to hold identity while recognizing the potential for and risk that exists in rigidly holding on to different self-concepts and identities even when it is not currently serving us. We can choose to identify as someone or in some way. This means that there is a 'we' or rather an 'I' that exists before we choose to identify in a particular way (the 'I' that chooses to say "I am an ADHDer"). Identities are useful in their way as long as we can stay in touch with that bigger 'I' who first chose to identify in a particular way. From this position, there is the flexibility to move in other directions when it is useful to do so rather than remain rigidly attached to a perception of how I am, have been, and will always be. Okay, sheesh, if I haven't lost you yet with my meandering attempts at philosophy... onwards! No more philosophy. Pinky promise.
Towards a Balanced Relationship with ADHD
Anxiety, concern, and skepticism are normal experiences when considering getting an ADHD diagnosis for yourself or a loved one. If you are considering getting an ADHD diagnosis, you might wonder whether there is really any point and whether you are just trying to make excuses for yourself and trying to avoid reality (maybe you think that you just need to "pull yourself together," whatever that means!). If you are a parent interested in getting an ADHD diagnosis for a child, you might worry about stigma, shame, and further disablement as a result of the diagnosis. If you are in a relationship with someone with ADHD, you might have concerns regarding whether they will resort to using the ADHD label as an excuse or a crutch. These concerns are normal and to be expected as you explore something new and unknown. Yet, as highlighted in this article, there are very real benefits waiting for you on the other side. Increased understanding and communication, a better relationship with yourself and others, and the opportunity to get real treatment and help for ADHD all become possibilities once a diagnosis is established. Although many of the fears and worries that people have pre-diagnosis do not play out as imagined, there is certainly the possibility for unintended consequences post-diagnosis. Some individuals with ADHD do use the label ADHD as a catch-all reason for why they cannot do something. Other people may in fact treat individuals with ADHD differently. Getting the ADHD diagnosis does not mean that we all start sailing off into a land of rainbows, puppies, unicorns, and eternal bliss. Yet, even if these challenges do occur post-diagnosis, they tend to be significantly better outcomes compared to what often happens pre-diagnosis. Shame, labelling, and disability happen before diagnosis as much as - if not more than - the experience post-diagnosis. Moreover, the potential harm that can occur post-diagnosis can be mitigated by learning more effective ways to relate to self-concepts, labels, and the experience of ADHD. This can allow us to so to speak have our cake and eat it too by attaining the significant benefit of an ADHD diagnosis while minimizing undesirable outcomes.
Treatment for ADHD
With a diagnosis in hand, new treatment options become available. Individuals with ADHD can experience significant benefits from cognitive behavioral therapy for ADHD (CBT for ADHD), mindfulness for adult adhd (MAPs for ADHD), and psychotherapy for ADHD, all of which are offered at our practice. Parents, partners, and spouses of people with ADHD can benefit from psychotherapeutic support and guidance for working and living with their loved ones with ADHD, support and guidance that is offered by our psychotherapists (learn more here about our ADHD-specific support for family members of people with ADHD). If you are looking for support in navigating ADHD for yourself or a loved one, you can reach out to our team at Shlomo Radcliffe and Associates. We offer psychotherapy and support for ADHD with in-person and online sessions in Toronto and online sessions available throughout Ontario, Canada. Learn to relate to ADHD experiences in a way that enables rather than disables and get support for navigating ADHD-related challenges in your relationships, work life, home life, and in every way that ADHD shows up for you. From this new perspective, you might just find that it is possible to get your needs met, feel supported and connected, and move towards what's important to you in the presence of an ADHD diagnosis.