Last week, we began separating common ADHD myths from reality. We explored how ADHD does not always look like obvious hyperactivity and may instead appear as quiet inattentiveness, forgetfulness, or disorganization. We also explained that ADHD is not simply an inability to pay attention, but rather difficulty regulating attention—making it possible for someone to struggle with routine tasks while becoming intensely focused on something stimulating or rewarding. This week, we continue by examining three more common misconceptions about ADHD.
Myth 3: ADHD Is Either Overdiagnosed or Underdiagnosed
Reality: Accurate Diagnosis Requires a Careful Evaluation
Due to increased awareness, as well as the understanding that ADHD can present in many different forms, the term ADHD can sometimes be thrown around haphazardly. Something I see all too often is a child who is referred to me by the school because they “need to be on medication for ADHD.” Teachers and other school staff, including guidance counselors, rebbeim, and administrators, are incredible resources and partners in helping children and parents find the right support. More recently, schools have become increasingly aware of the signs and symptoms of ADHD in children and are able to guide parents toward help. These children are then able to obtain the appropriate support and tools to succeed.
However, at times, it seems that many other issues are being viewed through “ADHD-colored glasses.” While the child may truly be struggling with ADHD, many other struggles can mimic the symptoms and look very similar to ADHD. A child with a learning disability may lose focus or appear distracted because they are having difficulty learning or keeping up with the class. This child may even act up or disrupt the class as a coping mechanism for their struggle to keep up. A child with high anxiety may use avoidance mechanisms, such as becoming the class clown, not participating in classroom discussions, or leaving class often. A child who is experiencing a personal or family struggle may be so preoccupied with thoughts or worries that they appear distracted and unable to complete their work. A child struggling with obsessive thoughts will have a lot of difficulty paying attention in class, will often be irritable, and may even exhibit defiant behaviors or chutzpah. A child may simply be having difficulty seeing the board, and glasses may magically fix their attention problem. And these are just a few examples.
This is where a complete and thorough assessment is paramount. Each of these scenarios would require its own unique and nuanced treatment plan, which would look completely different from the others. Treating only the symptoms of hyperactivity, inattention, or impulsivity is like going to the doctor and being diagnosed with a fever. In order to provide the appropriate care, the doctor must find out where the fever is coming from, and depending on the source of the fever, the treatment can look completely different. The same is true here.
However, just as ADHD is sometimes incorrectly diagnosed, the opposite occurs as well. Often, kids or adults with ADHD are mistakenly diagnosed with conditions ranging from anxiety and depression to oppositional defiant disorder. Ensuring that a proper assessment is conducted by either a therapist or a psychiatric provider is vital to receiving the correct treatment. For years, ADHD was significantly underdiagnosed, especially among females, adults, and individuals who did not fit the stereotypical image of ADHD. Increased awareness and decreased stigma have possibly created a pendulum swing. The good news is that professionals throughout the community are working tirelessly to educate and expand access to care, allowing for proper assessments and tailored support rather than blanket diagnoses.
Myth 4: You Grow Out of ADHD
Reality: ADHD Often Continues into Adulthood
While the presentation of ADHD may change over time, many individuals continue to experience symptoms well into adulthood. Hyperactivity may become more internal, presenting as restlessness, racing thoughts, or difficulty slowing down one’s mind. For this reason, without a thorough evaluation and assessment, adults with ADHD can often be misdiagnosed with anxiety. This can lead to inappropriate treatment and, therefore, poor results and the perpetuation of symptoms. While ADHD and anxiety can coexist—and, in fact, often do—in some cases, the symptoms of anxiety actually stem from unmanaged ADHD and can be resolved with ADHD treatment alone.
Another way ADHD can present in adulthood is in the area of executive functioning. In a neurotypical brain, there is a control center located in the prefrontal cortex that acts as the brain’s organizational manager. Executive functioning includes the ability to manage time, plan, keep track of important belongings, dates, and appointments, and organize and juggle tasks. These are the skills we refer to as executive functioning. In ADHD, the brain networks responsible for executive functioning work less efficiently, making skills like planning, organization, prioritization, and time management much more difficult.
As the demands of adulthood increase, these executive functioning challenges often become much more noticeable. This is one reason many individuals are not diagnosed until later in life. A parent may look around and wonder why everyone else seems to have color-coded schedules and their weekly menus fully planned out by Motzei Shabbos while they are drowning in a tangled web of responsibilities. Someone who was able to compensate throughout childhood may suddenly find themselves unable to juggle all the balls necessary to keep a household—or even themselves—afloat. This can lead to missed appointments, constantly running late, forgotten responsibilities, or feeling overwhelmed by the day-to-day demands of life.
It is important to note that, for an ADHD diagnosis to be considered valid, symptoms must have been present in childhood as well, although they may at times have been missed or misdiagnosed. ADHD is a neurodevelopmental disorder, and it is not possible to first develop ADHD as an adult. However, the added pressures and responsibilities of adulthood can often intensify the severity of the symptoms and the extent to which they interfere with functioning.
Myth 5: People with ADHD “Have So Much Potential! If Only They Would…”
Reality: ADHD Is a Challenge with Execution, Not Effort
Fill in the blank: If only they would apply themselves, if only they would focus, if only they would sit in their seat, if only they would stop making trouble, if only they would study, if only they would try harder—the list can go on and on. This is one of the most damaging misconceptions surrounding ADHD. At the core of ADHD are difficulties with executive functioning, which includes skills such as initiating tasks, organizing, prioritizing, shifting attention, and following through. Many individuals with ADHD are putting in tremendous effort behind the scenes. Often, they know exactly what they need to do but struggle to consistently translate intention into action.
From the outside, this can look like procrastination, but in reality, it often feels more like having 28 browser tabs open at once and no idea where the music is coming from. A child with ADHD may feel like a failure: If every other kid can do it, why can’t they? And if the adults in their life feel they are capable, then something inside them must be broken. This can lead to the disastrous ADHD domino effect: ADHD behaviors – adult disappointment or reprimands for those behaviors – more negative feedback and less positive feedback – the child is unable to meet the expectations set for them – the child feels broken or like a failure – poor self-esteem and a negative self-image that can stay with them through adulthood and affect many areas of life.
ADHD is not laziness, a lack of intelligence, or a lack of willpower. It is a neurodevelopmental condition that affects how the brain regulates attention, motivation, behavior, and executive functioning. Let’s stop talking about “potential” and focus more on the child in front of us and the support we can provide to help them succeed. By doing this, we can put a stop to the domino effect and provide children with the proper tools, support, and encouragement to grow into healthy and successful adults.
While ADHD presents real challenges, many individuals with ADHD also possess remarkable strengths, such as creativity, curiosity, resilience, energy, humor, and the ability to think outside the box. The goal of treatment is not to change who someone is, but to reduce the barriers that prevent those strengths from shining.
Levana Feldstein, PMHNP-BC, is a board-certified Psychiatric Mental Health Nurse Practitioner and founder of Moonlight Wellness, a private psychiatric practice serving children, adolescents, and adults in New York and New Jersey. With over a decade of experience in mental health, she is passionate about educating the community, reducing stigma, and providing compassionate, individualized care. She can be reached at This email address is being protected from spambots. You need JavaScript enabled to view it..
