Attention, Focus, and Concentration Difficulties Don’t Necessarily Mean “ADHD”
Attention, Focus, and Concentration Difficulties Don’t Necessarily Mean “ADHD”
Dr. Kohlhase, Psy.D., LP
TikTok has its uses. It also has its pitfalls. As a clinical psychologist who provides testing to diagnose or rule out Attention-Deficit/Hyperactivity Disorder (ADHD), I see both the utility and the downsides. Many clients walk through my office door, more ready to discuss their mental health concerns because they have seen countless videos normalizing and de-stigmatizing the experience of anxiety, depression, and attentional concerns. However, the easy access to anecdotal “evidence” of these various diagnoses also frequently leads people to self-diagnose, convincing themselves that they have lived their whole lives with undiagnosed ADHD and simply need someone to confirm this.
Since beginning my work in psychological assessment and diagnosis, I have consistently been surprised by how relatively few people coming in for confirmation of their “ADHD” actually meet criteria for this disorder. I was recently asked how often I actually diagnose ADHD among my testing patients, and I reflected that perhaps I am landing on this diagnosis 3 out of every 10 assessments. This begs the question then – “If it’s not ADHD, what else could it possibly be?”
One of the amazing, albeit sometimes frustrating, aspects of diagnosis is that many of the most common “umbrella” diagnoses in mental health share common symptoms. Behaviors such as difficulty sitting still, frequent issues with forgetfulness, “zoning out” during conversations, being easily distracted, and not being able to start or complete tasks These issues all have several possible explanations. It is not necessarily common knowledge that anxiety and depression can present in a similar manner or that exceedingly high expectations of ourselves can result in distracting intrusive thoughts that prevent us from being able to attend to what is happening in the moment.
One of the clinical topics that I am most passionate about is helping people to identify how the experience of “developmental trauma” can impact day to day functioning, often in ways that are difficult to recognize, throughout the rest of their lives, if left unaddressed. So many people, including those who identify happy and relatively stress-free childhoods, often struggle to admit that they internalized messages of being “not good enough” or constantly worrying about letting others down. For these individuals, their difficulty in time management, organization, and memory may initially appear like “attention deficit” concerns. Certainly, for some of them, these issues DO stem from ADHD. However, there are many people who are so accustomed to the demands of their “internal voice,” urging them on to “do more,” “accomplish more,” “figure it out on their own,” and “take care of others, even if it means not getting their needs met.” Constantly believing that, no matter how hard one tries or how successful someone is, it is “never good enough” can lead to low motivation, feelings of despair, memory concerns, barriers to task completion, and trouble focusing and concentrating. Without the knowledge about “developmental trauma,” many individuals jump to the conclusion that they are experiencing symptoms of ADHD.
In addition to completing a formal testing process, there are other “hints” as to whether or not someone may be struggling with ADHD or a different emotional health concern. Whenever a client tells me that they never had difficulty with focus or concentration as a child, that they found academics to be easy, and that they felt fully functional for years, I immediately begin to question the likelihood of ADHD. Due to the fact that ADHD is a lifelong condition, it does not suddenly “appear.” While sometimes these symptoms become more prevalent during later years, such as when young adults enter college and are suddenly faced with managing their own schedules and having to be self-disciplined about time management, by and large, there are indications much earlier in life that an individual has difficulty with impulse control, judgment, planning, and other more advanced cognitive skills. It is also notable when an individual identifies a specific traumatic event as being the point at which they ceased being able to stay focused, organized, or attentive. This realization often suggests that the stress and anxiety associated with a difficult event may be the underlying reason for organizational and attention-related concerns.
Given all of this information, it is understandable that people often feel confused about how to proceed when they are noticing or struggling with the above symptoms. I always highly recommend seeking out a formal psychological assessment process, as this is truly the only way to accurately differentiate between ADHD and other emotional health diagnoses. While some primary care providers will do a basic assessment and are agreeable to prescribing medication if enough symptoms are present, this process rarely addresses or acknowledges the other possible explanations for the difficulties that the individual is experiencing. It’s also worth mentioning that, for individuals who do not actually have ADHD but, instead, may be experiencing severe anxiety, a stimulant is very likely to result in increased anxiety and, therefore, even more extreme symptoms that the individual is trying to treat and eliminate.
Yes, it is time-intensive and can certainly feel overwhelming or even frightening to discuss and, in some cases, unearth past wounds. However, the process is generally validating, helpful, insight-generating, and most certainly healing. The more accurately each of us understands ourselves, the roots of our behaviors and feelings, and the most effective ways to feel better, the greater the likelihood that we will be able to create and live the lives that we each want for ourselves.
- Dr. Kohlhase, Psy.D., LP
