Impairment and Why Not Everyone Has ADHD
Want to put an ADHDer in a bad mood? Just tell them that “everyone has ADHD.” Works every time.
The reason the popular misconception that ADHD is just shorthand for life in the twenty-first century, not an actual neuropsychological condition, refuses to go away is that ADHD symptoms sound like things all healthy adults experience from time to time.
Feeling restless? Can’t remember something? Zoned out? Join the club.
One way to distinguish between ADHD and normal absentmindedness is by looking at the degree of the symptoms. Do you have trouble paying attention occasionally, often or pretty much all the time?
However, even this attempt at being quantitative can muddy the lines between typical human imperfection and actual disorder. What does “often” really mean? Two people can say they have trouble paying attention “often” and mean totally different things.
A clearer way to explain why ADHD is something serious that not everyone in fact has is by underscoring the fact that ADHD symptoms by definition cause problems in the workplace, in school, in social settings and in pretty much every sphere of life. If you get distracted sometimes, you don’t necessarily have ADHD. But if you get distracted a lot and it’s messing up a life, you might.
That’s why impairment is becoming a magic word in the ADHD community. “Impairment” is the one-word answer to everyone who would tell you “oh, I have that too” or “everyone gets distracted sometimes” or “we all experience that, just deal with it.” The DSM, the handbook psychiatrists in the United States use to diagnose ADHD, specifies that ADHD symptoms have to interfere with your functioning to warrant a diagnosis (see CDC’s page on ADHD symptoms).
OK, makes sense, but what does “impairment” look like in day-to-day life?
Here are some ways the inattentive symptoms from the DSM can significantly impair everyday functioning:
- Not paying close attention to details and making careless mistakes: Your careless mistakes probably aren’t impairing if you once made a typo. On the other hand, if you show up late to a job interview because you typed the wrong address into your GPS, then discover that you’ve brought your shopping list instead of a current version of your resume, then repeatedly call your interviewer “Bob” instead of “John” because you weren’t listening when he introduced himself, your careless mistakes might be causing you serious problems.
- Not being able to sustain attention: Everyone has trouble focusing sometimes. However, if you have to read through an unexciting but important report for work and end up re-reading every sentence repeatedly to the point that you’re ready to just give up on the whole project, broken attention is interfering with your life.
- Not listening: If you find your mind wandering while your great uncle lectures at length over Thanksgiving dinner about the importance of checking your oil every month, you aren’t necessarily experiencing a symptom of ADHD. But if you’re repeatedly missing out on important information from your boss, teachers, friends, spouse, etc., there could be something ADHD-ish going on.
- Not following through on work or chores: If you’re still feeling guilty about how you didn’t do the dishes that one day last week, you’re probably OK. If your boss is calling you into a one-on-one to discuss the meaning of the word “deadline,” you might have a bigger problem.
- Having trouble organizing tasks: It’s the night before you have to finish a big project and you’re just getting started. Are you thinking (a) “I messed up, I put this off too long” or (b) “I’m such a failure, I always put things off too long”? If it’s (a), everyone’s been there, done that. If it’s (b), well, you’ve at least got a little glimpse into everyday life with ADHD (and you’ve at most got ADHD yourself).
- Avoiding tasks that require sustained mental effort: Maybe you sometimes don’t enjoy doing homework, but that’s par for the course — there’s a reason they don’t call it “homefun.” Less par for the course and more indicative of possible impairment would be having such a visceral negative reaction to homework that you as a rule put it off as long as you can, then rush through it as fast as humanly possible (or simply never do it), to the point that it affects your performance in school.
- Losing things: If you once misplaced a penny, you don’t necessarily have to rush off to your doctor for an ADHD evaluation. If you’ve come to see a pencil as a tool you only get to use once before it disappears into the ether, you could be experiencing a symptom of ADHD. And if you regularly lose things that you need or things that are valuable, you could even be experiencing impairment.
- Being easily distracted: If there’s a mariachi band performing in the cubicle next door and you’re having difficulty proofreading a 52-page report, you might just be human. However, if you find the ceiling tiles endlessly fascinating as soon as you have to do any kind of work whatsoever, you might be a human whose distractibility interferes with your day-to-day functioning.
- Being forgetful: Perhaps you can’t remember the name of that movie you saw two summers ago. This likely isn’t cause for concern. But if you have a reputation as “the guy who forgets everyone’s names” or “the girl who says she’ll do stuff, then forgets to do it,” you’ll know that forgetting is easier than forgiving!
So people with ADHD aren’t just inattentive, distractible, disorganized and so on. They’re inattentive, distractible and disorganized to the point that it causes real problems in their lives.
Understanding this that ADHD is by definition impairing is the key to understanding why ADHD is a disorder and why not everyone has it.