What kinds of stigma and prejudice do people with ADHD experience day-to-day if they live in the UK?
“There are many misconceptions regarding ADHD in adults among healthcare professionals, opinion leaders in politics and the media and members of the public. People with ADHD are often portrayed as drugseeking, antisocial, dangerous or malingering, while others portray ADHD as a ‘disease’ manufactured by healthy people wishing to enhance cognitive performance with stimulants. In terms of aetiology, ADHD is variably portrayed as a behavioural problem related to bad parenting, an attachment disorder, the result of food additives, watching too much television or a problem with modern society” .
There are many different aspects of ADHD that people in the UK often have prejudiced views about, such as:
- Whether there is uncertainty about the reliability/validity of an ADHD diagnosis and the related diagnostic assessment.
- Whether to perceive individuals with ADHD as dangerous.
- What people with ADHD ‘look like’ in terms of their socio-demographic appearance – i.e. in terms of their age, gender, or ethnicity
- For example, research has shown that ethnically black boys presenting the same behaviour as ethnically white boys are far more likely to be dismissed as ‘bad’ than to be identified as possibly having ADHD.
- Likewise, diagnosis rates are 3x higher in males than females despite ADHD being equally prevalent regardless of gender.
- Adults with ADHD are frequently misdiagnosed with mood disorders, personality disorders, or bipolar, because people wrongly assume that ADHD only affects children.
- Whether to believe various stigmatising messages about ADHD treatment, for example those perpetuated by sensationalising TV programmes, journalists or members of the public.
- Whether somebody who has disclosed to you that they themselves have ADHD, or that they take medication to treat their ADHD, should be taken seriously (particularly in relation to anything they tell you about the disorder).
How has this happened? Why does ADHD get stigmatised so much?
For a long time, we’ve known stigma is often linked to ‘invisible’ conditions, and particularly those in which the symptoms might be thought to be under the individual’s control or ones that don’t have one single obvious cause . ADHD is a classic example of an ‘invisible’ condition, because:
- Unlike the symptoms of many other psychiatric disorders, the symptoms of ADHD aren’t sudden – you’re affected by them for your whole life so the people around you may think that your symptoms are just ‘what you’re like’.
- The symptoms of ADHD are all things that everyone has a bit of difficulty with now and again
- It’s often not obvious when people have ADHD – they don’t have to have had an injury, be in a wheelchair or wear a cast. Many adults with ADHD aren’t visibly hyperactive, even if this is their primary subtype.
This means that people can often mistake ADHD symptoms for character traits such as being lazy or rude, when they’re actually symptoms of a disability that the individual was born with and can’t control. Goffmann was talking about this way back in 1963 but a useful recent discussion of this in relation to ADHD is the Mueller et al (2012) paper listed in the references .
What exactly are people so suspicious about?
The scientific answer: It has been suggested that varying degrees of symptom presentation (predominantly hyperactive vs. predominantly inattentive) and variation of symptom severity across temporal and contextual situations increases the risk of questioning the disorders’ reliability [15, 16]. Diversity in the disorder’s etiology as well as the disorder’s heterogeneity across age groups  have been shown to enhance the disorder’s proneness to stigma, partly through questioning the disorders’ diagnosis, assessment, and treatment [17-23].
In other words, people are suspicious of ADHD because:
- There are different types of ADHD (some people are hyperactive, some people aren’t).
- ADHD symptoms depend on the situation. For example, people with ADHD can seem really good at focussing on some things, like videogames or a subject that they’re passionate about, but really bad at focussing on other things that they’re not so interested in. Most people think ADHD means not being able to focus, when it’s actually more like not being able to control what you focus on, so they get suspicious when people with ADHD can spend hours doing ‘fun’ things like playing on a videogame or reading on the internet about something they’re really interested in, but not even a minute on things that aren’t immediately rewarding or that they would find ‘boring’.
- People with ADHD will sometimes also seem so ‘normal’ or skilled in some activities that you would never imagine them to be very impaired in other activities that you would consider ‘easy’ or ‘day-to-day’.
- Just remember that some of the smartest people of all time have had disabilities that stopped them doing activities that others would find ‘easy’, which are easy to understand because they were physically obvious. ADHD is the same, you just can’t ‘see’ the impairment from the outside like you’d be able to if it was physical.
- The disorder also seems to be different for different ages, and this also makes people suspicious… Even though we know that the symptoms are different for young people than for old people, and when you think about it, this makes a lot of sense. For example, not being able to make your own lunch or hold down a job is fairly normal if you’re 7 years old and not likely to be a sign of a mental health disorder, but less normal and potentially a symptom of a mental health disorder if you’re 30.
- Because there is not one specific cause, which makes people suspicious that people might be able to pretend to have the disorder when they actually don’t. We’re not sure why someone would pretend to have the disorder, though, because we can’t think of anything that’d be worth going through the process of trying to get a diagnosis, which is long and very complicated. It’d also be extremely difficult to get a diagnosis if you didn’t have the disorder, because you need evidence of long-term impairment since childhood, and people that you work and live with will also have to provide assessments of your behaviour and symptoms – so its not just based on what you have to say. In other words, even if someone went for a diagnosis and said all the right things, unless their manager or schoolteacher confirms those things, it’s unlikely that this person will get a diagnosis.