It’s no exaggeration to suggest that the self-esteem of children with ADHD, over the span of their childhood, experiences a thousand cuts. Even in the presence of well-meaning and supportive adults an individual with ADHD is constantly reminded that they’re not quite making it: forgotten homework, incomplete chores, poor grades, reminders to be quiet, lost or misplaced shoes, gloves, jackets and school materials, and tardiness, to name just a few of the negative behaviors displayed by someone with ADHD. And then there are the comments: “how many times do I have to tell you?” When will you learn?” How hard is this?” “Why can’t you get this?” and “Just be quiet!” Then there is the endless parade of negative consequences: time outs, lost electronics, no recess, no play time, frowns, irritation, and disappointment from parents and teachers, and in some cases much worse consequences. Humans are resilient. A single cut, and the body heals itself. Multiple cuts, spread over a life-time, and the body heals itself. But a thousand cuts massed over a short time period, and the body dies.
In their book, “Death by A Thousand Cuts” Brook, Bourgon, and Blue note that the purpose of this type of execution isn’t just about inflicting physical pain and death. It was also meant to deny the victim hope of life after death, and inflict shame. The thousand cuts experienced by an individual with ADHD often has a similar effect, the infliction of shame and the loss of hope, not for a life after death, but a decent life while they still have breath. Adults with ADHD are disproportionally represented in incarcerated populations, experience more academic failure, more employment disruption, and more marital conflict.
What to do? First, we need to make sure we understand ADHD. It isn’t just about being hyperactive, impulsive, or inattentive. Individuals with ADHD experience a complex set of difficulties including emotional sensitivity, executive functioning deficits, social skill deficits and challenges regulating their attention. Individuals with ADHD can pay attention if the thing they are attending to is intrinsically interesting to them, or they have been offered a big enough carrot. The challenge for an individual with ADHD is arousing themselves to attend adequately to things that are tedious and monotonous. Additionally, individuals with ADHD may over-focus and have difficulty disengaging from what they are involved in.
What else? Let’s stop trivializing the diagnosis. ADHD won’t physically kill you, but it does contribute to a great deal of emotional distress and a lifetime of challenges. And, let’s start diagnosing it correctly. Take the time to get a thorough history, review school records, and get standardized questionnaires completed by parents and teachers. We also need to acknowledge that ADHD is a neurological problem that doesn’t fix itself, and doesn’t get fixed with psychotherapy. While therapy is often an important component of treatment, parents and children with ADHD need to be educated (constantly) about ADHD, individuals with ADHD frequently need increased structure (e.g., 504 plan, regularly scheduled homework time, bedtime, and mealtime), increased support (homework assistance, tutoring, organizing their backpack) and finally medication. We need to get educated about medication and quit being afraid of it. Enlist the support of a good psychiatrist or pediatrician, and a good psychologist if the diagnosis is not clear, or there are multiple diagnoses to be ruled out.
By acknowledging the emotional distress experienced by individuals with ADHD over their lifetime, we increase our ability to respond empathically and appropriately to our clients with ADHD, and put them in a better position to lead successful and fulfilling lives.