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William Dodson, MD, is the original creator of the interest, challenge, novelty, urgency (ICNU) framework. Read more about Dodson’s insights here,
Attention-deficit/hyperactivity disorder (ADHD) is an incredibly misunderstood and stigmatized condition. For many years, the Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria for ADHD did not extend to adulthood, and mental health professionals perpetuated the false belief children with ADHD would simply outgrow the condition. This is an incredibly ableist and narrow-minded view of how mental wellness is impacted by our environment and can naturally fluctuate over the lifespan.
The name of the diagnosis itself is also incredibly problematic. It is based on the observational perspective of how ADHD manifests and presents, rather than the internal lived experiences of people actually diagnosed with the condition. In addition, the term ADHD fails to consider additional internal experiences many people with ADHD share, such as rejection sensitivity, demand avoidance, executive dysfunction, emotional dysregulation, and others.
From an outsider’s perspective, it may appear people with ADHD have an undersupply of attention. However, people with ADHD rarely struggle from a lack of attention; rather, we appear to experience dysregulated attention when compared to the functional norms of our neurotypical peers. People with ADHD are often able to hyperfocus on certain topics or tasks so intensely, we lose all sense of time. This “time-blindness” leads us to become so immersed in an activity that we often forget to eat at regular intervals, go to the bathroom, and engage in other important and time-sensitive activities.
At other times, however, people with ADHD simply cannot muster the ability to initiate or maintain attention on very important tasks that are necessary for surviving in our modern world. Making phone calls, for instance, can cause people with ADHD so much anxiety, we avoid them altogether. Engaging in personal hygiene, self-care, and housekeeping tasks on a regular basis is a constant battle. As you can imagine, prolonged demand avoidance of important tasks can result in high-stress situations that can cause emotional dysregulation, feelings of overwhelm, and shame. Without accommodation and intervention, this cycle can progress to the point of complete functional impairment, which can be debilitating.