Like any child, John Casison was exuberant and curious. He seemed to be an endless ball of energy, constantly ready to tackle numerous activities, one after another. He was a quick and resourceful child, always finding roundabout ways to solve his young problems, like reaching the candy jar or building legos. With these qualities and John’s entrance into the educational world of Kindergarten, his parents had very few concerns regarding his academic abilities and while having high expectations for him, deemed him an intelligent, outgoing child. The weekend before school started, John sat on a highchair awaiting his new kindergarten haircut to be over. John hated hair cuts, and his mother certainly hated trying to keep him still in his seat. John felt like his twenty minute haircuts took hours. He constantly squirmed and wanted more than anything to get up and run around. The night before his first day of school, John readily anticipated learning new things and making friends. However, once he began, he quickly realized that school was as torturous as getting a haircut. Six long hours of squirming and wanting to run around, but restrained by the requirement of focusing on single assignments and activities, and worst of all, quiet time.1
On numerous occasions John came home with a dissatisfactory yellow card for being a distraction to his peers and for not completing his school work. John’s constant curiosity became a negative quality as he asked so many questions, and often went off topic. His constant need to be in motion led to issues with concentration, which led to incomplete assignments. Even the lunch line was a challenge for John, due to his impatient nature. His need to hurry things along became problematic as he would cut in line or rush to join his friends to play. John’s social skills and conversations were as sporadic as his mind. He felt the need to interrupt and leave conversations prematurely. When playing with toys, John would grab them from others instead of waiting his turn and then quickly abandon them. Thus, other students were not as inclined to be his friend due to his abrupt and impulsive behavior. With a growing list of problems, John’s passion and excitement were quickly overshadowed by frustration as he fell behind in his schoolwork and was scolded by his parents and teachers. At this young age, John felt the overwhelming pressure that came with these circumstances that seemed out of his control. Not only was there pressure from his parents and teachers, but also the pressure to be accepted by his peers. Though John’s parents were constantly informed of these ongoing issues, they were also aware that John had always had a lively personality and therefore felt justified in dismissing his conduct as typical hyperactive behavior. Since it was just Kindergarten, they were confident John would eventually catch up with his peers.2
Many who experience ADHD as a child can relate to John’s experience. The scenario above is specific to John, but like many others, ADHD has a prominent and often negative role in their childhood. Most children who experience symptoms of ADHD in their early childhood live their lives without any struggles up until the point when they enter school. Because of the way ADHD manifests itself, an environment such as school can often be what highlights the traits of ADHD.3
ADHD is an acronym that stands for “attention deficit hyperactivity disorder.” It is a medical condition in which an individual’s brain activity and development differ from the norm, resulting in varying levels of attention, self-control, and other individual-based aspects of functionality, like the simple ability to sit still.4 These fourteen characteristics are the most common signs of ADHD: fidgeting, interrupting conversations, self-focused behavior, distress waiting your turn, emotional turmoil, problems being quiet for a long period of time, lack of focus, avoidance of tasks needing extended mental effort, prone to mistakes and daydreaming, trouble getting organized, having unfinished tasks, forgetfulness, and displaying these symptoms in multiple settings. Self-focused behavior is exhibited by a lack of ability to recognize others’ needs and desires. This is linked to two other characteristics listed above: interrupting and having trouble waiting their turn. Children with ADHD often experience emotional turmoil and it becomes difficult for them to quell and regulate their emotions. Children may also have angry outbursts at inappropriate times. Many times, children affected by ADHD have trouble playing quietly or even engaging in lengthy and calm activities. These symptoms are accompanied by fidgeting, daydreaming, and a lack of focus.5 These particular symptoms make it difficult for children exhibiting ADHD to participate in classroom activities. Restlessness in the form of fidgeting can provoke activities like getting up and running around, excessive playing with their hands, and squirming when required to sit still. Many learning facilities now incorporate devices that allow kids a tangible outlet for the urge to fidget, things like desk attachments or fidget spinners. Children who lack focus often have trouble paying attention and processing information that is spoken or presented to them. This lack of focus often leads to inability to complete tasks and trouble with organization. On top of having trouble focusing, children with ADHD often show an interest in a multitude of things. For instance, they may start a project, homework, or responsibility, but quickly move onto the next thing that draws their attention. This may also result in trouble prioritizing responsibilities. Two particularly impacting traits that some children with ADHD exhibit are the avoidance of tasks requiring exhaustive mental effort and committing careless mistakes. That is why in many schools, smaller class sizes and teacher aids are put in place to accommodate those who struggle with learning disabilities like ADHD. Although a classroom setting highlights certain ADHD symptoms, ADHD manifests in other settings, for example, home or work.6
As John continued to progress through grade school, his symptoms persisted, if not amplified. Multiple teachers encouraged John’s parents to have John take an ADHD diagnostics test in both second and fourth grade. Despite the advice of his grade school teachers, John’s traditional Filipino parents did not acknowledge the problem or possibility of a learning disorder such as ADHD. His mother, a nurse, most likely refused to acknowledge this possibility due to the Asian culture’s insinuation of mental disorders as a Western fabrication or a representation of a soft culture. The connotation of undisciplined behavior was also a reflection of bad parenting in her mind. Her proposed solution focused on John’s personality and not the possibility of a disorder. When approaching his parents about what the string of letters (ADHD) repeatedly being thrown at him meant, he was quickly shut down. Deemed “a mental illness,” it made sense why his parents were so quick to deny and dismiss even the slight possibility that John may be affected by this disorder. Things like “it’s just in your head” and “you just need to focus” or “you need more self discipline” were told to him. Instead of a solution for how to focus, they only demanded focus. Instead of a suggestion of what changes can be made to help, they only demanded that John be different. This unsolved predicament only led to continued scolding from John’s teachers and parents for his inability to focus his mind. A negative cycle formed consisting of reprimands for his actions both at home and at school. This unfortunate combination took an emotional toll on young John. Due to lack of guidance, understanding, and options, his grades in school did not improve. Not only was school a problem, but his mental health was affected. Confusion and guilt plagued John as to why he was programmed this way. Knowing that his parents and teachers were upset with him, and his inability to fix it, devastated him. He obsessed over his desire to be different. He wished that his mind was not so jumbled and fast-paced. He wished that he could pay attention to the sentences people said, instead of just hearing words leave their mouth and fly all over the place. Most of all, he wished he could be normal and make his parents happy.7
In high school, many teachers suggested that John had ADHD. The more this was suggested, the more John began to realize the negative connotation associated with it. Ignorant about his condition, John felt fear towards the unknown. His only indication of how to feel about ADHD came from his parents’ adamant denial and the negative perceptions from the public. In the end, it seemed to John that there were only two possible explanations for the way he felt and thought. Either there was something “mentally” wrong with him or he was not disciplined enough. Neither explanation was beneficial as John’s self-esteem steadily declined. John decided to focus his energy on “correcting” his behavior and exerting more control over his actions. However, it was a hard task, one that resulted in short periods of optimistic change, only for him to return to behaviors and habits dictated by his ADHD. Another cycle began to form where John’s attempts to offset his ADHD without proper guidance and treatment would lead to unsatisfactory results and a return to previous habits. For John, it seemed as though his mind and actions were beyond his control.8
Race and ethnicity can influence how a patient and their family respond to a diagnosis of ADHD and its treatment. According to the study, “Racial and Ethnic Disparities in ADHD Diagnosis From Kindergarten to Eighth Grade,” among those diagnosed with ADHD, children from African American, Hispanic, Asian, and other minority households were less likely than Caucasian households to be diagnosed and prescribed medication for ADHD.9 The influence of a household’s beliefs can influence the child. Irene Loe and Heidi Feldman even stated in “Academic and Educational Outcomes of Children With ADHD,” that the lack of diagnosis and acknowledgement of such disorders result in the failure of the affected individual to grow out of these tendencies before they reach adulthood. ADHD is controversial due to its classification as a mental disorder as well as its high prevalence of medical diagnosis and treatment. Research indicates that lack of attention to ADHD and other mental illnesses lower the odds of diagnosis and treatment in minority households.10
Jonathan Leo from his scholarly book on racial-ethnic groups regarding mental illness, states that there is a heavy negative connotation on mental health illnesses. It is often seen as poor parenting or a hereditary flaw that connotes shame or fear. Seeking help like therapy also conflicts with the traditional value of interdependence in ethnic families.11 In many ethnic minority families, parents are immigrants from a war generation. With this trauma, older generations often view their children’s and their grandchildren’s generations’ hardships as less challenging. This mentality causes a disconnect in understanding their child’s issues and can cause young adults to feel guilt about their mental health struggles.12 Other times, parents, in general, lack an understanding of mental illnesses, and fear acknowledging any such possibility regarding their child. The fear of the unknown makes it feel logical to act in a manner of avoidance. By sticking to these types of mentalities, even if families fail to realize it, mental health care is discouraged by not fostering an environment where mental illnesses are understood or exposed. Experiencing an environment of despondency and lack of acknowledgment of mental health encourages many to seek outlets such as therapy to approach their struggles. Often times, people of racial-ethnic minority households report that they have tried therapy previously, but did not find it very helpful. In the field of psychology, there is a growing attention to mental health professionals who specialize in cultural competency. This specialization allows mental health professionals to provide a feeling of understanding to this demographic and diminish a disconnect between doctor and patient. By undergoing an initial experience in which an individual grew a distaste for therapy, they may shy away from approaching it in the future when in reality they just had not found the therapist who is compatible with them. Fortunately, mental health professionals are now much more aware of this phenomenon and are tailoring their practice to these types of problems.13 In such households, disparities of underdiagnosis leads to undertreatment and can be very impacting on an individual’s life.
Specific cultural behavioral patterns can also place certain individuals at risk for over-diagnosis or make it difficult to differentiate between symptoms and behavior. Things like whether or not a culture prioritizes punctuality or formality can affect a person’s understanding of ADHD. For example, some cultures consider skipping small talk and getting straight to business as an acceptable behavior while other cultures view this as rude or cold. A child that digresses and does not get straight to the point may have their behavior scrutinized under the possibility of ADHD in a culture where digressions are not common. On the other hand, their behavior is more likely to be overlooked in a culture where digressions are more acceptable.14 These cultural nuances are often confusing to apply in classroom settings and can lead to the other side of the coin, overdiagnosis. Overdiagnosis is statistically recorded to occur more often in caucasian households. This is a public health concern because children misdiagnosed with ADHD can experience adverse effects to medications meant for those with this disorder. Some report feeling dulled and agitated while others hyperfocus on one topic for an extended period of time. Whether it is overdiagnosed or not diagnosed at all, race-ethnicity have a solid influence on the detection and treatment of attention deficit hyperactive disorder.15
John entered young adulthood under the assumption that school was not for him. Frustration, due to the way his mind worked and how incompatible it was with academia, had become inextricably intertwined with school. This negative association was only natural. Despite this negativity, John promised himself that college would be his opportunity to reset. He readily acknowledged the challenges he needed to face in order to succeed. This included working twice as hard, putting in more time than some of his classmates, learning to redirect himself when he went off topic, and establishing a method to relieve anxiety. He researched tips to ensure a positive outcome and read numerous articles on how to set himself up for success in his upcoming college years. With this in mind, he moved into his new apartment and set up his study area. His desk was tidy and well lit. His calendar was large and ready to be marked up with assignment due dates and important events. He printed out his semester schedule and even placed fresh batteries in his alarm clock. John felt ready, excited, and extremely motivated for this new academic venture. By focusing on his external locus of control, John relied on his brain not to fail him. Unfortunately, John soon realized that his experience with the academic world and structure of schooling had seen little change. This carefully executed attempt, followed by disappointment, left John discouraged with little to no hope. His attendance in class diminished quickly. His study area became disorganized and messy. His once clean desk became a holder for stacks of books and random papers collecting dust. John avoided calls from his mom, unable to face his own disappointment in himself, let alone her’s. As the semester passed, John lost himself in various distractions to escape his frustration and the discouragement that school brought him. He partied, played games, and watched shows until the sun came up most nights. As these mental distractions became routine, John also neglected his physical self care. He rarely ate three meals per day, and when he did, it had very little nutrition. He stopped working out and ceased to even care about the things that he used to find solace in. Getting skinnier each day, along with the drop in grades, John was falling into a hole that would only be harder to get out of with each passing moment.16
On top of the responsibilities of school, John knew he needed to get a job to sustain his young adult college life. He began working at Kung Fu Tea. He enjoyed his job as much as any other part-time working college student would. That being said, he still tried his best to give what he could to the job. His responsibilities included cashier duties, taking customers’ orders, and making drinks according to the provided recipes. His boss and coworkers loved him, but sometimes thought he was a bit disorganized or irresponsible. The workplace environment made John feel scatterbrained and emphasized his unreliable short term memory. When receiving a customer’s order, John noticed himself being easily distracted. After receiving a customer’s order, John would need to constantly recheck the order to remember what they asked for. In some circumstances, John would find himself overwhelmed by the many orders coming in. John found himself in an all too familiar spot, feeling like he was working harder than his peers to just keep up.17
The effects of ADHD extend beyond a grade school classroom. Not only does it affect a vast number of Americans, it also affects the community of an individual as their experiences provoke chain reactions in public settings. For instance, those diagnosed with ADHD are more likely to suffer accidental injuries. Individuals who struggle with their own efficiency may also dampen the morale and productivity of a workplace.18 Studies have shown that individuals with ADHD switch jobs more frequently and impulsively. They are often more likely to miss work, have strained relationships with co-workers, or get fired. Substance abuse and unemployment are also higher among those diagnosed with ADHD who lack treatment.19 Although 4.4% of the adult US population is affected by ADHD (an estimated 2 to 5 million adults), less than 20% seek assistance and treatment. Many adults with ADHD are misdiagnosed with depression, anxiety, or character disorder. According to Dr. Lenard Adler, an ADHD specialist for adults, 30-40% of children with ADHD continue to have persistent symptoms into adulthood. ADHD has just recently been recognized by the Centers for Disease Control (CDC). According to the CDC, ADHD affects “the family, the school system, the peer system, and as the child progresses through development to other systems of care, juvenile justice, health maintenance organizations, the kind of benefits they provide and employers.” Statistics provided by CNN show that individuals affected with ADHD without undergoing treatment are less likely to complete school, and therefore have limited work options.20
As John felt like an outlier, he decided to take matters into his own hands. John read several articles on attention deficit hyperactive disorder and identified with most, if not all, the symptoms stated for ADHD. John scheduled an appointment with his university psychiatrist. Although he highly anticipated the appointment, John also felt guilty. He contemplated whether or not to tell his mom about his decision since she would not agree. He also felt slightly ashamed that he might have ADHD. The stigma associated with ADHD still lingered from his childhood, and had inevitably infiltrated his insecurities. However, the day John spoke with his psychiatrist, his life changed, not because he was prescribed a magic pill that would fix him, but because John finally grasped his brain. Told his brain worked a little differently and that many people had similar experiences gave John some relief. His whole life, John feared he was not as capable as his peers for reasons he could not pinpoint. He now understood that his brain functioned differently and in ways that conflicted with America’s classroom and workplace structures. Most of all, John felt hopeful again knowing that he had options.
John began taking prescribed adderall, a combination medication, amphetamine/dextroamphetamine that is used to treat ADHD. With this, John’s experience with school and work changed drastically. On a personalized dosage, he felt his brain working differently. His thoughts slowed down and proceeded in a more organized manner, unlike the jumble it was before. With this newfound clarity, he noticed his concentration, ability to finish long term projects, and overall confidence significantly improve. John finally approached his mom about this sensitive subject and managed to change her deeply set beliefs. She was able to see first hand how her son was able to take a scary, unknown “illness” and transform it into a manageable and surprisingly non-negative condition. John has since become a double major in cybersecurity and information systems. He ended his most recent semester with a 4.0 average while obtaining the manager position at his workplace. In hindsight, it is unbelievable and almost overwhelming to think about how ADHD can affect almost every aspect of an individual’s life, especially when unresolved. With that in mind, once ADHD is identified as the problem and one pursues the treatment and management of this condition, a whole new world opens up for those who were previously struggling. With such a simple, convenient treatment method, a drastic and significant improvement of one’s quality of life can be obtained. Tasks that previously seemed impossible for John are now opportunities for success. In the end, treatment is an individual’s benefit while awareness of mental illnesses and their effects is a community’s benefit. 21