View Full Version : How do you feel about being under the ADHD umbrella and with no sub-types?


sarahsweets
12-01-16, 10:13 AM
So it used to be ADD or ADHD. And there used to be three sub-types: primarily inattentive (PI) combined (C) or hyperactive (H). Now according to the new DSM, we are all classified as adhd and while we may lean towards more symptoms of one thing or another, there are no more official sub-types. I have a love hate relationship with the DSM. On one hand, I see the need for a uniform approach to mental health and other disorders-after all you have to have a collaborative group of symptoms and impairments to make diagnosis easier; but at the same time, it seems like re-classifying everything means either to throw our people who may have been diagnosed with things under the old standard, move them into different things, or attach certain symptoms with other disorders. Like I think they have alcoholism, substance abuse disorder problem drinking or is it called binge drinking disorder? Something along those lines. I wonder if its making people feel like they are alcoholics when their not, or helping people take a look at a lifestyle that may end up destroying them.

I also feel two ways about the sub-types. Although it helps people find their fit with others or isolate more ways to treat their adhd I still found there was a bit of a pi**ng contest over who had it worse. And I also found that a lot of people who would havbe been diagnosed with PI, would actually be considered combined but maybe they are not recognizing what hyperactivity could look like as an adult. And I can tell you that here, us combineds have aways felt a little funny because we dont have our own section. I see alot of people here who identify as PI- and I just wonder if they could have elements of other characteristics?

The issue of severity plays into this as well. I have always felt like I cant say how severe my adhd is because there doesnt seem to be a defined way of diagnosing severity- or that its subjective. I can say firmly though, some people here I would say have mild adhd but maybe thats due to their coping skills and treatment? And then I also do not want to turn severity into some sort of pi**ing contest either.

-what do you guys think?
- do you feel severity should be kept hush-hush so as not to offend or belittle or invalidate other people?
-do you think there is such a thing as mild or severe?
-do you think sub-types were/are helpful or harmful.
- did you feel that they caused a divide?
I am very interested in what people have to say about this and I am sure I forgot stuff that I will have to add.

XXXOOO

Little Missy
12-01-16, 10:36 AM
I never paid any attention to the sub-types so I must be really bad. :eek: Wait! None of the doctors I've ever seen ever mentioned them either. :confused:

Fuzzy12
12-01-16, 11:17 AM
I think the sub types were important to emphasize that some people might not be as hyperactive as others but could still have ADHD. Otherwise I think a lot of inattentive night have flown under the radar and received no help.

Clinically though, apart to aid diagnosis, I'm not sure if the sub types make sense or are required since they are given the same treatment. I'm guessing behavioural coaching might require different approaches depending on the exact symptoms. I don't think ADHD is well enough understood or defined to really say one way or another. I don't think the Sub types caused any harm.

I'm combined but ive never really felt that the combined ones got a worse deal on this forum. Since combined is the majority of diagnosis (and closer to the classic understanding of adhd) the whole forum really is for the combined. I don't see a point in having a special combined board and I wouldn't begrudge the inattentives their board.

At the end of the day I think very few members actually bother much about which posts are posted where. I reply to everything that interests me including the men's board and most of the time I dont even know which board the post I'm replying is in.

To be honest I've always got a bit of a feeling though thst on this forum that somehow the inattentives are considered less genuine than the combined. I could be wrong. Maybe it's not just this forum. Maybe it's because the inattentives don't really fit the classic profile of ADHD their diagnosis gets more often doubted.

I'm not sure if there is a ******* contest jn terms of severity but i do think thst a lot of people seem to want to be considered as severe. Maybe because there is so much contrlversy about adhd and because there is always the risk of being accused thst you just want performance enhancing drugs people feel that being severe lends more legitimacy to their diagnosis.

It is interesting thst whenever a post asks how severe we would rate our adhd most members claim to be very severe. Maybe they are. I wouldn't know. It's too subjective to answer. Maybe a diagnosticIan with lots of experience can answer or maybe we could go by impairments but it's still very subjective. Everyone would rate their problems as fairly severe..otherwise we wouldn't consider them problems but what they sre objectively is very difficult to say. I seem to be one of the very few who always say their adhd is mild but then I doubt my diagnosis anyway so it wouldn't make sense to say it's severe. Well to be honest I also got a tough time when I joined with being accused of just being another privileged college kid wanting drugs that I wouldn't dare call myself severe now.

I'm guessing that adhd (or somethinf) is severe enough to cause problems to moat members who are here or caused enough problems in the past or members wouldn't have signed up to this forum. I also think though that there js thE possibility that the truly severe are underrepresented here.

psychopathetic
12-01-16, 11:22 AM
I do think ADHD is like a lot of other disorders in that it's on a sliding scale of severity. So yes, I personally believe someone can have a mild case of ADHD, while another can have a severe case of it.

I think sub-types are helpful in that they're better able to pinpoint what's going on with you which can bring about better understanding and better help/treatment. Generalizing things and saying we're all just ADHD is too broad and doesn't make clear what's going on. There's a HUGE difference between inattentive and hyperactive. With subtypes I was able to make that clear. "I have ADD." Or..."I have ADHD-PI (Predominantly Inattentive)". But now I can't say that. Or I can, but then I have to explain myself further...I don't have an easy way of going about it. "I have ADHD." ... Nothing in that statement indicates that I'm inattentive and not hyperactive.

Do I think the sub types caused a divide?
Sure, absolutely. I relate less to those who are hyperactive and risk takers than I do with people who are inattentive. I think this is just natural and I don't think it's necessarily bad. It's not at all like I dislike hyperactives or think of them less than...absolutely not at all.

psychopathetic
12-01-16, 11:25 AM
And also, this:
At the end of the day I think very few members actually bother much about which posts are posted where. I reply to everything that interests me including the men's board and most of the time I dont even know which board the post I'm replying is in.

Sums it up nicely for me. :goodpost:

and...

To be honest I've always got a bit of a feeling though thst on this forum that somehow the inattentives are considered less genuine than the combined

I've never felt this way here at all. I'd be interested in hearing from other inattentives on this though.

Fuzzy12
12-01-16, 11:36 AM
Forgot to add:

I don't think severity needs to be kept hushed up. In an ideal world severity should neither bias us for nor against anyone and everyone should receive support irespective of their severity. It's not a matter of pride.

Like psycho said I also fully believe that the severity of adhd lies on a spectrum and some people really do have more severe symptoms than others. Impairments depend more on the environment I think.

I think though that how well.someone can learn and use coping skills probably depends on their severity as well. Even I was only able to successfully implement and stick to coping strategies, tricks and tools once I was medicated.

JosieK
12-01-16, 11:36 AM
I've always called myself ADD, not ADHD. I don't really like being referred to as ADHD because I feel like it implies I can't sit still or be quiet. Sure, I get a little fidgety sometimes, but I've never been hyperactive. I've always been the quiet daydreamer.

Dachshund
12-01-16, 06:03 PM
Personally, I don't think there is any good way to classify severity, except maybe in a controlled clinical setting.

No matter what type or how severe symptoms are, there are millions of other things that can impact our perception of severity. Someone could be primarily inattentive and just daydream a lot. But what if their dream is to be a doctor and they find that they can't study or organize their school life and so they give up on med school? That would be a severe impact in my opinion. Similarly, what if someone has severe hyperactivity, but found a great job that is active, fun, and keeps them on their toes? The ADHD might be more severe in a clinical sense, but the impact on their life might be less severe.

I think that many people tend to think on how ADHD has impacted their life, rather than clinical severity. Additionally, the people whose lives were impacted the most are more likely to seek treatment and forums like this. I don't think people mean to confuse the terms, I just think it's human nature to expand on our own experiences.

To me, it's like arguing over whose cold was worse. Maybe my cold caused more symptoms, but your cold showed up on a day when you had a big speech that was worth 50% of your grade, while I lounged and watched TV all day.

Long story short, I don't think that p*ssing matches over severity mean much because clinical severity and life impact are two different things. One is, arguably, measurable, but it's pointless to argue over the impact on life because there are millions of variables.

As for the subtypes, I honestly didn't pay much attention to them.

Lunacie
12-01-16, 08:57 PM
The DSM-5 still has the three sub-types, but now they are called "presentations."

Individuals with ADHD may present with both inattention and hyperactivity/impulsivity, or one symptom pattern may predominate. Three presentations of ADHD are commonly referred to: combined-type, inattentive-type and hyperactive/impulsive-type (Table 1). According to the DSM-5TM classification system, the appropriate presentation of ADHD should be indicated based on the predominant symptom pattern for the last six months.

http://www.adhd-institute.com/assessment-diagnosis/diagnosis/dsm-5tm/

20thcenturyfox
12-01-16, 09:08 PM
I have just supposed that the subtypes represented both a handy way of acknowledging that not all ADHD symptoms cluster in the same way, and to make sure that PI was recognized as a treatable disorder, not just a "lite" version of Hyperactive or Combined. I also expect that as more is learned about the anatomical, physiological and epi-genetic differences, not to mention variable responses to medication, we will also see "truer" subtypes emerge with clearer benefits for diagnosis and treatment.

As for severity, my guess is there is both an objective aspect (i.e. how far out on each neurological pathway spectrum your brain may be) and a conditioned aspect (how many adaptive and compensatory strategies you have adopted and how supportive and "lucky" your social and physical environment happen to be).

Just as the "nun's study" found little correlation between how severe a person's Alzheimer's symptoms were and how advanced the Alzheimers processes in their brain were at the time of their death, I think we might see with ADHD that some who are relatively far out on the physiological spectrum still function better than some with less physiological deviation from the norm, due to better skills and/or better environmental supports.

Also, just as the Alzheimer's symptoms correlated more strongly with the cumulative impact of strokes an individual had suffered than with Alzheimers itself, we may find that ADHD symptoms correlate more strongly with one or more other co-morbidities than with ADHD physiology itself.

Of course these are just guesses on my part. And since learning and practicing as much as possible of the compensatory and adaptive strategies (along with basic self-care and good habits) is the only part I have any control over, it suits me not to get caught up in questions of subtype or severity anyway, or be overawed by what this or that expert or study says.

sarahsweets
12-02-16, 05:41 AM
I never paid any attention to the sub-types so I must be really bad. :eek: Wait! None of the doctors I've ever seen ever mentioned them either. :confused:

You are not bad! My doctor mentioned them once in the 90's and thats the last I heard of them.

sarahsweets
12-02-16, 05:47 AM
I'm combined but ive never really felt that the combined ones got a worse deal on this forum. Since combined is the majority of diagnosis (and closer to the classic understanding of adhd) the whole forum really is for the combined. I don't see a point in having a special combined board and I wouldn't begrudge the inattentives their board.

At the end of the day I think very few members actually bother much about which posts are posted where. I reply to everything that interests me including the men's board and most of the time I dont even know which board the post I'm replying is in.

I always thought that it was more common to be inattentive but more likely to be the subtype that is missed or underdiagnosed because of how easily inattentives can fly under the radar. Interesting.
I hope I dont seem like I think there should be a forum section for combined, I think the sections that separate the subtypes are unnecessary anyway because I too dont care or mind what section they are posted in. I was just bringing it up because its an example of how subtypes are still at least mentioned or used.

To be honest I've always got a bit of a feeling though thst on this forum that somehow the inattentives are considered less genuine than the combined. I could be wrong. Maybe it's not just this forum. Maybe it's because the inattentives don't really fit the classic profile of ADHD their diagnosis gets more often doubted.

I definitely dont think inattentives are less genuine. If anything they are more likely to be misdiagnosed.

I'm not sure if there is a ******* contest jn terms of severity but i do think thst a lot of people seem to want to be considered as severe. Maybe because there is so much contrlversy about adhd and because there is always the risk of being accused thst you just want performance enhancing drugs people feel that being severe lends more legitimacy to their diagnosis.

It is interesting thst whenever a post asks how severe we would rate our adhd most members claim to be very severe. Maybe they are. I wouldn't know. It's too subjective to answer. Maybe a diagnosticIan with lots of experience can answer or maybe we could go by impairments but it's still very subjective. Everyone would rate their problems as fairly severe..otherwise we wouldn't consider them problems but what they sre objectively is very difficult to say. I seem to be one of the very few who always say their adhd is mild but then I doubt my diagnosis anyway so it wouldn't make sense to say it's severe. Well to be honest I also got a tough time when I joined with being accused of just being another privileged college kid wanting drugs that I wouldn't dare call myself severe now.

I can see your point. I think a lot of people may want to or see themselves as severe because they spent years struggling and trying to get their disabilities recognized, so maybe the severity or rejection of their adhd made things seem worse?

sarahsweets
12-02-16, 05:50 AM
I do think ADHD is like a lot of other disorders in that it's on a sliding scale of severity. So yes, I personally believe someone can have a mild case of ADHD, while another can have a severe case of it.

I think sub-types are helpful in that they're better able to pinpoint what's going on with you which can bring about better understanding and better help/treatment. Generalizing things and saying we're all just ADHD is too broad and doesn't make clear what's going on. There's a HUGE difference between inattentive and hyperactive. With subtypes I was able to make that clear. "I have ADD." Or..."I have ADHD-PI (Predominantly Inattentive)". But now I can't say that. Or I can, but then I have to explain myself further...I don't have an easy way of going about it. "I have ADHD." ... Nothing in that statement indicates that I'm inattentive and not hyperactive.

I agree alot with this.

]Do I think the sub types caused a divide?
Sure, absolutely. I relate less to those who are hyperactive and risk takers than I do with people who are inattentive. I think this is just natural and I don't think it's necessarily bad. It's not at all like I dislike hyperactives or think of them less than...absolutely not at all.

See this is where I am conflicted. I can see how they cause a divide yet, I never feel like I relate less to anyone because of it.

sarahsweets
12-02-16, 05:53 AM
Personally, I don't think there is any good way to classify severity, except maybe in a controlled clinical setting.

No matter what type or how severe symptoms are, there are millions of other things that can impact our perception of severity. Someone could be primarily inattentive and just daydream a lot. But what if their dream is to be a doctor and they find that they can't study or organize their school life and so they give up on med school? That would be a severe impact in my opinion. Similarly, what if someone has severe hyperactivity, but found a great job that is active, fun, and keeps them on their toes? The ADHD might be more severe in a clinical sense, but the impact on their life might be less severe.
Do you think the standard view of impairments and in what areas of life they occur affect severity?


I think that many people tend to think on how ADHD has impacted their life, rather than clinical severity. Additionally, the people whose lives were impacted the most are more likely to seek treatment and forums like this. I don't think people mean to confuse the terms, I just think it's human nature to expand on our own experiences.

can you explain a little more about what clinical severity is and how its measured?

sarahsweets
12-02-16, 05:59 AM
Thanks for that Lunacie! I totally overlooked the presentations part. I wonder too, if someones adhd can sort of change or "grow" with them in certain ways as they get older.
As a child I had equal parts hyperactive and inattentive and in my 20's less hyperactivity. In my early thirties I noticed more mental hyperactivity and my late thirties its like my physical hyperactivity has kicked up a notch and the inattentive part has gotten worse in the sense of disorganization and distracted-ness. I thought age makes it better. At this rate Ill be a mess as a 90 year old!

Dachshund
12-02-16, 04:59 PM
Do you think the standard view of impairments and in what areas of life they occur affect severity?

I honestly don't know. Perhaps. I could imagine that, for example, someone who wants to become a doctor but has ADHD and a hard time studying. That might place additional pressures and anxiety on the brain, which could "feed" the ADHD symptoms and influence severity. But I don't know if that would be considered differently by a doctor because it isn't just ADHD at fault.

I could also imagine that bad habits and no/little early interventions could perhaps reinforce symptoms and fuel severity. But, once again, I don't know.

can you explain a little more about what clinical severity is and how its measured?

I don't know how it's measured specifically for ADHD. I'd assume through testing, observation, and whatnot, probably by researchers. Mental diagnosis is hard to measure because it's so very personal, so most regular doctors would use the patient's experiences as a guide and often don't consider the clinical severity unless traditional treatments all fail or there is considerable distress in the patient.

I'll use the example my doctor gave me (he was a former adult ADHD researcher): think of the brain as a computer. Everyone has one, they all work a little different. Software is the external stuff in life (things like school, friends, parents, jobs, experiences, etc) and the hardware is the stuff that we were born with. People with ADHD have a slower RAM speed and like to open a lot of tabs in our brain internet browsers. We strain our computers with lots of stuff constantly running in the background.

So this is where my thoughts on your question come in: someone who uses their computer for high level gaming will notice and react to this slow computer a lot more than someone who only uses their computer for solitaire or word processing. Physically, we can measure how slow the computer is working. But the gamer is likely going to be a lot more frustrated then solitaire player, and is probably more likely to report that his/her slowness is more severe, because it had more of an impact. So in this analogy, the clinical severity would be how slow the computer physically is. The personal severity would be how frustrated/angry/sad/depressed/etc the user is.

Does that make sense? I know the analogy isn't 100% accurate, but I feel like it's the best way I can explain it at the moment.

WheresMyMind
12-03-16, 12:07 AM
To me, they're all pigeonholes. I don't want a name for what I have. I want to evaluate what bothers me and work on specific things that help those specific effects that I want to change.

IMO, to be treated on the basis of the name for a type, subtype, etc, denies the indivudality of the human involved.

ADHD causes some specific deficits. After about 5 years old, our personalities have evolved in a way that is affected by those deficits. Some of that needs to be un-learned, and some of it must be emphasized. Each person does this differently.

There are no methods that work for everybody...therefore IMO, the sub-type name would only do me a dis-service, because a practitioner would say "oh, you are ADHD sub-type x, therefore you must do this to cure your yyy problem." Uh, I don't have a yyy problem". "Sure you do, everybody who is sub-type x does."

Lunacie
12-03-16, 11:32 AM
To me, they're all pigeonholes. I don't want a name for what I have. I want to evaluate what bothers me and work on specific things that help those specific effects that I want to change.

IMO, to be treated on the basis of the name for a type, subtype, etc, denies the indivudality of the human involved.

ADHD causes some specific deficits. After about 5 years old, our personalities have evolved in a way that is affected by those deficits. Some of that needs to be un-learned, and some of it must be emphasized. Each person does this differently.

There are no methods that work for everybody...therefore IMO, the sub-type name would only do me a dis-service, because a practitioner would say "oh, you are ADHD sub-type x, therefore you must do this to cure your yyy problem." Uh, I don't have a yyy problem". "Sure you do, everybody who is sub-type x does."

By giving the deficits a name, it gives me an answer to people who blame me
personally and morally for those deficits.

It gives me a community to be part of and discuss problems and solutions with.
Isn't that why you're here?

I've never had a practicioner or doctor or psychiatrist tell me that I must have
yyy problem because I'm diagnosed with ADHD. Haven't seen this with any of
the docs my grandkids see either. Certainly would fire a doctor who said that!

ToneTone
12-03-16, 12:36 PM
Clinical severity reveals itself in all sorts of ways-and they aren't all that hard to notice.

Take my oldest brother, who was never diagnosed but who clearly had ADHD. Once I got diagnosed I immediately called him up because I could see where all the struggles I had, he had them far worse.

My brother lost far more documents and papers than I did ... misplaced keys and wallets and belts and all kinds of items more than I did. He missed bill payments much more than I did. His working memory was far worse than mine.

He was so absent-minded about returning permissions slips for his children ... that my mother simply stepped in and started doing this for her grandchildren.

He was unable to get started on tasks or to complete tasks far more than I do ... He never learned to drive ... Never learned to type ... He avoided any "new" technology and only started on computers after 95 percent of the world did so. Never owned a cell phone. The idea of learning new technology just frightened him.

Severity also shows up in work reviews ... people with more severe conditions most likely get lower job ratings ... and more complaints from spouses about not doing work around the house, etc ... My brother was constantly getting low ratings on his job, even though he had an ideal ADHD job as a probation officer who spent much of the day outside the office going to visit client.

The ultimate sign of his severity is that even after I told him about the condition and how much treatment could benefit him, he couldn't get himself together enough to go and pursue a diagnosis.

He routinely ran out of his blood pressure medication (which was not optional) and ultimately missing his meds most likely led to his stroke and then his early death.

Oh ... and he didn't complete a will before he died, so I have had to hire the attorney to manage his estate so that my nephews can get some money. He didnít name beneficiaries on his insurance policies.

I'm at least glad that I figured out that most likely he was ADHD because for most of my life, my family just told a story about him that he "wasn't together" ..."had something wrong" ... just couldn't get things done.

I think the severity of my brother's condition was quite easy to see.

Tone

20thcenturyfox
12-03-16, 04:40 PM
Clinical severity reveals itself in all sorts of ways-and they aren't all that hard to notice....

I'm at least glad that I figured out that most likely he was ADHD because for most of my life, my family just told a story about him that he "wasn't together" ..."had something wrong" ... just couldn't get things done.

I think the severity of my brother's condition was quite easy to see.

Tone

Easy for you to see, but apparently not so easy for others. With so much of the world caught up in the need to make judgements--most often disparaging ones--this type of perception is, unfortunately, still more the exception than the rule.

Whatever small pleasure people may take in labelling some people brave, persistent, struggling or admirable is generally overshadowed by the great self-satisfaction most take in labelling others lazy, disorganized, unmotivated and undeserving. Even being curious about the underlying process seems to threaten this self-satisfaction.

sarahsweets
12-05-16, 05:24 AM
IMO, to be treated on the basis of the name for a type, subtype, etc, denies the indivudality of the human involved.

I dont think treatment should ever be based on subtype or some general standards. ADHD follows no set standards.

ADHD causes some specific deficits. After about 5 years old, our personalities have evolved in a way that is affected by those deficits. Some of that needs to be un-learned, and some of it must be emphasized. Each person does this differently.

There are no methods that work for everybody...therefore IMO, the sub-type name would only do me a dis-service, because a practitioner would say "oh, you are ADHD sub-type x, therefore you must do this to cure your yyy problem." Uh, I don't have a yyy problem". "Sure you do, everybody who is sub-type x does."

I dont think I would ever stay with a doctor who wanted to treat all patients the same based on their labels. I am also Bipolar and I would never want a doc to treat me based on just a label. Docs should always work on treating the symptoms.

ginniebean
12-05-16, 01:07 PM
Severity tends to be measured by life impact.

Have no friends? Can't kerp a relationship? How many times have you been to jail? How many car accidents have you been in? How many jobs have you had? Can you remember to take meds? Have difficulty communicating?

These would be SOME of the indicators of severity.

Lunacie
12-05-16, 03:39 PM
Severity tends to be measured by life impact.

Have no friends? Can't kerp a relationship? How many times have you been to jail? How many car accidents have you been in? How many jobs have you had? Can you remember to take meds? Have difficulty communicating?

These would be SOME of the indicators of severity.

Although co-morbids can influence the severity.

I was too anxious or too depressed, or both, to do something jail-worthy. ;)

Little Missy
12-05-16, 03:54 PM
And I'm here still guessing. Do I neeed to know? Maybe its a generational thing. Honestly, not a word of it until on here. :confused:

ginniebean
12-05-16, 05:15 PM
Although co-morbids can influence the severity.

I was too anxious or too depressed, or both, to do something jail-worthy. ;)

yeah but you had the bad *** in ya didn't ya_ hehe

Lunacie
12-05-16, 08:33 PM
yeah but you had the bad *** in ya didn't ya_ hehe

Good thing I didn't fall in with a bad crowd I expect.

And amazingly I didn't get pregnant as a teen, which is another impulsive action of severity.

Fuzzy12
12-05-16, 08:38 PM
And I'm here still guessing. Do I neeed to know? Maybe its a generational thing. Honestly, not a word of it until on here. :confused:
I could be totally wrong Missy but my gut feeling is that you are combined as well.

Little Missy
12-05-16, 10:07 PM
I could be totally wrong Missy but my gut feeling is that you are combined as well.

I'm a COMBO! :D

Kunga Dorji
12-06-16, 02:47 AM
The subtypes are helpful in that they help people (especially doctors) to see that there can be different clinical presentations rather than the stereotype of little hyperactive boys bouncing off the walls and destroying the office after having had some red cordial.

That's what most people think of when they think of ADHD and that stereotype blinds most people to considering ADHD in any cases other than those that fit the stereotype.

Re ADD/ADHD-- the distinction is an artificial one that arises from the history of the way doctors classify the problem. DSM is a work in progress and the condition we now know as "ADHD" has been described under a number of names. I think it was DSM 3 that described it as "ADD with or without hyperactivity". This has had the unfortunate effect of making some think that ADD and ADHD are fundamentally different.

Now severity certainly does vary between individuals, but it is not easy to quantify severity, and that problem is worsened by the fact severity may be worsened by a range of intercurrent problems.

Any of us with ADHD will be worse when we do not have a stable environment because a stable environment allows us to set up behavioral compensations (ie coaching skills) that allow us to compensate for our forgetfulness, failure to register small changes in our environment and need for routine. Equally anything impairing sleep is a big problem- as sleep comes so hard to many of us with ADHD, and sleep deprivation will certainly worsen attention problems.

Equally other medical problems can confuse us as to severity. I am unfortunate to have the combination of ADHD and reasonably severe bipolar (which got somewhat neglected when my ADHD was uncovered). As a result of that neglect I have had 2 major flare ups of hypomania in the past 4 years. One aspect of this which is interesting in retrospect is the increase in
disorganisation. On the worst day early this year I actually locked myself out of my house and had to climb the fence seven times. Now I have had ADHD all my life (diagnosed 2008) and been working on my own behavioural management skills since 2008- and I should be able to cope with going out the front door of my house!!

What I am saying here is that all sorts of problems can aggravate ADHD symptoms. All of us should have a certain baseline of symptom severity that happens when everything is going well, and all of us should ask ourselves, when things are not going well, whether the flare up of our ADHD symptoms was not due to other causes.