Why are we so inattentive?

What's missing in the conversation about ADHD

Image by Elisa on Pixabay

I recently saw a comedian on social media (unfortunately I can’t recall their name) describe ADHD as a pyramid scheme, where you get the label and then pass it on to seven friends. It made me chuckle because it fits with my recent experience. In the last few years, it suddenly seems that every second person is diagnosing themselves with ADHD (Attention Deficit and Hyperactivity Disorder), and its close cousin Neurodivergence.

This post is intended in no way to minimise the genuine struggles that people who truly meet these criteria experience, and the additional challenges they face in navigating daily life.

I don’t doubt that there are a percentage of people who were born with a brain wired atypically, who experience the world differently from what we might consider the ‘norm’. If this is you, diagnosis and treatment could be life-changing. I recommend researching it.

I’m also aware that increased awareness and social acceptability of a range of mental health issues have led to people receiving diagnosis who, in the past, would have been overlooked and struggled on without assistance.

And I’m aware that medication has been incredibly helpful for some.

These are good things.

However, I’d like to encourage us to be more thoughtful about what these labels mean and what might be underlying this apparent sudden increase. I believe there is more going on than meets the eye.

What troubles me is that, in clinical practice, I see a wide range of different issues being given the label of ADHD. I fear that once this label is received, people tend to assume they have a life-long condition, and that the only recourse is a lifetime of medications, such as Ritalin.

I know that these drugs have been life-savers for some. However, placing large numbers of people on stimulants or amphetamines for life seems to me rife with problems.

It can also close down our curiosity about what may be driving someone’s struggle with attention, and stops us looking to address the problem at its root cause.

Stimulants and amphetamines jump-start the central nervous system, in a similar way to caffeine, and adrenaline. But do we stop to ask why the nervous system needs jump-starting?

Perhaps it has something to do with how overwhelmed and burnt out our nervous systems are.

Struggles with attention, concentration, restlessness, and hyperactivity are incredibly common after-effects of trauma and long-term stress. Trauma, particularly the ongoing kind, such as growing up around adults who were highly dysregulated, disrupts nervous system functioning. It can leave us in a hypervigilant state where we are continually scanning our surroundings for potential cues of threat. The body and brain are wired to focus first on threat, for the purposes of survival. When trauma has happened in the context of relationships, this hypervigilance may focus on social and relational cues and may show up across many domains of life, such as work, study, social situations, and intimate relationships.

If we’re functioning in hypervigilant mode, it is very hard to sustain our attention on a non-survival-related task, in the same way that we would struggle to read a book while a Sabre Tooth Tiger was heading in our direction. When a sense of threat is present, real or perceived, it is unwise from a survival point of view to focus on anything else.

Trauma can also generate a survival response of checking out, dissociating, and shutting down. This coping style, while protective in situations of overwhelm and danger, can spill into daily life, leading to absent-mindedness that makes it very hard to focus. We are not fully present in the here and now.

For people who’ve experienced trauma, this can be incredibly debilitating and the effects can be long-term, but healing is possible with a range of different therapeutic modalities.

You may be thinking that the term ‘trauma’ does not apply to your life story, but what I have learned is that trauma can be subtle and insidious. It can be passed on from generation to generation via dysregulated nervous systems, and even though there may be no big event in your history that you would label as Trauma with a capital T, it may still be encoded into your nervous system and influence how you operate in the world.

Consider your brain and its capacity to focus. What would you say are the main drivers of this? When is your attention the sharpest? When is it the most compromised?

I know that my brain is highly inattentive when I’m overwhelmed by too many tasks, chronically stressed, or sleep-deprived. When my nervous system is dysregulated, my attention and focus is scattered, my follow-through on tasks goes out of the window.

This can also be true when we’re under the influence of alcohol or other substances.

Some people are living in these states long-term – with relentless stressors, long-term sleep challenges, or addiction issues. For some, this is their norm, and they may not even recognise it as the water they are swimming in. But they can be helped with appropriate therapeutic interventions.

As trauma heals over time, as memories are processed and integrated, as hurts are grieved, and as the nervous system becomes more regulated, attention and concentration tend to improve vastly. As we learn to down-regulate, to come to a safe, settled, calm, and spacious state within ourselves (the ventral vagal branch of the nervous system), we develop the capacity to sustain a more steady focus and energy in daily life.

The other elephant in the room is the role of technology. The rise in ADHD presentations has happened in tandem with the exponential increase in our use of devices. This is particularly true for the younger generations. Have you noticed how scattered your mind becomes after too much screen time? Have you ever noticed how much more settled you can become if you spend a week away from your screens? We need to include this in the conversation. If our first assumption is that our brain was wired this way from birth, we may miss countless ways that we can influence and potentially change our experience.

I think there’s an important role for diagnosis, and I certainly value the fact that treatment options exist for those who depend on them. But I think perhaps this condition is being over-diagnosed and we need a more nuanced perspective on what is causing attention deficits and a wider range of treatment possibilities than just medication.

You might choose to take medication if it improves your life. And there’s a growing field of resources and strategies (like the in-vogue Pomodoro method) that can help to improve focus and concentration. But I encourage you also to remain curious about what may be underlying these patterns and not assume you necessarily have an incurable condition. There is hope, and that hope often comes in the form of a more regulated nervous system.

As ever, I’d love to hear your thoughts. Does this resonate with you? Have you noticed a relationship between your nervous system, your focus and attention? Or your screen use? What do you think is behind the rise of ADHD? I’d love to hear your experiences. And please consider sharing this post to help expand the conversation around this subject.

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