ADHD: An Overview and a Discussion of Stigma

ADHD, or Attention-Deficit/Hyperactivity Disorder, is the most common neurodevelopmental disorder, yet it is also the most widely misunderstood. Neurodevelopmental disorders are characterized by developmental deficits that produce “impairments of personal, social, academic, or occupational functioning”, while ADHD is specifically defined by “impairing levels of inattention, disorganization, and/or hyperactivity-impulsivity”, as its name suggests (American Psychiatric Association, 2013, Neurodevelopmental Disorders section, p. 31). Individuals with ADHD experience difficulties with staying on task, listening, losing their belongings, fidgeting, staying seated and more at levels inconsistent with development at their age. ADHD typically begins in childhood before the age of 12. Moreover, recall of childhood symptoms in adulthood tends to be unreliable, highlighting the importance of substantial awareness and clinical attention starting from a young age. By early adulthood, ADHD is associated with an increased risk of suicide attempt, particularly when additional mood, conduct, or substance use disorders are simultaneously present (American Psychiatric Association, 2013). According to the DSM-5 (2013), surveys indicate that ADHD occurs in about 5% of children and about 2.5% of adults in the majority of cultures. Heredity and genetic factors play a significant role in the development of ADHD, but while specific genes have been identified to be correlated with the disorder, causation has yet to be established. Generally, ADHD is more frequently diagnosed in males than in females, with females more likely to exhibit primarily inattentive features of the disorder (American Psychiatric Association, 2013). Individuals with ADHD often experience chronic anxiety and stress as a result of the difficulties in their everyday life, sometimes leading to tense relationships with peers or family and harmful stereotyping. Awareness of stereotyping is extremely crucial for those diagnosed with the disorder, not just to recognize its detrimental effects, but also to recognize their own struggles and actively seek professional help. 

 

A Timeline of ADHD:

 

1775

German physician Melchior Adam Weikard includes the first medical description of ADHD known to date in his book De Philosophische Artz. In the chapter on attention disorders, those lacking attention were described as being “reckless, careless…since they did not devote enough time and patience to achieve the necessary skills” (Corrales De la Cruz, 2022, para. 4). We now know that this is not true; ADHD is due to biological differences rather than a lack of self control. Surprisingly, Weikard also included descriptions of treatments that are still recommended today. 

1798

Studies into neurological conditions from Dr Alexander Crichton were some of the first documents recording traits commonly found in ADHD, then characterized as a disorder of attention that the individual is born with. 

1902

Sir George Frederic Still presented a series of lectures to the Royal College of Physicians about “abnormal physical conditions in children”, with descriptions consistent with problems in self-discipline and attention (The Autism Service, 2024, para. 5).

1936

Benzedrine was approved as a medication by the Food and Drug Administration (FDA). Dr. Charles Bradley found that his young patients’ performance and behavior in school improved when he administered Benzedrine to them. However, these findings were largely ignored at the time. 

1952

The first edition of the Diagnostic and Statistical Manual of Mental Disorders, or the DSM was issued by the APA. ADHD was not recognized in this edition. 

1955

The FDA approved the stimulant methylphenidate, or Ritalin. As awareness and understanding of ADHD grew, the medication gradually became a popular treatment. It is still used today. 

1968

The second edition of the DSM was published. It included a condition called Hyperkinetic Disorder, characterized primarily by inattention, hyperactivity, and restlessness. 

Late 1960s

The first studies and articles on ADHD in adults began to appear.

1970s

Anneliese Pontius demonstrated that affected adults also exhibited similar symptoms as children. She was also able to identify associated brain regions such as the frontal lobe. However, the general consensus still remained that ADHD was a disorder of childhood and adolescence. 

1980

Noting that not all children who were diagnosed with Hyperkinetic Disorder exhibited hyperactive traits, the publication of DSM-III introduced the term Attention Deficit Disorder with or without hyperactivity, also known as ADD. 

1987

The name ADD was updated to be ADHD in DSM-III. With breakthroughs in studying adult ADHD, this version of the DSM formally recognized that the disorder may persist into adulthood. Stimulants such as Ritalin, Dexedrine, and Cylert began to be widely used as medication. 

1990s

The 1990s saw a significant surge in the number of ADHD diagnoses. Refinement of the description and symptoms of the disorder allowed doctors to make diagnoses more efficiently. ADHD also made its way into popular media, increasing awareness. However, this also elicited panic in the general public, even leading to the media making claims that the disorder wasn’t real. The panic eventually led to the early formation of stigma, with some attributing the condition to laziness or poor parenting. 

2000

The DSM-IV was released, organizing the disorder into 3 subtypes: predominately hyperactive and impulsive, predominately inattentive, and combined. 

2008

The National Institute of Health and Clinical Excellence (NICE) formally recognized ADHD in adults. Diagnostic criteria was modified to include struggles that adults with ADHD might face, such as complications in the work setting. 

 

The DSM-5 currently includes the most recent comprehensive diagnostic criteria for ADHD. Inattention primarily manifests in those with ADHD as “wandering off task, lacking persistence, having difficulty sustaining focus, and being disorganized”, with these symptoms not being due to “defiance or lack of comprehension” (American Psychiatric Association, 2013, Attention-Deficit/Hyperactivity Disorder section, p. 61). Older adolescents and adults who are affected may also be easily distracted by unrelated thoughts. Hyperactivity refers to excessive motor activity. In children, it generally manifests as running about when it is not appropriate, fidgeting, tapping, or extreme talkativeness. In adults, hyperactivity may be presented as restlessness or wearing others out with their constant activity. Individuals with the disorder often show impulsivity that reflects an abnormal inability to delay gratification, although the desire for immediate rewards is something that influences us all. It is important that symptoms of the disorder are present in more than one setting, and confirmation of the display of symptoms must be acquired from those who have seen the individual in different settings. Typically, symptoms vary across different contexts. According to the DSM-5, mild delays in language, motor, or social development often co-occur but are not necessary symptoms for the diagnosis of ADHD. Academic or work performance is often impaired in those with ADHD without the presence of any particular learning disorders. While ADHD is primarily associated with difficulty focusing, a lot of people also experience periods of intense and sustained attention, known as hyperfocus. This is usually triggered by tasks or activities the individual finds particularly interesting or engaging, although sometimes leading to a neglect of other responsibilities (Attention Deficit Disorder Association, 2026).

 

Currently, the exact pathophysiology of ADHD is not yet fully understood. ADHD arises from the interplay of various factors, including genetic, neurological, and environmental causes. Researchers have yet to find a single biological indicator that serves as an adequate diagnostic marker (Nazarova et al., 2022). Furthermore, it is important to note that the neurobiological mechanisms underlying ADHD are not uniform: different individuals may experience different levels and combinations of the cognitive characteristics of ADHD. 

 

ADHD is associated with the functioning of vast interconnected brain networks rather than attributed to one abnormal brain region. Several structures have been frequently identified to be involved (Rege, 2026):

• Hippocampus and amygdala: involved in memory processing, emotional response and behavioral regulation

• Prefrontal cortex (PFC): involved in working memory, attention, planning, response inhibition, and behavioral control

• Anterior cingulate cortex: involved in attention and cognitive control

• Basal ganglia and striatum: involved in movement, motivation, and reward

• Cerebellum: primarily involved in motor control

 

Neuroimaging studies have demonstrated abnormalities in the volume, development level, and activation patterns of these brain regions in people with ADHD (Wilkins, 2026). For example, research has shown that the PFC matures more slowly in children with ADHD. Several of the brain structures mentioned above have also been found to be smaller in volume. However, this difference in size becomes less significant by adulthood, meaning it should not be treated as a reliable diagnostic feature (Wilkins, 2026). Abnormalities in communication between different brain regions and neural networks appear to be more prominent. For example, ADHD has been shown to alter the connections between the PFC and other areas of the brain, contributing to the characteristic symptoms of forgetfulness, poor planning, and inattention (Attention Deficit Disorder Association, 2026). Another crucial difference involves the default mode network (DMN), a connected group of brain structures that activates when the brain is in a state of wakeful rest, while the person is not focused on the outside world (Azarias et al., 2025). This network is normally more active during inwardly focused thought, such as when daydreaming or recalling memories, and becomes less active as the person focuses on an external task. However, in those with ADHD, the DMN tends to be less effectively suppressed when completing tasks that require sustained attention (Attention Deficit Disorder Association, 2026). This helps to explain why staying focused is a much harder task for individuals with ADHD– not because of laziness, but because of biological differences. Research has also highlighted networks that are responsible for selective visual attention, which contribute to difficulty in filtering out irrelevant stimuli (Wilkins, 2026). 

 

Apart from neural structures, two neurotransmitters have also been repeatedly shown to be especially involved in the brain chemistry of ADHD: dopamine and norepinephrine. Dopamine is primarily responsible for regulating motivation, reward processing, and learning. Rather than stemming from a simple “dopamine deficiency”, ADHD involves differences in dopamine regulation and signaling (Attention Deficit Disorder Association, 2026). This affects how the brain processes reward and motivation, contributing to a preference for immediate rather than long-term, more significant rewards. Furthermore, dopamine contributes to the mesocortical pathway, which connects dopamine-producing regions with the PFC, supporting executive functions such as working memory and decision-making. An unusual number of dopamine transporters in the brains of those with ADHD may be responsible for disruptions in the mesocortical pathway (Wilkins, 2026). Norepinephrine similarly plays a role in attention, working memory, and inhibitory control. ADHD may disrupt its transmission in the brain, causing difficulty in retaining information and suppressing distractions. However, it is important to make the distinction that ADHD is not simply the result of differences in the number of neurotransmitters or neurotransmitter transporters; rather, it is caused by more complicated problems involving regulation, signaling and neural circuits. 

 

ADHD treatments consist of medication and behavioral approaches. The most effective interventions usually involve a combination of the two. For children younger than 6 years however, parent training in behavior management is generally recommended before the use of medication, as younger children may be especially affected by side effects (Centers for Disease Control and Prevention, 2026). An effective treatment plan not only involves the appropriate selection of treatment types, but also the close monitoring of physiological and behavioral responses, making suitable adjustments when needed. 

 

ADHD medication primarily involves stimulants and non-stimulants. Stimulants such as methylphenidate and amphetamine, increase and balance neurotransmitter levels in the brain and are the most commonly prescribed type of ADHD medication (Mayo Clinic, 2023). Around 70-80% of those with ADHD experience fewer symptoms when taking these fast-acting medications (Centers for Disease Control and Prevention, 2026). Non-stimulants such as atomoxetine are often recommended as secondary treatment options if the individual experiences severe side effects from stimulants, though non-stimulants often take longer for the patient to feel significant changes. Behavioral and lifestyle interventions can further reduce symptoms when paired with medical treatments. These include psychotherapy and cognitive behavioral therapy, teaching skills such as positive thinking, time management, emotional control, and mindfulness meditation. Dietary interventions and physical exercise have also been shown to be effective, along with help from support groups, family members, and close friends (Nazarova et al., 2022). 

 

Awareness of ADHD has improved substantially with the rise in diagnoses starting from the 1990s and the development of social media. However, many still fail to recognize the fundamental biological differences between those with ADHD and those without, labeling individuals with ADHD as lazy and lacking self-control even when they have already tried their hardest to meet the demands of everyday life. ADHD increases the likelihood of injuries, substance use disorders, traffic accidents, poor academic or workplace performance, and broken family or peer relationships. These challenges are not in any way caused by laziness or a lack of discipline, they are simply linked to how the ADHD brain regulates and processes information. Yet disclosing their condition risks the discrimination that an ADHD label brings, while hiding it often leads to condemnation from those around them for being disorganized, impulsive and forgetful without the excuse of a disorder. It is thus unsurprising that those with ADHD suffer from low self-efficacy, a lack of confidence, and a desire to mask their symptoms. Sometimes, they may internalize negative stereotypes, destroying motivation and the desire to be successful. On the other side is denial of having a mental disorder at all. This is especially dangerous because it prevents the person from seeking professional help, potentially worsening the development of the condition.

 

ADHD is a lifelong condition that has no real cure. Up to 50% of children with ADHD continue to experience symptoms into adulthood (Cleveland Clinic, 2022). Yet ADHD is still commonly thought of as a childhood disorder, imposing harsh stereotypes onto affected adults, often claiming that they fabricated their condition to compensate for failures and excuse their “laziness”. It was found that, on average, adults with ADHD agreed with the statement “I feel I have to mask my personality when I am at school, work, and at home” (Maeda et al., 2026). Similarly, people continue to think of ADHD as a “male problem”, causing heavy stigmatization for girls and women. In many cultures, girls are expected to be quiet, polite, and feminine. When ADHD leads to behavior that goes against those expectations, they often face heavier criticism and marginalization. Boys are more than twice as likely than girls to be diagnosed with ADHD, but this doesn’t necessarily mean that boys are more susceptible. Females are likely underdiagnosed due to a variety of factors, including differences in the expression of symptoms and a bias towards focusing on males in research (Holland, 2024). ADHD is a real condition, no matter the age or gender, that deserves real attention.