: Class notes by a student with ADHD. ADHD can show up in counterintuitive ways for those that go undiagnosed—including hyper-organization, making it difficult to identify.

Franklin juniors and identical twins Lily and Evelyn Hillebrandt are both 4.0 students, lifeguards, and ADHD. In addition to school and their jobs, they are both heavily involved with the Franklin theater department, having co-starred in this year’s production of Hamlet. Carrying highlighters and colored sticky notes in their backpacks, they found ways to cope with ADHD as students long before they were diagnosed. While they may not fit the typical image of ADHD, the disorder has had a significant influence on their lives. With symptoms of restlessness, a lack of focus, and procrastination, paired with more serious aspects—including executive dysfunction and anxiety—ADHD can cause serious impairments. However, especially for girls, internalization and a lack of diagnosis until later in adolescence and even into adulthood often lead to advanced coping mechanisms. This is why it can be difficult to identify ADHD.

“I feel like I have to work extra hard just to get past focal things… I have to work harder than someone who might not have [ADD.]”
–Lily Hillebrandt

Attention Deficit Hyperactivity Disorder (ADHD) is defined in the fifth addition of the Diagnostic and Statistical Manual as a persistent pattern and/or hyperactivity-impulsivity that interferes with function or development. It is a disorder present from early childhood, although it may be diagnosed later, and has three subtypes of how it presents—predominantly hyperactivity/impulsivity, predominately inattentive (often referred to as ADD), and combined.

It is unsurprising that identical twins would have it: ADHD is usually hereditary. However, Lily was diagnosed at 16, a year after her sister. ADHD looks different for each person; symptoms vary, as do the way those symptoms present themselves.

ADHD is an incredibly complex disorder. Even its name can be deceptive: people with ADHD often describe feeling overstimulated, essentially: paying attention too much. Stigmatization around ADHD and a lack of public understanding means that many people are not diagnosed until they are adolescents or even adults. This is especially common for women, whose symptoms tend to be more inattentive versus the hyperactivity more often present in media.

A 2013 study by the Centers for Disease Control and Prevention (CDC) found that about 11 percent of children in the US are diagnosed with ADHD; for adults, the number is closer to four percent. The smaller rate of diagnosis in adults may signify that recognition of ADHD has increased in recent years. The study also found that boys are more than three times more likely to be diagnosed than girls.

Dr. Ellen Littman is a clinical psychologist who specializes in identifying complex manifestations of ADHD and is the internationally-recognized co-author of Understanding Girls with ADHD. According to Littman, the initial definition of ADHD was based on how it affects boys with hyperactive symptoms. Due to this, the assessment and diagnosis of it “still focus on external behaviors that interfere with other people.” Littman believes this helps explain the decreased diagnosis and more frequent misdiagnosis or comorbidity (having multiple disorders) for women. “Most women struggle with an internalized sense of impairment that affects their sense of self and qualitative life management skills.”
Lily testifies to this experience; she was diagnosed with depression and anxiety before ADHD. “When my psychiatrist brought it up… it just made a lot more sense, definitely with anxiety, because the effects of ADD tie in with that,” she explains. “The unfocusedness can cause anxiety to worsen, because when you don’t really know what’s going on, it’s kind of like a cycle.”

The stereotypical image of ADHD also might help explain why white boys are diagnosed at a significantly higher rate. A study funded by the American Academy of Pediatrics and conducted over the course of nearly a decade found African American children were 69 percent less likely to be diagnosed, while Hispanic children were 50 percent less likely, and children of other races/ethnicities were 46 percent less likely. Analysis of the results found clinicians to be “disproportionately responsive to white parents,” who were also more likely to seek treatment.

The stigma around what ADHD looks like (i.e. hyperactive white boys) affects many people with it. As Evelyn describes, it was hard at first to identify with, due to this set narrative. “Initially I mostly just associated ADD and ADHD with restlessness, being fidgety, not be able to sit down or pay attention, but there’s a lot more stuff that goes into it; like executive dysfunction is a huge thing for me and just checking out a lot… there’s just a lot of other things you don’t really hear about with it.” Lily agrees, but with increased exposure to others with it, she has “learned… even though I don’t show those hyperactive signs, it still affects me.”

This inequity based on race and gender is dangerous; the long-term effects of ADHD/ADD can be severely impairing—teenagers with ADHD are more likely to struggle with substance-abuse, eating disorders and other mental health issues. Children with ADHD have shown to be more likely to drop out of school and even end up incarcerated. While unfortunate, this is not surprising; the impulsivity and general ‘neurodivergence’ makes the structure of school difficult.

Half way through the interview, Evelyn bursts out laughing, having lost her train of thought mid-sentence. “ADD, everyone.” The inattentiveness caused by ADHD/ADD is more than just jumpiness or spaciness: it’s always losing a thought in the middle of a sentence, forgetting basic words, being unable to make simple decisions of what to eat, wear, or do, struggling to conceptualize time, searching for your glasses that are on your head, standing there for 15 minutes trying to think of what it is you came down here for. Even the seemingly mild aspects of ADHD are impairing in the constant way in which they show up.

“I feel like I have to work extra hard just to get past focal things or stuff that goes with it… the ADD part is something I have to push past too, so it means I have to work harder than someone who might not have it,” Lily adds. However, that has not stopped her, Evelyn, or the many successful actors, artists, athletes, entrepreneurs, writers, and more: including Olympic gold medalists Simone Biles and Michael Phelps, as well as award-winning actors, Ryan Gosling, Will Smith, and Jim Carrey.

For people with ADHD/ADD, with an often unique view of the world and thoughts constantly rushing too fast to keep up with, high levels of intelligence and creativity come hand-in-hand. Despite the difficulties, success for kids with ADHD is not a long-shot. As actress Wendy Davis describes, “ADHD makes you different, not defective.”

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