ADHD But Not Hyper? It is Possible

From the meaning of the acronym, ADHD, Attention Deficit Hyperactivity Disorder, it’s already easy to see why many people believe that the neurodivergent condition is all about being hyperactive🤔. Then, we see children and adults actually diagnosed to have never-ending energy and frequent movement. This often creates the false belief that if a person does not display these behaviors, they could not possibly have ADHD. However, this may not always be the case. There is much to learn about ADHD, so let's start with its detailed history.

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Attention Deficit Hyperactivity Disorder appears to be first talked about in 1798 by Sir Alexander Crichton. This Scottish doctor noticed the behavior of some people who are easily distracted and have unusual concentration skills compared with others. He described it using the following words: “the incapacity of attending with a necessary degree of constancy to any one object.” However, Sir George Frederic Still, a British doctor, was the first person to research what seemed to be the same disorder in children 🧒 and described it as "an abnormal defect of moral control in children," which can make them have difficulty staying focused and managing their behavior. But even though they have trouble organizing tasks or difficulties focusing as a neurotypical child would, they are believed to be intelligent.

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Attention Deficit Hyperactivity Disorder (ADHD) was not coined yet during those times, so parents of young children as well as adults with behavioral symptoms continue to wonder about the traits they are experiencing. 

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When Benzedrine, a treatment for ADHD💊, was approved by medical professionals in 1937, one can say that it’s an “accidental discovery.” Charles Bradley (1902 - 1979), observed that 14 out of 30 children who took medicine for a week had a sudden behavior change, which helped them have improved focus and were much more attentive. 

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The early intervention of Benzedrine may have paved the way for Attention Deficit Hyperactivity Disorder (ADHD) to be tackled seriously by the medical community.

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ADHD or Attention Deficit Disorder?

Upon discovering the behavioral improvements brought by Benzedrine, experts wondered why a stimulant would affect treating ADHD (then still not called such). With studies, they have noticed that psychostimulants increase certain neurotransmitters (like dopamine) and can improve brain function 🧠 for people struggling with ADHD. 

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In the late 1960s, the American Psychiatric Association (APA) included what is now called ADHD in their Diagnostic and Statistical Manual of Mental Disorders (DSM). But, again, it was not called Attention Deficit Hyperactivity Disorder (ADHD) yet. During this time, they started to use the term "Attention Deficit Disorder." Back then, mental health professionals believed that hyperactivity is not a common symptom of this neurodivergent disorder. So they categorized it as Attention Deficit Disorder with or without hyperactivity.

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But then, after many pieces of research and peer-reviewed studies📚, the American Psychiatric Association (APA) decided to include hyperactivity as a common symptom, and decided to stop calling it ADD. In 1994, they renamed it as Attention Deficit Hyperactivity Disorder in the third edition of their Diagnostic and Statistical Manual of Mental Disorders. In the 4th Edition of DSM, they recognized hyperactive and impulsive ADHD traits as part of ADHD and categorized the neurodivergent disorder into three categories: Predominantly Inattentive ADHD, Predominantly Hyperactive-Impulsive Type, and the combined type ADHD presenting both inattention symptoms and hyperactive traits.

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We Aren't Always Hyperactive

The acknowledgment of the American Psychiatric Association of the categories paved the way for those with Attention Deficit Hyperactivity Disorder to be diagnosed and to better understand their symptoms. Although the name of the neurodivergent disorder has "hyperactivity" on it, not all people with ADHD are constantly bouncing off the walls or storming in and out of the room because they have too much energy to spend😅.

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Some experience difficulty sustaining attention and staying focused. Others with ADHD can exhibit impulsivity in decision-making or have trouble waiting. Of course, there are those who are always on the go. 

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It is important to note that not all people with ADHD experience the same symptoms, and not all of them are always "hyperactive." There can be many other symptoms aside from being ecstatic and full of energy.

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Hyperactivity doesn't need to manifest physically to be diagnosed with ADHD. Some either mask their hyperactivity well because they've learned to control it or they may have the Predominantly Inattentive Type. Whichever path you take with your struggles, your feelings are always valid, and you are not alone😘.

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A Quick Rundown of ADHD Categories

To fully understand Attention Deficit Hyperactivity Disorder, we must first understand the struggles we experience based on our category. Knowing them gives us enough chances to manage ADHD symptoms better. Previous versions only consider a child's symptoms of ADHD. The DSM-5 update provides us with enough information about adult ADHD, too, which validates adult struggles concerning ADHD🙋‍♀️. Experts categorized ADHD into three:

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Hyperactive-Impulsive Type

The symptoms of Attention Hyperactivity Disorder under this type can mostly be physical. A person with Predominantly Hyperactive-Impulsive Type might have issues controlling their impulses. Behavior problems such as fidgeting or squirming are often associated with this type of ADHD. It can also be common for a person with hyperactivity to talk excessively and disrupt conversations or be constantly on the go.

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Inattentive Type ADHD

Predominantly Inattentive Presentation of ADHD can manifest differently. A person with this type of Attention Deficit Hyperactivity Disorder might be easily distracted, have difficulty focusing on a task, and often forget things. They might also space out during conversations 😵 or daydream more than the others. This type can be easily missed, especially if a person is good at masking it.

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Combined Type

Of all the nine symptoms of Hyperactivity-Impulsivity Type and nine symptoms of Inattentive Type, a child with Combined Type would have at least six of each category (at least 5 of each for adults). 

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According to research, the combined type (ADHD) is the most common presentation. People who experience almost all of the symptoms of ADHD can struggle with competing tasks, difficulty listening, and tend to be forgetful.

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Remember that before you get diagnosed with any ADHD category, you must get a qualified mental health professional 👩‍⚕️ for an official ADHD diagnosis.

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The ADHD Stereotype

Because of the history of Attention Deficit Hyperactivity Disorder, many misconceptions can revolve around this neurodivergent disorder. Some people may think of a young boy squirming on his seat and bouncing his legs restlessly🧒. However, this is only the tip of the ADHD iceberg. There are lots of experiences that a person with ADHD can struggle with. The difficulties of other people with inattentive ADHD can sometimes be invalidated. That's why raising awareness on breaking the stigma regarding ADHD is essential.

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In reality, the predominantly inattentive type of ADHD can sometimes be overlooked as they are challenging to diagnose. This may result in lots of people continuously struggling with inattentive ADHD, who can go through their whole lives being undiagnosed. The possibility of having ADHD but without the hyperactive symptoms can be explained with the following reasons:

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Masking Hyperactive ADHD Traits

Hiding predominantly hyperactive-impulsive symptoms can be a person's way of avoiding conflict or judgment brought by their behavior and action. It can also be a way for them to cope with their difficulties. They can pretend everything is okay while masking their hyperactive traits. Some signals of masking hyperactive ADHD symptoms may include:

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• Secretly fidgeting things where no one can notice
• Trying their best not to interrupt conversations and keep comments to themselves
• Releases all suppressed energy when alone or no one is looking
• Hiding creative ideas in fear of being shamed

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The mental effort to cover up the hyperactivity inside an ADHD brain can sometimes be exhausting and there are chances of developing an imposter syndrome because of it🥺. This is when we develop coping mechanisms to pretend we are someone else by hiding our struggles because we are afraid of the judgment of everyone around us.

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Inattentive Symptoms of ADHD

People with inattention symptoms can still be diagnosed with Attention Deficit Hyperactivity Disorder even though they are not physically hyperactive. When we are categorized under the predominantly inattentive presentation for ADHD, hyperactivity may still happen, but this time, it's inside our ADHD brains🧠. The overly active brain activities may cause different struggles in our daily lives. These inattentive symptoms may include:

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• Trouble keeping track of time and schedule
• Can get easily distracted in school or activities, which may develop into  learning difficulties
• Difficulty to stay focused and tendency to make careless mistakes.
• Producing a thousand creative ideas but have struggles in completing tasks

These inattentive ADHD symptoms may not be as apparent as the hyperactive-impulsive ones, which makes it more difficult to be diagnosed. However, that doesn't mean that their struggles are invalid. People with a predominantly inattentive presentation of ADHD are still worthy of getting the help and support they need🙌.

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How to Support People with ADHD?

Now that we understand that not all people with ADHD are hyperactive, and that others can be struggling with Attention Deficit Hyperactivity Disorder (ADHD) quietly, one of the best ways we can support them is by raising awareness. We can start by educating ourselves and others about the different presentations of ADHD. By knowing these circumstances, we can stop invalidating people’s feelings with their ADHD's struggles💪. 

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Having ADHD can affect a person's everyday functioning, and they may not always have the choice to do things whenever they want. It's essential to be considerate and to understand that some people with ADHD may not be able to do things on time or the way you want them to. You can help by breaking down instructions and being more specific with what you want them to do. Another way of supporting people with ADHD is by being more patient. Some tasks that may seem easy for you may be a little more complicated for them.

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If you have a friend or a loved one with ADHD (like me), the best thing you can offer us is your never-ending support and understanding whenever we seem to continually fail to complete tasks or commit careless mistakes most of the time. Let us know that you are always there for us and will never give up on us, no matter how difficult things may get. The support we get from our family members and closest friends hit differently and can make a more impactful difference in our lives.❤️

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And lastly, take the advice of your mental health professional or ADHD coach seriously. They are the ones who know what's best for you and will always have your best interest at heart. They may give you different tips on how you can manage your ADHD symptoms better. Follow their instructions carefully, and don't be afraid to ask questions whenever you need clarification👩‍⚕️ .

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ADHD But Not Hyper: FAQs (Frequently Asked Questions)

1.  Do people with ADHD always exhibit hyperactivity?

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Despite having the “hyperactivity” in the name of the disorder, a person can be diagnosed with ADHD even though they are not physically hyperactive. After all, there are three presentations of ADHD: Predominantly Hyperactive-Impulsive, Predominantly Inattentive, and Combined. 

2. Why do some people believe that Attention Deficit Hyperactivity Disorder always has hyperactive symptoms?

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It mainly has something to do with the way ADHD was first discovered. You see, initially, it was observed in hyperactive people. Moreover, the inattentive symptoms are easier to miss than the hyperactive symptoms, like running around and fidgeting.

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3. What could be the reasons why Inattentive ADHD is difficult to diagnose?

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There could be two reasons why: the first is what we discussed, being inattentive is easier to miss. Secondly, the person may have learned to mask their hyperactive symptoms to avoid conflicts or judgment.

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