The past year has seen an upsurge in interest in and diagnosis of ADHD, especially in adult women and girls. There has been debate about imaging evidence in the brain, diagnosis and the overlap with anxiety and oppositional defiance disorder and the relative merits of medication or skills and parent training to address the symptoms. The difficulty accessing a diagnosis, both financially and in finding a qualified professional, has highlighted inequality underpinning the search for help. Less interest has been paid to the meaning attached to a diagnosis and how this intersects with identity.
Identity
Bower(method) the integrative model developed at Bower Place analyses and intervenes in all difficulties through four lenses. One of these is development, which includes our physical, genetic, cultural, trauma and family elements and our identity. The question ‘who am I?’ encompasses our productive identity; what we do, attachment identity; who we belong to, peer identity; our friends and sexual identity. A diagnosis has implications for how we understand ourselves and how others interact with us.
ADHD and Identity
Once a diagnosis has been secured the next question is treatment, and this is powerfully influenced by an understanding that this is primarily a ‘brain disorder’ or a skills deficit underpinned by differences in the way the brain functions. If the primary understanding is that ‘I am wired this way, I always have been and always will’ and that strategies may help but are not central, a person may well look to medication as the solution and not beyond. They and others in their world may not put time, effort and thought into developing strategies to counter inattention and disorganization and limit their success.
Productive Identity
The idea that a person may have a disability which makes them less capable than others and a failure to address it in practical ways, can result in a limiting of productive identity. A belief they are not as proficient may result in a lowering of goals and limiting of dreams by both them and others. A lack of encouragement to try new things and the accompanying belief that success is possible if appropriate support is in place, may further narrow productive identity and deny that person opportunities.
Attachment Identity
A family’s negative view of a person and attachment style may be reinforced by the diagnosis. Where an individual has been viewed as difficult and odd, a diagnosis of ADHD may reinforce their difference from other more successful family members and become the sole explanation for tensions. It can also become a reason to exclude and demean as they are framed as ‘sick’ and ‘just too difficult.’ Unhelpful patterns of interaction and deeper more troublesome family issues can be ignored when one person is framed as the source of all problems. For adults, the diagnosis may become the full explanation for all past and present difficulties, allowing a shutting down of exploration of more troublesome experiences.
Peer Identity
Some people express immense relief at discovering why they have struggled personally and in friendships and a diagnosis may become a reason to give up trying. Instead, they may decide to only interact with others who share their diagnosis on the grounds that others ‘just can’t understand.’ Support is valuable, but narrowing one’s social world and definition of self to a diagnosis is unwise.
Sexual Identity
A similar choice may be made in relation to sexual identity where a person decides the difficulties inherent in exploring their sexuality and risks of rejection are too high and choose to remain isolated.
In Conclusion
A diagnosis of ADHD can be a relief, explaining to a person and others in their world why seemingly simple and easy tasks are so difficult. For many, medication is the key to change. However, a recognition that the way the world understands and responds will dictate the future and whether the diagnosis enhances the person and their world or further limits it.