ADHD Stigma: Effects on Diagnosis and Treatment

Today, our medical understanding of attention deficit hyperactivity disorder (ADHD) comes from an abundance of studies that have helped identify the physical, mental, and behavioral characteristics of the disorder. Broadly, social awareness surrounding ADHD has improved too, thanks to news, articles, social media content and more—all about ADHD.

But even with all the educational resources out there, many people still face negative stigma related to ADHD symptoms, behaviors, and even medications.

ADHD is characterized by ongoing challenges of inattention or hyperactivity—symptoms which in themselves can lead to social and mental health struggles. However, ADHD stigma itself can contribute to additional social barriers, impact an individual’s performance at school or work, delay or prevent diagnosis, and lead to other adverse effects.

Getting diagnosed for ADHD can already be a complicated process, and stigma only creates more obstacles. In this article, we’ll discuss ADHD stigma, and its effects on health, diagnosis, and treatment. Plus, we’ll explore how clinicians can avoid reinforcing stigma to support patients in getting an accurate ADHD diagnosis and effective treatment.

Why Does ADHD Have a Negative Stigma?

The negative stigma related to ADHD can come from many places, including social and cultural expectations as well as misrepresentation in media.

ADHD stigma involves negative stereotypes about the characteristics of a person with ADHD. These depictions and beliefs may be inaccurate, dramatized, or generalized—and often prevent people from understanding the many different ways ADHD presents. They may also go hand in hand with negative ideas about how to respond to someone with ADHD, such as being exclusionary or punitive, and therefore can impact a person emotionally, mentally, socially, and materially.

There are a few different types of ADHD stigma to be aware of:

• Public stigma, or socially perceived stigma: External sources of stigma directed at a person with ADHD, such as bias or discrimination in school, the workplace, or the clinic. For example: hurtful words, exclusion, denial, etc.
• Courtesy stigma: External sources of stigma directed at people associated with a person with ADHD, such as family members, friends, caregivers. For example: A parent being told that their child’s ADHD was “caused by their parenting.”
• Internalized stigma, or self stigma: Internal sources of stigma that a person with ADHD directs towards themself. For example: low self esteem, isolation, not seeking help, etc.
• Affiliate stigma: Internal sources of stigma that family, friends, caregivers of those with ADHD direct towards themselves. For example: A parent of a child with ADHD internalizing beliefs about “failure.”

Defining ADHD Stigma

Stigma related to ADHD shows up in beliefs, behavior, and words expressed by anyone from peers, colleagues, family members, friends, and healthcare providers—or directed at oneself as internalized stigma.

Common misconceptions about ADHD include that:

• It isn’t a real disorder
• It’s a result of laziness or lack of discipline
• It’s a result of too much screen time
• It only affects children, not adults
• It only affects boys or isn’t as severe in girls and women
• It only shows up as hyperactivity, not as inattention

Research shows that there are differences between ADHD brains and those unaffected. These differences can show up in variation in cognitive skills, such as executive functioning, reaction time, sustained attention, and more.

Stigma Related to ADHD Medication

Even patients who overcome the obstacles to getting tested and diagnosed for ADHD—such as healthcare access limitations or internalized shame or denial—can experience stigma in other forms during the treatment plan process, particularly when medication is involved.

That’s because there’s also stigma about ADHD medication, including that:

• Medication is over-administered
• People with ADHD are over-medicated
• Medication leads to other negative impacts
• Medication is the “easy way out”
• Medication is not the “natural way” to overcome ADHD symptoms
• See note

Some people seek out alternatives to medication for treating ADHD, either led by the healthcare provider recommendation or the patient’s preference. Multimodal approaches to treatment may involve lifestyle changes, exercise, mindfulness, diet, therapy, and social or community support, as well as medication.

While medication is not appropriate for everyone with ADHD, medication helps many. Clinicians have the challenging task of discerning whether medication is appropriate and tracking the impacts on mental and cognitive health over time to adjust accordingly.

Some of the ways clinicians determine a treatment plan, with or without medication, include:

• Computerized cognitive assessments: Cognitive tasks can help measure attention, problem solving, and other indicators of ADHD..
• Self-report questionnaires: Self-report questionnaires can help capture information on a patient’s emotional wellbeing in regards to their symptoms. Examples include the ASRS and the VARDS ADHD tests. Along with cognitive tasks, these tools offer a baseline of cognitive and mental health and measure symptom changes throughout treatment.
• Clinical or therapeutic interviews: Hearing a patient’s subjective experiences is a valuable launching off point for further testing, as these conversations may signal other challenges related to ADHD, such as sleep disruption, comorbid conditions, or social factors. Patients can also relay their feelings related to medication effects, so a clinician can adjust dosage or offer alternatives.
• Biological labs: Measuring biomarkers such as vitamin deficiencies can help determine if lifestyle and nutritional changes are a more effective first step for reducing a patient’s ADHD symptoms of inattention, for example.

How Does Stigma Impact ADHD Treatment and Diagnosis?

From a clinical standpoint, stigma impacts ADHD treatment and diagnosis in a few key ways:

• Delayed diagnosis and treatment
• Inaccurate or missed diagnosis
• Over- or under- medication

For individuals living with ADHD, stigma can permeate many areas of their lives and can compound their symptoms. Some of the areas impacted include:

• Social challenges
• Difficulties in school
• Workplace discrimination
• Internalization, shame, denial

Reliability of ADHD Testing and Diagnosis

With so much information about ADHD available online and on social media, many people turn to self diagnosis to understand their symptoms. When the alternatives are long wait times for testing and referrals, or out-of-pocket expenses to see a specialist—or anxiety surrounding the medical system—it makes sense why. But reading lists of symptoms, learning from soundbites on social media, or taking an online ADHD test don’t offer the scientific validity and support that a healthcare provider can. That’s why reliable measures for diagnosing ADHD are critical in rebuilding trust and getting patients the care they need.

Accurately diagnosing ADHD already comes with challenges. For example, up to 90 percent of children with ADHD have at least one comorbid disorder, which may have lifelong effects.

ADHD stigma can further affect the accuracy and reliability of ADHD testing and diagnosis, such as when it leads to:

• Delaying or bypassing testing
• Relying only on subjective measures, such as clinical interviews
• Allowing gender or age bias to influence diagnostic decision-making
• Overlooking common ADHD comorbidities or failing to address them
• Assigning symptoms to a related or comorbid condition without addressing ADHD

Read more: ADHD Assessment by Creyos: A Scientifically-Validated Protocol & Report

Who is Affected by ADHD Stigma?

Experiences of ADHD are shaped by both systemic and social factors as well as mental and cognitive conditions. There are many different ways people experience ADHD across age groups, gender, sexual identity, and race, to name a few examples.

Read on to learn some of the specific ways ADHD stigma can arise for each of these groups.

How ADHD Stigma Affects Children and Teens

An estimated 6 million U.S. children between 3–17 years old are diagnosed with ADHD. Children displaying ADHD symptoms can experience stigmatization at home, in school, and among peers. This can sound like receiving excessive negative feedback or being told they’re lazy, badly behaved, disruptive, or inherently poor performers in school. Unfortunately, stigma experienced in childhood can have long-term consequences.

Examples of how ADHD stigma affects young people can include:

• Peer rejection
• Low self esteem
• Learning difficulties
• Acting out, or behavioral problems
• Social isolation

Stigma towards children with ADHD can also lead to:

• Not asking for help or seeking learning accommodations.
• Not receiving treatment they need for ADHD symptoms. An estimated 23% of U.S. children diagnosed with ADHD receive no treatment.
• Other mental, emotional, or behavioral disorders, as seen in 60% of children with ADHD.
• Long-term social and material impacts. High school graduates with ADHD earn an average of 17% less annual income than those without ADHD.

How ADHD Stigma Affects Adults

ADHD is often, mistakenly, thought of as being a condition only experienced in childhood, but this can lead to the erasure of adult ADHD. Of children diagnosed with ADHD, 50–70% will continue to meet the diagnostic criteria into adulthood. Adults with ADHD can experience stigma in the form of:

• Public stigma
• Discrimination at work, school, or among peers
• Internalization, or self stigma

Adults with ADHD may have already internalized beliefs that they are simply not working hard enough, when in reality they’re dealing with untreated ADHD symptoms. They may also continue to face negative perceptions at work, public stigma, and material consequences that can lead to additional difficulties, such as with mental health.

To mitigate some of the risks of perceived public stigma, adults with ADHD may have also developed ways to cope with or “mask” ADHD symptoms. These coping strategies can make it even more difficult to detect and diagnose ADHD through typical means.

Differences in ADHD Stigma Across the Gender Divide

Gender bias is at play when identifying and diagnosing ADHD. In the U.S., boys (11.9%) are diagnosed with ADHD at a higher rate than girls (5.5%). Often this is because boys present with more hyperactivity symptoms, while girls present with more inattentive symptoms—which are quieter and more difficult to identify.

These biases and gender expectations can feed into stigma, and create issues when seeking an ADHD diagnosis. It’s inaccurate to say that ADHD symptoms present universally and consistently across gender (i.e., girls can also experience hyperactivity, and boys inattention).

Parents, teachers, and clinicians can potentially do more harm if they respond to these differences in how ADHD presents by asserting that these variations are “wrong” or “strange” according to gender expectations. For example, a boy with inattentive symptoms may not be assessed for ADHD because he doesn't have the typical hyperactivity. Stigma gets complicated even further for those whose gender expression falls outside of norms.

ADHD Stigma in LGBTQ+ Individuals

Gender disparity in diagnosing ADHD extends to LGBTQ+ identifying individuals. The gendered social expectations about how ADHD shows up are compounded by other types of stigma these individuals face in their daily lives.

Transgender, nonbinary, and gender diverse patients already face several barriers to healthcare access. The most commonly reported challenges include:

• Discrimination
• Financial and socioeconomic barriers (e.g., transportation)
• Health system barriers (e.g., inappropriate records)
• Lack of healthcare provider expertise with transgender care

Misplaced gender biases can further complicate providing LGBTQ+ patients with an accurate ADHD diagnosis. Healthcare professionals may attribute an individual’s symptoms (e.g., difficulty focusing, anxiety, stress) to their gender identity, rather than ADHD, as this example from ADDitude magazine highlights:

“Queer folks are often under tremendous pressure from broader society to fit into norms. And when they don’t, it’s usually attributed to their sexuality or gender identity, so they’re not encouraged to consider that their experiences may be consistent with [ADHD] instead.”

Diagnostic Disparity in Marginalized Racial Groups

Research suggests there are inequities in ADHD diagnosis based on race and ethnicity. According to survey data from the CDC, “ADHD is more commonly diagnosed in Black, non-Hispanic children (12%) than White children (10%), Hispanic children (8%) and non-Hispanic children (3%).”

Another factor of stigmatization is education about ADHD, and there are cultural dynamics to this as well. One survey found that compared to White adults, adults from African American descent lacked information about ADHD, were less likely to accept ADHD as a real medical condition, and experienced more mistrust towards schools when faced with descriptions of a child’s symptoms.

ADHD stigma inequities can be attributed in part to:

• Biases from teachers and clinicians
• Sociocultural expectations
• Structural racism
• Imbalanced community resources
• And other factors

These factors can affect the type of care people receive in healthcare settings, lead to medical mistrust, and even influence families of youth not to seek services. When social and systemic factors are already stacked against marginalized individuals or groups, common stereotypes about ADHD can create greater obstacles. By being aware of these structural and stigma-based factors, clinicians can help counter medical inequity and deliver better patient care.

The Impact of Stigma on Caregivers

Many caregivers of young people with ADHD experience stigma, such as courtesy stigma or affiliate stigma. As a person close to someone with ADHD, they’re often closely engaged in advocacy—and this also means they have to contend with the same misinformation and stigma.

Caregivers may experience stigma in similar ways to someone with ADHD, such as:

• Exclusion or peer rejection
• Increased stress
• Lower quality of life
• Mental health issues

While it’s clear that stigma is a wide-reaching and interpersonal challenge, there’s good news for healthcare providers. With appropriate education and treatment for ADHD patients, you’ll also equip their family members, social circle, and caregivers with resources to support the wellbeing of all of them.

4 Ways Healthcare Providers Can Help Reduce ADHD Stigma

A primary care physician or therapist may be a person’s first point of contact when seeking support and diagnosis for ADHD. Understanding ADHD stigma and taking steps not to reinforce these harmful ideas can make a world of difference in patient experience—potentially leading to better appointment and treatment follow through and getting the care they need.

1. Avoid Reinforcing Stereotypes

Simply by knowing the common misconceptions about ADHD, clinicians can avoid reinforcing negative messaging that patients are likely to have experienced in other areas of their life—whether that’s school, work, or home. A clinician’s perspective and action hold significant weight for patients.

A few ways to empower patients:

• Actively listen, ask questions, and don’t assume a patient’s experiences
• Avoid generalizations and broad-strokes solutions
• Avoid reinforcing messages around laziness or simply needing more discipline by taking a multi-modal approach to treatment
• Communicate the importance of gathering objective data to support their concerns

2. Use Patient-Centered Language

Even though ADHD has characteristic symptoms, it can look and feel different for every patient. A patient’s emotional and mental health response to their ADHD experience will vary, too.

Using patient-centered language can mean gauging whether a patient identifies with being neurodivergent—and providing them with resources for education if they’re unaware of what this means. Some patients can find relief in knowing why their brain is different—and that they can still succeed even with its unique strengths and challenges.

Knowing that ADHD diagnosis is already influenced by gender bias, another key to patient-centered language is to avoid imposing gendered social norms when describing ADHD symptoms. A common practice to avoid is describing the ways ADHD shows up differently in boys and girls in broad strokes—especially with gender diverse or LGBTQ+ patients who already face excess pressure to fit into social expectations.

3. Learn From Lived Experience and Educational Sources

Continuous learning is a cornerstone of great healthcare. Medical knowledge is always evolving—and so is society and technology. So staying up to date on the latest ADHD research and insights is important.

There are several associations and publications that share educational resources about ADHD. Here are a few places to start:

• CHADD
• Attention Deficit Disorder Association (ADDA)
• ADDitude Magazine

Additionally, one of the benefits of the abundance of social media representation is that there are more opportunities to encounter real first-person stories about what it’s like to live with ADHD. These lived experience perspectives can be very beneficial for clinicians and patients alike. And sharing credible sources with patients can also help them better understand their brain, discover positive outlooks about living with ADHD, and even find social support or community—without further spreading stigma and misconceptions online.

4. Use Data-Driven Measures to Understand Diagnosis and Symptoms

Using objective markers of ADHD symptoms takes some of the guesswork out of diagnosis and identifying the appropriate treatment. Plus, using objective data can help reduce stigma and bias in a healthcare context. The rise in online ADHD tests available today is a reflection of the high demand coming from patients—but they’re no replacement for scientifically-validated tools administered by a healthcare professional.

Fortunately, today there are tools physicians can use to gather objective data, alongside valuable subjective self-report or clinician interview insights. Computerized cognitive assessments allow clinicians to measure aspects of attention, executive function, short-term memory, and other areas that can be indicative of ADHD.

Using objective measures, clinicians can:

• Diagnose and treat ADHD with greater confidence
• Identify the presence of and independently treat ADHD comorbidities
• Measure the efficacy of treatment
• Track significant changes to cognitive performance

Measure markers of ADHD with confidence and distinguish comorbidities in the Creyos Health platform

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Changing The Narrative On ADHD Care

The negative effects of ADHD stigma are far-reaching—and can be especially detrimental when they interfere with the diagnosis and treatment of ADHD. Advances in medical knowledge and social awareness of ADHD have certainly improved, yet many people still face negative perceptions and multiple forms of stigma.

Health professionals play an important role in challenging misconceptions and negative biases about ADHD. Providing educational resources, being careful not to reinforce stereotypes, and using objective data to accurately measure ADHD biomarkers are just a few impactful ways healthcare professionals can reduce stigma and support patients in getting the appropriate diagnosis and treatment they need for optimal wellbeing.