Are People with ADHD Lazy?
The moral diagnosis of ADHD
Posted Apr 09, 2012
Ned Hallowell likes to talk about the "moral diagnosis" of ADHD—the idea that ADHD symptoms, such as difficulty completing tasks or having trouble sitting still, are really moral shortcomings. “If Johnny would just try harder…he has so much untapped potential…” is a common refrain heard by those with ADHD when they are growing up—implying that, unlike you and me, Johnny doesn’t care whether he succeeds or fails. Or that he is simply lazy. Or selfish. The "moral diagnosis" was what people used to turn to when they didn't know as much about ADHD as we do now—that it is biologically based, and not a matter of willpower.
Yet the idea that a person with ADHD is just being lazy is amazingly persistent. This doesn’t adequately acknowledge the significant amount of effort that they are often exerting. Their minds are working away, trying really hard to organize a boatload of undifferentiated information in their brains, even as they might seem "lazy" because they have trouble completing (and sometimes even starting!) tasks. But fMRI research conducted with children who have ADHD reinforces that “lazy” is simply an ADHD myth. In a presentation to the Society for Neuroscience, biologist Tudor Puiu suggested that in children with ADHD an important mental control area of the brain (the dorsal anterior cingulate cortex), works much harder and, perhaps, less efficiently than for those without ADHD. "These networks are disrupted. The ADHD brain has to work harder than the normal brain," he said.
ADHD adults can tell you they are working really hard to get mentally organized—expending tons of energy on it—yet are frustrated that they get consistent feedback from important people (teachers when younger, parents, spouses, friends) that they aren't working hard enough. This confuses hard work with results—and the two are sometimes strikingly disconnected for those with ADHD. One person I know described what it feels like to have ADHD as “having the Library of Congress in your head, but with no card catalogue.” Think about how hard it would be to get organized—a Herculean task! Dealing with this sort of mind 24/7 can lead to a sense of helplessness—a sort of "I'm dancing as fast as I can so please don't ask more of me" feeling. Sometimes that feeling is voiced (and often met with a disbelieving, "Then why aren't you doing better if you're trying so hard?" from a frustrated spouse or parent.) Sometimes the "I’m dancing as fast as I can" feeling is not voiced but simply leads to feelings of overwhelm or paralysis.
The idea that the brain is already working really hard already is also one reason why "trying harder" doesn't work as well with ADHD as "trying differently," i.e., in ways that work for those with ADHD brains. “Trying differently” usually includes creating external structures to support action and decision-making. Examples include setting audible alarms, creating master packing lists to help remember what you need, and using written decision-making charts to help keep the elements of potential decisions organized while you consider them.
It's important for non-ADHD partners and parents to understand the effort that ADHD folks are putting in. Among other things, it can lead to better empathy. In the best cases, this understanding helps a non-ADHD partner or parent move into the role of "understanding advocate" and away from "chief critic." (Example: When you know how long it takes to organize that “Library of Congress” brain it’s pretty easy to justify requesting extended time on tests in school rather than telling your child he has to do it like everyone else.) It's also good to remember that the extra effort it takes to organize the ADHD brain needs to be taken into account when you set your expectations, particularly around organizational tasks. Put into plain English, most folks with ADHD won't do the same things as quickly as their non-ADHD counterparts because it takes some extra steps inside the head. You don't see those steps, but they are there.
Of course, "my brain is already working really hard" isn't a reason for a person with ADHD to not seek to reach difficult goals or make changes. In other words, it should not become an excuse for inaction. Rather, it simply supports the "don't try harder, try differently" concept. Develop habits that are “ADHD-friendly,” remember to include extra time when scheduling, and pursue treatment that calms the mind and improves focus. ADHD people are far from lazy. Please don’t label them so.