ADHD: Why We Do What We Do


Why We Forget Sometimes

For the ADDer, Information and memories that are out of sight are out of mind. Her mind is a computer in RAM, with no reliable access to information on the hard drive.

Working memory is the ability to have data available in one's mind, and to be able to manipulate that data to come up with an answer or a plan of action. The ADDer's mind is full of the minutiae of life ("Where are my keys?" "Where did I park the car?"), so there is little room left for new thoughts and memories. Something has to be discarded or forgotten to make room for new information. Often the information ADDers need is in their memory…somewhere. It is just not available on demand.

Why We Don't See Ourselves Clearly

People from the ADHD world have little self-awareness. While they can often read other people well, it is hard for the average ADDer to know, from moment to moment, how they themselves are doing, the effect they are having on others, and how they feel about it all. Neurotypicals misinterpret this as being callous, narcissistic, uncaring, or socially inept. Taken together, the ADDer's vulnerability to the negative feedback of others, and the lack of ability to observe oneself in the moment, make a witch's brew.

If a person cannot see what is going on in the moment, the feedback loop by which he learns is broken. If a person does not know what is wrong or in what particular way it is wrong, she doesn't know how to fix it. If ADDers don't know what they're doing right, they don't do more of it. They don't learn from experience.

The inability of the ADHD mind to discern how things are going has many implications:

> Many people with ADHD find that the feedback they get from other people is different from what they perceive. They find out, many times (and often too late), that the other people were right all along. It isn't until something goes wrong that they are able to see and understand what was obvious to everybody else. Then, they come to believe that they can't trust their own perceptions of what is going on. They lose self-confidence. Even if they argue it, many people with ADHD are never sure that they are right about anything.

> People with ADHD may not be able to recognize the benefits of medication, even when those benefits are obvious. If a patient sees neither the problems of ADHD nor the benefits of treatment, he finds no reason to continue treatment.

> ADDers often see themselves as misunderstood, unappreciated, and attacked for no reason. Alienation is a common theme. Many think that only another person with ADHD could possibly "get" them.

Why We're Time Challenged

Because ADDers don't have a reliable sense of time, everything happens right now or not at all. Along with the concept of ordination (what must be done first; what must come second) there must also be the concept of time. The thing at the top of the list must be done first, and there must be time left to do the entire task.

I made the observation that 85 percent of my ADHD patients do not wear or own a watch. More than half of those who wore a watch did not use it, but wore it as jewelry or to not hurt the feelings of the person who gave it to them. For ADDers, time is a meaningless abstraction. It seems important to other people, but ADDers have never gotten the hang of it.

WILLIAM DODSON, M.D., board-certified in psychiatry, specializes in treating adult ADHD in Greenwood Village, Colorado. This article is adapted from his forthcoming book, What You Wish Your Doctor Knew About ADHD.


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