ADHD Has These Three, Sometimes Clashing Definitions

Attention-deficit/hyperactivity disorder is commonly defined by difficulties maintaining attention or with goal-directed behavior. While ADHD is commonly recognized as a disability, new ideas have started to emerge as to the origins and the nature of ADHD. While they all have some merit, they come from inherently different places.

The Clinical Model

The clinical view sees ADHD as a condition to be treated. Clinicians aim to identify what is wrong so they can treat it as efficiently as possible. The clinical view relies on the DSM diagnostic criteria to evaluate patients' treatment needs. One of the diagnostic criteria is that ADHD must significantly impair life to be diagnosed.

This means that the clinical model inherently sees ADHD as a deficit, or a condition, because the way it approaches it is with a treatment in mind. This can create issues, though, where individuals who appear "functional" are missed and don't receive the help they need because of compensatory mechanisms. This is where research clashes with diagnosis.

The Biological Model

In the biological model, ADHD is seen as a bundle of behaviors and traits that co-occur. It studies the biological origin, the traits that emerge, and where these traits may differ significantly from the population. The biological model, however, has no particular classification of good, bad, or impairing on these traits; it merely studies whether some things are different, and why.

Similarly, the biological model studies which conditions or environments can affect traits, and how. For example, a study showing that individuals with a similar DRD4 mutation experienced different outcomes as a function of the sedentarity or mobility of their environment. The biological model introduces nuance, saying that the same set of traits may be advantageous in one environment and detrimental in another.

This is why we also see the emergence of studies showing that people with ADHD perform better at a virtual foraging task than people without ADHD. Or that individuals with ADHD concentrate better with music than without music. Finally, we also see studies showing the correlation of ADHD with other conditions such as c-PTSD, which introduces an additional level of complexity.

The goal of all of these studies is eventually to make treatment and detection better, but initially it's merely about trying to understand how ADHD brains work, and what level of complexity exists in the heterogeneity of this particular neurotype.

The Social Model

Finally, ADHD is also an identity that co-exists within a dynamic and complex society. An ADHD diagnosis gives access to medication through clinical assessments. But the social dimension of ADHD also comes with changes in identity, self-perception, community, adjustments, rights, etc.

The social dimension of ADHD seeks to define it not as a disability, but as a difference. It considers the stigma and discrimination that go with it, and the need to reframe certain challenges so they can be more accepted by society at large.

The social model often distances itself from the clinical definition, and many people, in fact, end up refusing to call ADHD a disability or prefer to rename it as a "superpower" in the right conditions.

The Intersection

None of these views is inherently wrong. The clinical model is essential to help people find treatment. The biological model offers nuance and understanding—but is also the most complex to approach. The social model considers the complexity of human societies that require the participation of individuals with ADHD, and tries to make that participation as painless as possible.

Many conflicts, however, arise between people from these three worlds, who each believe their view is the correct one. The thing is, all three views are correct, but they serve different purposes. Understanding the purpose of each view is key to better understanding ADHD in its entirety. It is a complex neurotype that can have disabling consequences that require treatment. Its origins are multiple, difficult to track, and traits may change as a function of interventions, environments, or habits. Its place in society is still ill-defined, but a new language around it is also necessary to avoid stigma and discrimination.

In the end, it's not about who is right, but about which model is serving you at one specific moment.

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