Diagnosis

Like many of us growing up in the 90s, I had a very specific vision of what ADHD looked like. To my knowledge, ADHD manifested as disruptive inattentiveness and hyperactivity: it was the little boy who couldn’t sit still, who misbehaved in class, and who couldn’t listen to directions.

I’ve since learned that ADHD has many other forms. It’s often sneaky, hiding behind high performers and people who simply couldn’t afford to fail. I’ll never forget that time in graduate school, when I was administering an ADHD diagnostic assessment to a college student. It was a simple test, where the client was supposed to hit a button every time one stimulus appeared, but not when another stimulus appeared. (For example: press the space bar when you see a letter, not a number). Typically, folks with ADHD really struggle with this task.

I was in the back room, watching the results come through on a little machine in real time. Their responses were remarkably accurate — even more so than we would expect from a neurotypical patient. Given this person’s self-reported concerns, it didn’t add up, and so I took a peek through the one-way mirror:

My client was sitting as close as possible to the computer, their nose just a few inches from the screen. They had one hand on the spacebar, and one shielding their vision like a horse-blinder. I have never seen someone so locked-in in my entire life.

I gave them a test, and they did everything in their power to pass it. If I had simply looked at the results, I’d have missed it. In my clinical opinion, their performance on that test didn’t negate my working diagnosis — it validated it.

When you look at diagnostic criteria for mental health disorders, it’s almost always accompanied by a requirement for “clinically significant impairment.” Essentially, if you’re still able to function well in society, it doesn’t meet the threshold. That’s not necessarily problematic for the diagnosis itself, but it is a problem when the diagnosis unlocks other things, like support services, or even just personal validation. Just because someone can muscle through their impairment doesn’t mean they wouldn’t benefit from support.

So often, we define the validity of our struggle by outcomes. We say, “Well, if you were able to achieve, you must be fine.”

Holy shit, is that misguided.

Clinical diagnosis alone isn’t meant to tell you how your brain works; it determines dysfunction in the context of broader society.

Let me say that again: Clinical diagnosis determines dysfunction in the context of broader society.

In my life, I have been diagnosed with ADHD, CPTSD, and a traumagenic disorder you don’t need to hear about. Today, right now, in this moment, I probably don’t meet the criteria for any of those things. I have created a life with structures built to keep these things in check. Yet all of those structures — they took effort, and they still do. And things get messy when they inevitably sometimes fall.

All of this to say: don’t define your struggle by your outcomes. Don’t rely on clinically determined language to define your reality. For the love of all things holy, please do not claim diagnoses that have not been given to you by a trained professional — but also, don’t assume that those things are necessary to validate your own experience of your own brain.