Telling Your Family About ADHD: “We Didn't Have That Back Then”

Nearly everyone who shares an ADHD diagnosis hears this sentence from somewhere: "We didn't have such things in our day."

Sometimes at the dinner table, sometimes on a holiday visit, sometimes never said aloud at all, just with a raised eyebrow.

I was angry at this sentence for a long time. Then I began to listen a little more carefully. Because inside the sentence there is as much a correct observation as a wrong piece of information.

The side of the sentence that is right

Yes, in their day there was no word "ADHD." At least not in the sense it has today, in everyday language.

But the absence of the word does not mean that what it describes did not exist. A review examining the history of the ADHD concept shows that extremely restless, inattentive and impulsive children have been described in the medical literature since the 19th century, and that some of these early descriptions resemble today's definition quite closely (Lange et al., 2010). What changed is not the behavior but the name given to the behavior and the theory that explains it.

So those children existed back then too. They were simply called by other names: naughty, absent-minded, lazy, a daydreamer, "his head is somewhere else," "if he only worked a bit harder he would do so well."

A more accurate version of "we didn't have it in our day" might be: in our day it had no name.

The objection "but now everyone has it"

This is usually the second sentence. ADHD is talked about everywhere, social media is full of it, everyone is diagnosing themselves.

Here two separate things need to be told apart: how much ADHD is talked about, and the actual frequency of ADHD.

A meta-regression study that examined the prevalence of ADHD in children across a thirty-year period found no evidence of an increase in the number of children in the population meeting ADHD criteria when standard diagnostic methods were used. Differences between studies were largely explained by differences in method; the year in which a study was carried out was not related to prevalence (Polanczyk et al., 2014).

This finding is about the proportion of children in the population who meet the criteria; how many people are diagnosed or how many receive treatment is a separate question. In my view, most of what has increased today is how much it is talked about and noticed.

There is also the adult side. A representative survey conducted in the US found the prevalence of ADHD in adults to be 4.4 percent and showed that most of these people were not receiving treatment for ADHD (Kessler et al., 2006). So the number of adults living with ADHD without treatment is not small at all.

A review examining underdiagnosis in adults paints a similar picture: many adults remain undiagnosed and untreated, struggle in education and working life, and often come to the clinic with a complaint of co-occurring depression or anxiety, while ADHD may never come up (Ginsberg et al., 2014).

Reading this, the previous generation comes to my mind. The stories of some of the people described as "irritable," "disorganized," "always tired" or "unable to stay in one place" were perhaps stories of an ADHD that was never named. I cannot know this for certain and do not want to claim to know it on anyone's behalf. But saying "we didn't know" instead of "it didn't exist" seems to me both more accurate and more compassionate. The second sentence blames no one; it only accepts the limit of that time's knowledge.

Part of the feeling that "everyone has it now" comes from a crowd that went unseen for a long time beginning to become visible.

Why the family sometimes gets defensive

Here the emotional side of the matter comes into play more than the informational side.

The first reason is heredity. A review bringing together twin studies reports the heritability of ADHD at about 74 percent (Faraone and Larsson, 2019). This means ADHD clusters in families. While you describe your symptoms, the person facing you may hear themselves somewhere in it too. After "you were always like this" comes the question "am I too?", and that is not a comfortable question for everyone.

After the diagnosis I too looked at the family photographs with different eyes. My father, who looks for his keys every day. My aunt, who starts a new hobby and a few months later moves on to another. I am not diagnosing anyone; no such assessment was made in their childhood and I am not a specialist. But it is also hard not to see the trace of a pattern. I wrote in more detail about what heredity means in the article is ADHD hereditary.

The second reason is guilt. When a parent hears that their child grew up with a difficulty that went unseen for years, they may hear it as "you didn't notice." Yet the biggest reason it went unnoticed is the lack of knowledge of that time. Very few people in those years would have thought that a quiet child with decent grades who did not turn the classroom upside down could have ADHD.

The third reason is stigma. A review examining stigma around ADHD discusses how stigma affects the family and relatives of the person with ADHD too (Mueller et al., 2012). The reaction "this kind of thing doesn't happen in our family" sometimes comes exactly from here: from perceiving the diagnosis as a family shame.

Knowing these three reasons showed me this: the defensiveness in front of me is often not against me but an escape from a question directed at themselves.

A way I find worth trying when explaining

I covered the general decision of whom to tell, when and how much, in the article whom to tell about an ADHD diagnosis and when. Here I focus on the side particular to a family conversation.

Start with behavior, not the label

The sentence "I have ADHD" immediately opens an argument: do I, don't I, is it real, is it a trend. The sentence "I have trouble sensing time, so I am always late" leaves nothing to argue about. The person facing you has known that behavior for years anyway.

You can add the label afterward: "I learned that this has a name."

Say what you are asking for

Let there be a request at the end of the explanation. An explanation with no request is left hanging, and because the other side does not know what to do, they either dismiss it or worry too much.

• "If you also write the appointment time in a message, I won't forget."
• "When I'm late, don't read it as not caring; I'm setting an alarm on my phone."
• "I'm not asking you to fix anything, I just wanted you to know."

The last one is a request too. Sometimes what is wanted is just to be known.

Talk about the past without judging

The sentence "I wish you had noticed when I was a child" would be one that comes from within me but that closes the conversation when I say it. Saying this instead opens more room: "Back then nobody knew, and I didn't know either. Now we know."

The anger and grief after a diagnosis are real and legitimate. But a family conversation may not always be the right place to work through those feelings. I described that process separately in the article grief after diagnosis.

Do not expect to convince in a single conversation

People do not give up an explanation they have held for years in one evening. What the glossary calls reframing, that is, reading the same past through a new frame, is a process that takes time. It probably was that way for you too.

Thinking of the first conversation as a seed makes things easier for me. Say something short, leave a source, close the subject. A few weeks later a question may come on its own.

Do not diagnose anyone

One of the easiest traps to fall into when explaining to family is this: "I think you have it too." However well-meant this sentence is, it most often makes the defensiveness bigger. Tell your own experience; if the other side is going to see themselves there, let them see it on their own.

Prepare a short sentence. Before going into the conversation, write a three-sentence summary: what you noticed, that you learned it has a name, and your single request of them. When emotions rise, long explanations scatter; a ready sentence gives you something to hold on to where the conversation falls apart.

If you are never understood

This is a possibility too, and I do not want to pass over it without saying so. Some families do not accept. Some accept years later. Some never do.

Not being understood does not show that the diagnosis is wrong. The family's approval is not a precondition for arranging your own life. Giving up explaining is also an option; so is finding your own support outside the family, among friends, in reader communities or with a specialist. How to cope with the outside-facing side of stigma I discussed in the article stigma in ADHD.

When I hear this sentence today

When "we didn't have it in our day" is said, instead of getting into an argument I now think to myself: it existed. There were people who looked for their keys, who changed hobbies, who were called absent-minded.

It was just that nobody gave them an explanation.

Perhaps part of the point of having this conversation is this: so that the next generation does not recognize itself so late.

There is a diary entry about family warmth: Tarhana warmth.