522513

research-article2014
JADXXX10.1177/1087054714522513Journal of Attention DisordersJones and Hesse

Article
Journal of Attention Disorders

Adolescents With ADHD: Experiences

2018, Vol. 22(1) 92­–102
© The Author(s) 2014
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DOI: 10.1177/1087054714522513
https://doi.org/10.1177/1087054714522513

Negotiations of Self-Image and Identity journals.sagepub.com/home/jad

Sheila Jones1 and Morten Hesse1

Abstract
Objective: To develop an understanding of the meanings and consequences of a diagnosis of ADHD for young people
during the transition from childhood to adolescence. Method: Nine youth with an ADHD diagnosis were interviewed
using a semi-structured interview guide on topics of management of identity and their own experiences of their difficulties
relating to ADHD. Results: The meanings and consequences of the ADHD diagnosis is best understood in terms of
overall identity development and social connectedness. In addition, cultural understandings of what ADHD is play a major
role in negotiating the role of ADHD in identity. Conclusion: Youth with ADHD moving from childhood to adulthood
need support for identity development. Health care professionals should be aware of young people’s experiences of
ADHD symptoms in the context of their life situations and the cultural understanding of ADHD during treatment and
psychoeducation. (J. of Att. Dis. 2018; 22(1) 92-102)

Keywords
ADHD, adolescent ADHD, age, coping, culture

Introduction in schools (Graham, 2006), in part from problems within

families that dealt with disruptive children (Bussing,
Ask not what kind of illness the patient has, ask what kind of Schoenberg, Rogers, Zima, & Angus, 1998), and in part
patient has the illness. from discoveries in medicine (Bradley, 1937; Conrad,
—Attributed to Dr. William Osler
1975). For families and patients, an ADHD diagnosis offers
access to mental health services and may provide a possible
explanation for the difficulties a person has been experienc-
What does it entail for a young person to live with a diagno-
ing most of their lives. ADHD is conceived as a brain dys-
sis of ADHD? Children tend to initiate treatment based on
function (Barkley, 1997), and as such places the problems
their parents’ preferences (Fiks, Mayne, DeBartolo, Power,
within the body of a particular individual.
& Guevara, 2013), but then discontinue treatment as they
The contemporary medical view places the brain as the
reach adolescence (McCarthy et al., 2012; Zetterqvist,
center in which all human behavior and affect are produced
Asherson, Halldner, Langstrom, & Larsson, 2013). This
(Frattaroli, 2001). In that sense, the brain, and by extension
suggests that important changes in the perceived need for
the mind, becomes closely tied to self-image and thus to a
treatment occur during the transition from childhood to
person’s personality. By being conceived as a brain dys-
adulthood (Zetterqvist et al., 2013). However, it is possible
function, ADHD becomes an understanding that is applied
that these changes are associated not only with a changed
not only to the difficulties of inattention, hyperactivity, and
perception of the medication, but also with the diagnosis or
impulsivity, but also in some sense to the person as a whole,
condition itself. But what can these changes be and how do
to their self-image, and to their identity.
they relate to the general developmental tasks associated
with becoming an adult? And how do they relate to broader
cultural developments?
The criteria for ADHD describe problems with inatten- 1
Aarhus University, Copenhagen, Denmark
tion, impulsivity, and hyperactivity to a degree where they
Corresponding Author:
become problematic for the individual (Barkley, 2010). For Morten Hesse, Aarhus University, Artillerivej 90, 2nd, Copenhagen,
society, ADHD represents a challenge in schooling young 2300, Denmark.
children, and the diagnosis has grown in part from problems Email: mh@crf.au.dk
Jones and Hesse 93
In that way, ADHD can be regarded as what Clarke,
Shim, Mamo, Fosket, and Fishman (2003) call a technosci-
entific identity, that is, an identity that is produced through
the application of sciences and technologies to our bodies.
Technoscientific identities are by definition identities that
are inscribed upon individuals. When young persons are
referred to a doctor and diagnosed with a disorder, they
have to relate themselves to the diagnosis, that is, an exter-
nally applied category and somehow come to terms with
being placed in this category. As such these individuals
have to be able to act and define themselves within a system
or structure that categorizes them as individuals who lack
certain abilities that are thought to be common for all nor-
mal human beings and as individuals who in certain ways
are handicapped or flawed in their very constitution.
Elaborating on Clarke’s theory by incorporating Charmaz’
(1995) theory of illness identities, Sulik (2011) describes
how a technoscientific illness identity can work to increase
a sense of control over experienced illness by applying bio-
medical information and characteristics directly to the per-
son’s sense of self and thereby encourage the person to
become the classification, for example, become a “hyperac-
tive child” or an “autistic child.” This entails that parts of
their self-image is not created through self-reflections about
their differentness compared with others, but on an exter-
nally applied definition on this differentness. Becoming a
classification does not happen in the instance one is classi-
fied as belonging to a certain diagnostic category. A person
has to somehow be able to recognize himself or herself in
the description offered by the diagnostic category and
accept belonging to this category, as well as potentially
make identity trade-offs, as they adapt to the limitations
incurred by the disorder (Charmaz, 1995).
Most people who receive an ADHD diagnosis are diag-
nosed as children or adolescents (DeNisco, Tiago, & Kravitz,
2005). Adolescence is a period in life where the foundation
of an identity is formed. The process of identity formation
involves the adolescents questioning who they are, who they
want to become, and where they fit into society (Erikson,
1968). In that sense, identity can be understood as the story
one has to tell of oneself; the story of one’s past experiences,
one’s present now, and the future one imagines for oneself
(McLean & Pasupathi, 2010). The opportunities or lack
thereof, with regards to education, social relationships, and
so on, can to some degree limit the individual’s possible
identity (Anderson & Mott, 1998) in the sense that identity
formation is dependent on cultural, social, and environmen-
tal structures. In this regard, the adolescent has to cope with
the societal expectations with regards to social and academic
functioning to form an acceptable social identity.
Identity also involves self-image, that is, the way that an
individual sees himself or herself. Since the early days of
modern psychology, the interactive nature of self-image and
self-worth has been a central focus (Cooley, 1902; Mead,
1934). While this view has developed in many ways, a cen-
tral tenet of our understanding of identity and self-image
remains that they develop through interactions with and
relations to others (Hollway, 2010).
A qualitative study on the experience of receiving an
ADHD diagnosis by Young, Bramhan, Gray, and Rose
(2008) described how individuals who had been diagnosed
with ADHD in adulthood went through a six-stage process
before reaching an acceptance of having ADHD: (a) relief
and elation, (b) confusion and emotional turmoil, (c) anger,
(d) sadness and grief, (e) anxiety, and (f) accommodation
and acceptance.
However, understanding how these processes interact
with the personal and contextual situation of the individual
is important. Nobody arrives at a diagnosis of ADHD with-
out a personal history, a self-narrative and real-life experi-
ence. These real-life experiences will invariably include
experiences of social relations to family members, peers
and teachers, and experiences with one’s own ability to con-
trol one’s life circumstances. At the same time, a person
receiving a diagnosis of ADHD has a lay understanding of
what ADHD entails. Although ADHD is in fact a disorder
with a very heterogeneous expression and as such com-
prises three different subtypes, the main cultural image of
ADHD relates to the hyperactivity dimension of the disor-
der, and unfortunately, has been presented mainly in the
media as relating to deviant and unruly children (Horton-
Salway, 2011; Schmitz, Filippone, & Edelman, 2003).
The common representation of children with ADHD most
often involves a description of socially inappropriate behav-
iors, and it is mostly the combined or hyperactive types that
are presented in the media, while the core symptom of inat-
tention and the inattentive subtype are neglected (Horton-
Salway, 2011; Schmitz et al., 2003). Therefore, by being
diagnosed with ADHD, the child or the adolescent may per-
ceive themselves as becoming a member of a group that has
a devalued status in society. Therefore, the addition of an
ADHD diagnosis might for some be viewed as an application
of a stigma (Goffman, 1974). As our self-esteem is to some
degree dependent on the status of the groups we belong to,
being diagnosed with ADHD might have a negative impact
on the self-esteem of adolescents categorized as such, as
identification with in-groups has been shown to affect self-
esteem (Dietz-Uhler & Murrell, 1998). However, the impact
on self-esteem might be modulated if the individual is able to
change their perceptions of the group (Tajfel, 1981).
Narrative identity development concerns the way in
which adolescents integrate their past and present and artic-
ulate and anticipate their futures (McLean & Pasupathi,
2010). At the same time, life narratives speak to the organi-
zation and structure of lives while explicitly addressing
issues of context (McAdams, 1993). The questions of where
we have been, where we are going, and how these are con-
nected are answered in narratives, and these are well-suited
94 Journal of Attention Disorders 22(1)
for understanding the dynamic interplay and processes
within the individual and between the individual and his or
her micro- (e.g., family) and macro-environment (e.g., cul-
ture). Narratives of successes or failures, of loving or lack
of love, of fitting in or falling out of social contexts, play a
central role in how individuals cope with the diagnosis, and
may shape how and why the diagnosis is rejected or accom-
modated into self-image and self-worth.
The aim of this study was to investigate ways in which
adolescents relate to the externally applied category of
ADHD and how they negotiate their identity and self-image
in relation to being placed in this category using a case series
based on qualitative interviews. The aim was not to identify
common or general trends, but rather ways in which young
people could relate to themselves and their diagnoses. To
achieve these aims, in-depth analysis of a small number of
cases can provide the necessary personal and social context
to describe ways of handling identity tasks (Dreier, 2009).
Method
Exclusion and Inclusion Criteria
Inclusion criteria for the study were being between the age
of 15 and 21 and reporting a diagnosis of ADHD given by a
doctor (in practice, a psychiatrist or neurologist, see below).
In addition, informants or their parents had to give consent
to the study. The only exclusion criterion was having a his-
tory of drug use.
The decision was made to exclude adolescents with illicit
drug use from the study because the comorbidity between
ADHD and substance use disorder carries with it increased
levels of other psychiatric disorders, such as mood and anxi-
ety disorders (Wilens, 2004) and conduct disorder (Lee,
Humphreys, Flory, Liu, & Glass, 2011), which might have
complicated any analysis on the effects of ADHD on identity
development. As no diagnostic assessment was made during
the interview, the validity of the participants’ ADHD diagno-
sis rested in part on self-report, and in part on their recount-
ing of the diagnostic process leading up to them receiving
the ADHD diagnosis in the interviews. All participants had
gone through extensive psychiatric assessment prior to being
diagnosed with ADHD. According to Danish medical regu-
lations, only psychiatrists or neurologists can initiate phar-
macotherapy for ADHD, and diagnoses are given according
to the International Classification of Diseases, 10th revision
(World Health Organization, 1992).
Procedures
For the study, youth with ADHD was recruited through two
sources. The initial approach was to recruit volunteers
through the Danish ADHD Association who were kind
enough to bring an advertisement in their newsletter calling
for participants with ADHD for the study. Inclusion criteria
included age (15-21 years) and no experience with illicit
drugs. Six individuals (five females, one male) with ADHD
were included in the study from this source. To bring up the
number of participants, youth with ADHD (15-18 years and
no experience with illicit drugs) were identified through
self-reported ADHD diagnosis in the first part of an ongo-
ing survey in four municipalities in Denmark with 1,975
participants by Donbaek, Elklit, & Pedersen (2014) and
contacted by the first author. In the survey, individuals were
asked if they had ever been diagnosed with ADHD by a
medical doctor, and respondents were asked if they were
willing to be contacted for further follow-up. Three indi-
viduals with ADHD were included from this source (two
females, one male).
Sample
The nine participants in the study were seven girls and two
boys in the age of 15 to 21 years. By their own account, five
of the participants (all female) did not have any learning
disabilities, whereas the remaining four either had had, or
were still struggling with learning difficulties when they
were interviewed. Age of initial diagnosis varied from 6 to
16 years. Therefore, some of the participants had become
accustomed to their diagnosis, whereas others were still
finding themselves in relation to the diagnosis. Four of the
participants (all female) had initially gone through psychi-
atric evaluation because of depression, whereas the remain-
ing had been evaluated because of their difficulties in school
or because of disruptive behavior. Only two of the partici-
pants were classified as ADHD-combined (both boys),
whereas the remaining were classified as ADHD-inattentive
or attention deficit disorder (ADD). Six of the participants
did not experience difficulties in social functioning, that is,
they had many friends and a well-functioning social life,
whereas three by their own account experienced severe dif-
ficulties in social functioning. They were all currently
working on getting an education by attending either board-
ing school or high school and one was training to become a
blacksmith. Six of the participants were on different forms
of medication for ADHD, whereas the remaining three had
either stopped taking the medication or had declined to take
them altogether.
No individuals that we contacted were unwilling to be
interviewed.
Interview schedule. To gain insight into the experience of
receiving and living with an ADHD diagnosis, a semi-struc-
tured interview guide was constructed concerned with over-
all questions of family relations, friendships, school
experiences, stigmatization, and their own perception of both
the ADHD diagnosis and their experiences with the difficul-
ties associated with the disorder. To aid the conversation,
Jones and Hesse 95
three visual diagrams were constructed. One containing two
photos of a mother with characteristics illustrating dimen-
sions of loving/caring versus harshness, and a similar dia-
gram with a father. Another was for friends, with four photos
illustrating obedient versus disobedient and insiders versus
outsiders. Using a semi-structured interview guide allowed
for the participants to elaborate on the subjects and for the
interviewer to encourage elaboration on the topics. For the
most part, the interviews took place in the participants’ homes
and two took place at the Center for Drug and Alcohol
Research. The interviews lasted between 30 and 75 min. The
interview guide and graphical materials are found in Supple-
ments 1 to 4.
Data analysis.  The study applied a narrative psychological
approach to the analysis. This approach was chosen because
of its ability to let us explore and attempt to understand the
inner lives of individuals through the stories they tell and
the way they create meaning of the events in their lives
(Lieblich, Tuval-Mashiach, & Zilber, 1998). Different indi-
viduals attach different values to the experiences and events
in their lives, such as being diagnosed with ADHD, and the
influence of their pre-existing experiences will affect the
degree to which being diagnosed with ADHD will affect
their identities and their self-images. Narrative analysis lets
us get a picture of their identities and their self-images and
the modulations of these as a consequence of having an
ADHD diagnosis through the stories they tell and the value
they attach to their problems as relating to ADHD. It also
allows us to get an account of the ways in which their sto-
ries, and as such their identities and self-images, get recon-
structed following being diagnosed with ADHD.
The interviews were not constructed in a way that opened
up for a life-story analysis; however, following Lieblich
et al. (1998), a categorical-content perspective was applied
to the data. All interviews were transcribed, and the analysis
began by a detailed examination of the transcripts, reading
and re-reading each interview. Using a deductive technique,
each interview was coded for overall themes of self-image,
any statements regarding how they perceived themselves;
self-worth, any statements regarding how they valued them-
selves; self-stigma, statements concerning their own ideas
of how others perceived persons with ADHD and how they
themselves perceived individuals with ADHD in general;
and last, any statements on the process they went through
after receiving a diagnosis of ADHD.
Results and Discussion
The analysis revealed four overall narratives: becoming or
remaining different, resigning to the difficulties including the
diagnosis, narratives of a new understanding and problematic
symptoms versus valued traits. All of these narratives involved
thinking about past and present experiences in terms of social
relationships, self-image, and acceptance. Some would rein-
terpret their past experiences in light of the diagnosis, and for
some the diagnosis would simply become part of their pre-
existing self-understanding.
Becoming or Remaining Different
A central theme across interviews was negotiating normality
and abnormality in relation to the self and others. Feelings of
being abnormal or different from others is a theme that has
been previously described in qualitative research on children
and youth with ADHD (Kendall, Hatton, Beckett, & Leo,
2003; Meaux, Green, & Broussard, 2009). Several of the
interviewees in this study described a feeling of not being
normal, not being like their peers. They often felt they lacked
social skills with regards to appropriate behavior and verbal
expression in social settings, such as schools. These narra-
tives of being abnormal were not linked to them belonging
to the diagnostic category of ADHD per se, but rather to
their experiences of standing out and of social exclusion and
failure in connecting to others. Also, the failure to fit in was
often described as dating back before the diagnosis. Being
diagnosed with ADHD, however, provided some with an
explanation for or an understanding of these social difficul-
ties, whereas others saw it as a cementation of them not
being normal. The analysis will start with the stories of two
girls who were both diagnosed in their adolescence. Being
diagnosed in adolescence rather than in early childhood
called for a reassessment of both their past experiences and
their self-image in the light of the new understanding that the
diagnosis of ADHD offered. However, whether or not this
new understanding was received as a welcome gift was
affected by the views the girls held on the ADHD diagnosis
and the image they had of themselves. For Louise in the
quote below, the label of ADHD seemed to further increase
her feeling of not being normal. She had experienced being
diagnosed with ADHD like being labeled as “a weirdo.” The
weirdo label was an internalized ADHD stereotype of hers.
I just think they would label me as a weirdo as soon as I told
them “I have ADHD.” Ok, what’s that? Weirdo! . . . I remember,
before I was diagnosed, I was down at the [youth] club and
there was this person called J. They kept calling her DAMP
[dysfunction in attention, motor and perception, a diagnosis
that was earlier used to describe a syndrome similar to ADHD,
SJ] child and I remember I just looked oddly at her every time
she came around, because she walked oddly, talked oddly,
behaved oddly, did odd things. She was just odd. We used to
have a tree outside, one time she just stood out there and threw
. . . a teddy up in the tree, it got stuck and she climbed up to get
it. And I thought “Ok, weirdo!” But then when I was diagnosed
myself I didn’t want anyone to know because . . . what if they
thought the same about me. (Louise, 20)
96 Journal of Attention Disorders 22(1)
For Louise, the image of the “odd girl” was linked to the
ADHD diagnosis and as such to an idiosyncratic stereotypi-
cal representation. Studies have shown that individuals who
believe more strongly that they fit the prototype of a group
are more reliant on the status of the group with regards to
their self-esteem (Badea, Jetten, Iyer, & Er-Rafiy, 2011) and
as she believed and had been told that she herself had a
tendency to behave oddly, and thereby resemble her proto-
typical representation of individuals with ADHD, to dis-
avow the diagnosis might have acted as a buffer against the
negative emotions that the perceived discrimination or
devaluation that went along with the diagnosis could have
inflicted. She therefore attempted to ignore that she had this
diagnosis and was very reluctant to embrace or investigate
the understanding of her problems as relating to an ADHD
diagnosis, as it somehow increased her feeling of being dif-
ferent. So for Louise, it was not just a matter of receiving a
label of ADHD imposed on her from outside forces, it was
her own ideas about how individuals with ADHD behave
and her own sense of being different and odd that hit a vul-
nerable place in her and made her reject the diagnosis and
refuse to learn more about it. For others, the diagnosis of
ADHD provided them with an acceptance or understanding
of their own differentness and a background from which to
work on improving on the skills they felt they lacked.
Veronica, a gifted student who described herself as “the
crooked piece of the puzzle” and who by her own account
had severe difficulties in social relations and had no friends
in school, took a hands-on approach to the difficulties she
experienced. The possible explanation that an ADHD diag-
nosis carried with it was welcomed as a place of departure
for her to come to terms with her loneliness and to place the
blame for her inability to establish social relationships out-
side herself.
In connection with me getting the diagnosis a lot of thoughts
about it emerged of course. Thoughts like “Am I really that
strange” and such. But as it has settled and as I have thought
about it, it has been an explanation for why I have had these
problems. The problems that I have, I of course have to erase
them or fix them, I need to find a way to start structuring, I
have to find ways to talk to people, become more secure about
how you act and become more used to being around people,
because I’ve been a little bit isolated the last couple of years.
(Veronica, 17)
So, although not always being successful, she attempted
to adapt to having ADHD by restructuring her life, for
example, using her mobile phone to help her bring some
structure to her everyday life and being open with others
about having ADHD in the hope, that they would get an
understanding of why she did not interact with them in a
way that conveyed that she was actually interested in mak-
ing friends.
The personal situation of the two girls differed in that
prior to being given a diagnosis of ADHD, Veronica had
tried to accept her inability to make friends in school by
staging herself as someone who did not want to belong in
the class, describing her classmates as bullies, and in this
way, reframe her perceived inability to be accepted as part
of the group as a personal choice. Louise, however, had
tried to be accepted and had experienced being ostracized
for her attempts. So the personal situation with regards to
social functioning and the image they had of themselves in
relation to their peers had an impact on the reception of the
ADHD diagnosis for these girls.
Resignation. While some ignored or adapted to having an
ADHD diagnosis, yet others resigned to the diagnosis, in
the sense that it would come to both encompass their self-
image and render them incapacitated with regards to mani-
fest other parts of their selves that was not affected by the
diagnosis. Christian, a young man who had been diagnosed
in early childhood and who was working toward becoming
a blacksmith, spent most of his free time playing online
computer games. In elementary school, he reported that he
would spend around 12 hr every day playing computer
games, and currently he had reduced the time to around 5 to
6 hr per day. He had few face-to-face contacts, and was very
shy about participating in the interview. In addition, he
described that he felt physical discomfort in the presence of
others, even people he had known for several years.
When asked, he described ADHD as a visible flaw that
he had, “I immediately think that others can see, that I have
ADHD. And then I immediately think that they won’t like
me.” At the same time as viewing ADHD as a flaw and
experiencing negative emotions as result of that, he viewed
all others with ADHD as his friends by definition. This all-
inclusive stance toward others with ADHD indicates a
strong sense of membership to the group of people who
have ADHD and that his self-image was tied up in having
ADHD making it the filter through which he interpreted his
experiences.
When I was in elementary school I thought they didn’t like me
because I had ADHD. But it could of course have been because
of other things.
Having experienced both ostracism and setbacks in edu-
cation, Christian was struggling to define himself. Defining
ADHD as his in-group, he was able to identify himself
socially with other young people. At the same time, he
described ADHD as a flaw, and as the factor that kept him
from moving forward in society. Christian’s perspective
may be indicative of a gendered view of ADHD, where the
externalizing behavior associated with the ADHD stereo-
type may be easier for a boy than a girl to accommodate.
Jones and Hesse 97
Christian’s responses contained little or poorly con-
ceived social reflection and self-reflection. His explana-
tions for his own successes and failures were vaguely
termed, and he could be said to be consistently hypomental-
izing (Frith, 2004). That is, he would form only very vague
ideas about the thought processes of others, such as why
someone would reject him, or what kind of qualities he or
others could possess that would make them good matches
for friendship.
Interpersonal relations are a fundamental aspect of life
that affects a person’s overall well-being and self-worth
(Brown & Lohr, 1987), although a new understanding for
the difficulties in social relations was offered by the diag-
nosis, how a person reacts to this and the degree to which
they are able to reframe their self-image in relation to
social functioning seems to be affected again by how one
views the diagnosis or those affected by an ADHD diagno-
sis, but equally importantly by the personal context and the
individual resources of the young person. In these inter-
views, having difficulties with learning, as many of the
participants by their own account did, might not affect self-
worth in the same degree as not being able to create lasting
and meaningful relationships, as the drive to create these
relationships might be more inherent (Baumeister & Leary,
1995).
A new understanding. Most of the participants who were
diagnosed in adolescence had felt a sense of relief. How-
ever, just as Young et al. (2008) found in their study, several
of the youth in this study expressed that this initial relief
was followed by anger toward professionals by whom they
had felt misunderstood. Nevertheless, being able to create a
new story incorporating the ADHD explanation for their
difficulties was welcomed and several of the participants
expressed that they wished they had known that their diffi-
culties were caused by ADHD earlier, as they believed it
could have shielded them from a lot of the let downs they
had experienced and the frustration they had felt from their
parents and their surroundings.
In these instances, the application of the ADHD diagno-
sis enabled the adolescents to get a new understanding of
why they had behaved the way they did and enabled them to
place the blame for this as relating to problems associated
with ADHD rather than aspects of their selves. At the same
time, as the diagnosis gave both them and their parents a
better understanding of their problems, they still struggled
with the inability of others to understand or accept that the
problems they had were real, often feeling that others under-
estimated their difficulties.
A 19-year old girl described how her own understanding
developed after learning about ADHD:
I didn’t really understand why I felt so different compared to
others, I didn’t understand why I needed five hours to pull
myself together and never really was able to concentrate . . .
then I started to read a lot about it and then I thought, you
know, it was almost like an epiphany to find out that there
actually is an explanation for all of these things. I had always
thought that everybody feels like that. But then I found out, not
everybody does. (Cecilie, 19)
Some of the participants described how they would keep
the extent to which they were sad and unhappy secret from
their families because they did not want to be a burden on
them. For some, then, the application of an ADHD diagno-
sis may have affected both their self-identity and their self-
worth positively, because it filled a blank spot in their
self-understanding. Experiencing that the problems they
had dealt with all of their lives had been recognized in the
literature and by mental health professionals relieved them
in some way of an experience of suffering in solitude and
enabled them to open up to their friends and relatives.
Somehow it is really nice to know that it is not something that
is only me and it is not something that makes me a mental
monster or something like that. That there actually is like a
word, that others have it too, somehow that helped a lot.
(Veronica, 17)
Another girl described how knowing about ADHD could
have been helpful for herself and her mother when she was
growing up:
There are a lot of things I remember from my childhood where
I’m thinking; it would actually have been very nice to have had
this diagnosis from the beginning. Because my mother was
insanely hot-tempered when I was younger. And I understand,
because I forgot everything and you know, just threw my stuff
around, it would take me 20 years to get out the door in the
morning and I just remember her standing and yelling at me.
(Marie)
Thus, as Marie sees it, the diagnosis would have given
her mother an understanding of her that would have helped
her cope with having a daughter who seemed unable or
unwilling to pull herself together. The theme of being
understood, seen, and treated as a person with a disability
was recurrent in relation to the value of being knowledge-
able about ADHD. For many informants, it was even impor-
tant to defend their diagnosis against doubts raised by peers
or adults.
For instance, one informant described how others’ ques-
tion the validity of her diagnosis:
There are a lot of people who don’t really believe it and they
think; “Well, I have those problems too and I also have
problems concentrating” and stuff like that. (Cecilie, 19)
Another described how she was not getting the help she
was entitled to.
98 Journal of Attention Disorders 22(1)
I have experienced many times that people don’t understand.
Because in many ways I seem to be well-functioning . . . For
instance in my new school, you can apply for extra hours with
the educational board and stuff, right. And I have been granted
an extra three hours per week but on average I get less than one
hour per week, they haven’t been very good at understanding
me in that regard. (Clara, 18)
ADHD is an invisible disorder, in the sense that indi-
viduals who do not present with symptoms visible to the
eye will appear normal to others. Many of the participants
in this study described themselves as well-functioning in
many of the areas often disturbed in individuals with
ADHD, and struggling mainly with attention problems. As
a consequence of appearing normal to others, they expressed
often feeling challenged by the lack of understanding by the
people in their lives. This lack of understanding both cre-
ated an obstacle for some of the participants, as well as
making them feel responsible for their shortcomings. “It
always ends in some kind of argument or something like
that. I am extremely lazy” (Martin, 17); “I think she is get-
ting a little sick of it; that I am not on top of things . . . I try,
I really do” (Marie, 18).
Despite initial disbelief, most of the participants eventu-
ally accepted and even embraced the ADHD diagnosis as
being the filter through which they understood the problems
they had experienced. As Veronica metaphorically explained:
In the beginning it was really, really hard for me because it was
the opposite of everything I perceived myself as being . . . you
go there and you get this problem-child diagnosis. It was a total
departure, my self-image was pulled up by the roots because I
got this diagnosis, but I had just been replanted. (Veronica, 17)
For most of the participants in this study, who received
an ADHD diagnosis in early adolescence instead of in
their childhood, the initial process stage was shock and
disbelief, as they did not recognize themselves in the gen-
eral cultural image of children with ADHD. However,
after having read about the nature of ADHD, most found
the descriptions of common symptoms associated with the
disorder to mirror their experiences, and this recognition
initiated a process of integrating this new understanding of
their difficulties with their past experiences and creating a
new story to be told, and in that sense, they formed a new
identity which incorporated the ADHD diagnosis as part
of their constitution and as explaining the parts of their
behavior that had made their life troublesome at times.
Those, for whom the ADHD diagnosis was eventually
welcomed as an explanation of their difficulties, it had a
positive impact on the way they felt about themselves and
their shortcomings. Knowing that they were not alone
with these difficulties and that these difficulties had been
recognized and described in the literature made them more
legit somehow.
Problematic symptoms versus valued traits. The diagnostic
concept of ADHD views hyperactivity and impulsivity as
symptoms that produce problems for people. However, a
high level of physical and mental activity and impulsivity
may not always equal trouble. This is likely to vary both
across individuals and over time within individuals. Some
of our informants were able to give clear descriptions of
how their “symptoms” in fact helped them function or
improved their quality of life. They did not have the same
conceptualization of the two symptoms and viewed them as
inherent traits rather than symptoms of a disorder. In that
way, what might be understood as problematic for schools
and families may be valued by the person. Veronica
describes how she declined taking medication, as it put a
break on her usual thought pattern:
I have some medication that I am supposed to take, but I have
chosen not to. Because I don’t like the effect it has on me. I
don’t like that it stops the brain completely, that’s really scary
. . . Instead of one thought I have four thoughts that run
simultaneously which communicate with each other and do
things together. [They] are still a part of me, still my thoughts.
Somehow I have been able to do something constructive with
them, in the sense that they help me. For instance, I am very
fast when it comes to solving mathematical problems . . . and
when I take medication I feel like I only have one thought and
then my head is totally quiet.
So while clinicians, teachers, and parents might view the
excessive amount of thoughts Veronica experienced as a
symptom and sign of mental hyperactivity, she herself val-
ued these both as a means for her to complete assignments
faster and as an inherent part of who she was.
Another informant viewed her impulsivity as a personal
trait that she valued positively:
I also sometimes think it’s a good idea to be impulsive, but
also, that I think differently . . . well, I think since your
thoughts are all over the place all the time, you get a lot of
input . . . I also think there are a lot of good things about it. I
like the impulsiveness, without it being too much, I like that
part. I think that’s very much “me.” So I think that’s positive.
(Cecilie, 19)
Cecilie appreciated that she was different in her thought
pattern, and she believed, and was told by others, that she
had a different focus or perspective on things, and she
believed this was because of her many thoughts. She found
herself to be able to both reflect on things and be impulsive
and “wild.” She liked that she was a bit loud at times instead
of being a quiet, timid girl. She was able to find the positive
aspects of her experiences and not just view them as prob-
lematic and symptomatic. Another girl described how oth-
ers would be surprised, that she had ADHD, because she did
not fit well with their ideas about ADHD having to do with
Jones and Hesse 99
unruly children (Marie). At the same time, she described
how she felt like she had an extra gear compared with her
friends that made her able to go out and have fun with them
without drinking alcohol. An ability her friends did not have
and that she found to be “quite cool.”
Note that these are not peripheral facets of ADHD that
could make up a “silver lining” for the condition. Instead,
the three women described how the most central features of
ADHD, hyperactivity presented as “many thoughts,” and
impulsiveness were beneficial to them and were linked to
what made them feel proud, and maintained their relatively
high self-esteem. The ability to view aspects of ADHD as
positive and as an integrated part of who one is, were also
found in children and youth with ADHD in studies by
Walker-Noack, Corkum, Elik, and Fearon (2013) and
Kendall et al. (2003). But as was evident in the accounts
given in the present study and in the study by Walker-
Noack et al. (2013), the negative aspects of having ADHD
greatly outnumbered the positive aspects. One could argue
that the tendency to apply negative characteristics to the
category of ADHD might be connected to the overall cul-
tural view discussed earlier. However, research suggests
that it is mainly the behaviors and to a much smaller degree
the diagnostic label that leads to rejection (Law, Sinclair, &
Fraser, 2007; Ohan, Visser, Moss, & Allen, 2013). Being
able to hold on to a positive view on characteristics of
ADHD might have helped these girls accept and adapt to
having ADHD.
How the young person functioned in terms of education,
how they managed school, and the view they had of them-
selves in relation to education shaped their interpretation of
what it meant when they were told that they had problems
with attention, hyperactivity, and impulsiveness. If they saw
themselves as highly successful and competent, the diagno-
sis would challenge their self-image, which represented a
threat that they might not continue to function well in the
future. Their ability to experience and handle emotions was
important for how they coped with this threat. Perhaps most
importantly, the young person’s view of themselves in rela-
tion to their friends and peers was extremely important with
regards to how they dealt with the stigma of the diagnosis
and with acknowledging that some of their problems related
to having ADHD.
In terms of other literature on reactions to receiving a
diagnosis of ADHD, we know only the study by Young and
colleagues (Young et al., 2008). Young et al. described a
six-stage process operating in individuals diagnosed with
ADHD in adulthood. Does a stage model describe the reac-
tions in these interviews well? The dynamics described by
Young et al. were indeed present in many of the interviews.
For instance, a sense of relief, acceptance, and anger over
not having been understood earlier, were all prominent in
these interviews as well as in the Young and colleagues
study (Young et al., 2008).
However, in other ways, the processes emerging in the
interviews with the informants in the present study differ
sharply from the view that coping with a diagnosis of
ADHD forms a progression through stages that is likely to
be similar across different individuals. What were much
more prominent in the present material, were the differ-
ences between the informants in terms of their life circum-
stances, self-image, and way of relating to others and how
these were related to their reactions of being in the diagnos-
tic category of ADHD.
The interviews were structured differently, and the aim
of our study was not to assess phases in acceptance.
Nevertheless, the differences were striking. Some of our
informants expressed intense self-doubt and continued to
question themselves.
Another reason why we might observe a different pro-
cess compared with Young et al. (2008), is that our infor-
mants were adolescents instead of adults. The adults in
Young’s study might have formed an identity around being
apparent failures, being initially relieved that their self-
image could be modified, and take away personal blame for
their shortcomings, whereas the participants in this study
were just embarking on the venture of forming an identity.
In addition, being adults at the time of being diagnosed with
ADHD, the patients in Young’s study are likely to have had
much more of a say in terms of whether or not they were to
be assessed for ADHD, whereas our informants were gener-
ally diagnosed on the initiative of their parents, and some
had even been diagnosed with ADHD for years and using
medication, before eventually being informed of the diag-
nosis for which they were taking the medicine. The process
of accommodating one’s self-image with a technoscientific
identity must be extremely different, depending on whether
the identity is imposed from the outside by parents or
schoolteachers or is a process initiated and regulated by the
patient.
Likewise, although having ADHD can be conceived as a
new situation for the informants in Young’s study, some of
our participants had been diagnosed in early childhood and
had somehow always had to relate to this fact, whereas for
others it was a recent discovery and a new situation.
Therefore, the participant’s stories in this study can be
regarded as narratives of accommodating to an ADHD
diagnosis at different stages of the process, which coupled
with the personal and emotional life of the participants pro-
duced very heterogeneous accounts.
Strengths and Limitations
There are several limitations to this study that limits gener-
alization to young people with ADHD based on the infor-
mation from the participants of the study. First, as most of
the participants were female, they might have had a greater
tendency to internalize insecurities stemming from their
100 Journal of Attention Disorders 22(1)
difficulties in social relations, which is evident in that about
half of the female group initially went through psychiatric
evaluations because of depression. This might have biased
the results regarding the direct effect of an ADHD diagnosis
on identity and self-image. Furthermore, because ADHD is
a disorder with three different subtypes, and the participants
in this study mainly manifested symptoms of inattention
rather than hyperactivity, the results of the analysis regard-
ing identity-work and self-image speak to a particular group
within the population of adolescents diagnosed with ADHD.
We did not confirm the diagnoses, or assess comorbidity.
However, the focus of the study was on individual patterns
of meaning relating to themes, rather than on describing
groups of patients with ADHD.
Being based on in-depth analysis of a small sample of
participants, the analysis was also limited in its ability to
compare groups (e.g., boys vs. girls, young people who
took medication vs. young people who did not, those with
learning disabilities vs. those without). Quantitative
research with large samples is generally more suitable for
this kind of analyses.
A further limitation is that both researchers were trained
as psychologists and may have focused more on psycho-
logical perspectives than perspectives that other profes-
sional groups would have done (e.g., sociologists or
anthropologists would possibly emphasize the significance
of the historical and cultural context more).
However, the study also had strengths. Compared with
previous qualitative work, the narrative approach allowed
us to take fuller advantage of the qualitative method. In par-
ticular, the narrative method allows us to focus more on
individual contexts and meanings that differ between indi-
viduals compared with theme-driven approaches (Kendall
et al., 2003; Meaux et al., 2009; Shattell, Bartlett, & Rowe,
2008). The themes in a narrative analysis are analyzed in
relation to their meaning for each individual respondent,
rather than in terms of their general place in the overall dis-
course among a group of individuals.
Conclusions
Becoming oneself with ADHD is a complex and multifac-
eted process. The narrative and ideographic approach used
in this study does not lend itself to simple conclusions.
What was evident in these interviews was that young peo-
ple’s pre-existing experiences and anxieties provided the
central framework for their accommodation or rejection of
the label of ADHD. Stereotypes of ADHD as a “problem
child” label or a “weird child” label shaped their reaction.
For those who were socially isolated and had few close
friends, the idea of being even more deviant produced pro-
found anxiety about never being able to fit in. For those
who were socially conforming, the idea of receiving a
“problem child” diagnosis led to a conflict.
The condition itself, ADHD, was not simply a mental
disorder for our informants. For some, it was the global
label of their shortcomings and loneliness, at times with an
unclear demarcation of what was the label and what was
their personal limitations. For others, it included traits that
improved their quality of life or their abilities in some way.
Psychiatric diagnostic categories, such as ADHD, can and
should be viewed as useful tools in aiding therapists, patients,
and families to acquire a general knowledge about the most
common symptoms associated with a condition and use this
coupled with knowledge of the individual in treatment and
everyday life. Unfortunately, there is always a risk that even-
tually, others will view people in terms of their diagnosis.
These analyses illustrate why it is important that a person
with ADHD is not seen as an inattentive or hyperactive child.
The person is a person with hopes, dreams, goals, experi-
ences, anxieties, and values. Recently, the Diagnostic and
Statistical Manual of Mental Disorders (5th ed.; DSM-5;
American Psychiatric Association, 2013) work group devel-
oped the Levels of Personality Functioning Scale (LPFS),
now included in the DSM-5 manual as an instrument for fur-
ther research (Bender, Morey, & Skodol, 2011; Morey et al.,
2011). The LPFS is an attempt to assess global functioning in
areas such as intimacy, empathy, identity, and self-directed-
ness. This attempt to return to a holistic view of personality
provides a perspective for the analyses presented here. The
ability to function in life across domains and maintain a sta-
ble self-image is the key to understanding how and why these
young people reacted to the diagnosis the way they did.
Acknowledgment
The authors would like to thank Birgitte Thylstrup for taking the
time out to read and give valuable comments on the final draft of
this article.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with
respect to the research, authorship, and/or publication of this
article.
Funding
The author(s) disclosed receipt of the following financial support
for the research, authorship, and/or publication of this article: The
first author, Sheila Jones, has received a scholarship from the
School of Business and Social Science at Aarhus University, a
government-funded university in Denmark.
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Author Biographies
Sheila Jones, cand. Psych, is a doctoral student at the centre for
Alcohol and Drug Research at Aarhus University. Her research
interests include ADHD and substance use disorders,
Morten Hesse, PhD, is an associate professor in the Centre for
Alcohol and Drug Research at Aarhus Univeristy. His research
and clinical interests include substance use disorders, and the
treatment and diagnosis of co-morbid personality disorders,
ADHD, anxiety and depression.