ADHD
by Kat Otey and Meara Fay
Although the symptoms that make up an ADHD (Attention Deficit Disorder) diagnosis were first compiled in 1908, ADHD and ADD (Attention Deficit Disorder) would not be formally recognized until 1987, when it was added to the third edition of the Diagnosis and Statistical Manual of Mental Disorders. With its addition to the most widely recognized catalog of symptoms and diagnoses, ADHD diagnosis and treatment has risen rapidly in the early 21st century.
“[ADHD] is hard to spot sometimes, especially in kids who are really smart. They kind of get away with doing the minimum when they’re younger, but when they get to middle school and high school where everything’s a lot harder, they can’t just get by,’” Redondo Beach Pediatric Neuropsychologist Lisa Waldman said.
ADHD symptoms often become more noticeable with age, especially as academics continue to get more rigorous. As of 2019, 13.2% of adolescents ages 12 to 17 were diagnosed with ADHD or ADD. It’s not uncommon for ADHD to go unnoticed or undiagnosed until teen years or later. For those with severe symptoms, however, the need for diagnosis can become apparent sooner. This was the case for junior Joey Mertz, who recalled their struggle with ADHD beginning in elementary school.
“It was just constantly like, ‘Stop talking, stop moving, sit in front of the class. You can’t talk to your friends, don’t do this, don’t do that.’ And because of that, I became fearful of the teachers and how they would react to me doing anything,” Mertz said. “I did have a lot of friends, but I was so hyperactive I was hard to be around and I felt so awful about that. I have to try so much harder than everyone else: to be friends, to work with my teachers, to understand what’s going on, to read social cues. And because no one in my life really knew that I had ADHD [nor] to the extremes that I did, no one understood what I was going through.”
When undiagnosed, ADHD can lead to academic and social struggles that have seemingly no explanation, which can lead to feelings of isolation and low self-esteem. ADHD can go undiagnosed long after “difficulties” have already arisen, Waldman notes.
“A lot of times parents bring their teenager in thinking ‘My teenager, maybe she has ADHD, we always thought she just didn’t want to do her homework.’ So by that time, a child with ADHD has already had a lot of school difficulties, or maybe their parents are on their case,” Waldman said. “They’ve already had all these difficulties that could have been [unnecessary] or totally avoided, making things a lot easier for them, if they’d had that diagnosis early and got the appropriate treatment and developed coping skills to deal with their struggles.”
This “appropriate treatment” most commonly takes the form of stimulant medication, which Mertz has been prescribed since their diagnosis and has significantly impacted their academic ability.
“If you could flunk out of middle school, I probably would have,” Mertz recalled. “I was getting straight F’s. And then, in eighth grade, I got the medication near the end of the year. Freshman year? Straight A’s.”
Although medications can’t “cure” ADHD, they can lessen its effects. Most commonly prescribed are stimulants such as methylphenidate and amphetamine, in the form of Vyvanse, Adderall, Ritalin, and other brands. These stimulants generally increase activity in the brain, specifically in areas that control attention or behavior. Almost two-thirds (62.0%) of children with ADHD in the US take medication, according to a parent-reported survey, making it the most common treatment for ADHD.
“I can’t function without [my medication]. I mean, I’ll get through the day, but I’m not going to be able to do anything. I’m not going to be able to do work, or talk to people, or keep up with friends because I’m gonna be too tired,” Mertz said, comparing the reactions to a domino effect: if one thing goes wrong, a “spiraling” reaction can follow. This is a common symptom of anxiety, which is also often exhibited in ADHD.
Although many struggle with anxiety or struggle to pay attention at some point in their lives, Waldman notes that it’s the “pattern and severity” of symptoms that draws diagnosis. Because ADHD can impact daily life, therapy and other forms of behavioral treatment can also be a useful tool for ADHD people. About half of individuals 2 to 17 with ADHD use some form of behavioral treatment, most commonly therapy. Therapy is a particularly common tool because ADHD is often linked to other disorders that affect behavior, such as depression, generalized anxiety, and autism spectrum disorder–64% of that same demographic report a confounding mental, emotional, or behavioral disorder alongside their ADHD.
“It is helpful to talk about [ADHD] with someone else who knows it,” sophomore Tristan Sword, who goes to therapy for his ADHD, said. “Because there’s a lot of false stereotypes around it. Like, ‘all people with ADHD are hyper.’ But there’s also ADD–ADHD, but without the hyperness–which my sister has.” This is not uncommon; ADHD is a genetic disorder.
According to Waldman, seeking help from adults and field professionals to decipher the root cause is the most important first step a teen suspecting ADHD could take.
“[Kids] should seek support by reaching out to adults at school and their parents. It’s important to try to get clarification to find out [if you have ADHD] because people can have attention problems for all different reasons. You could have a learning disability where reading is really hard, so of course it’s hard to pay attention because you don’t have great reading skills. You could also have attention problems if you’re anxious,” Waldman said.
Besides medication and therapy, students with ADHD diagnoses are legally entitled to 504 plans (per the Rehabilitation Act of 1973), which provides them with a variety of accommodations. Although they vary by student request and availability, accommodations for ADHD most commonly include extra time on exams and homework, preferential scheduling and seating.
“I have the ability to get notes earlier because when we do notes in class I can’t always focus on the notes and the writing, and we go so fast that I can’t get everything down,” Mertz said. “And last year, for the entire year, one of my teachers said no [to my accommodations]. At that point, my counselor didn’t know what to do, so I was sent to administration. I had to get a note to give to [my teacher] saying, legally, you have to let me do this–it’s not just like I’m asking. I think that people forget that a 504 is a legal document that says you have to [allow the accommodations]. It is illegal for [anyone] to deny me these things.”
With the combination of medication, therapy, and school accommodations, many students such as Sword are able to alleviate their ADHD symptoms and the distress they cause.
“I noticed [with medication] I have a more clear thought process–I can get from point A to B more clearly, which is definitely helpful. I can [better] articulate myself and my thoughts and act upon things more easily, so I can set goals and reach them more easily,” Sword said.
According to Waldman, a common misunderstanding about ADHD is its difference in presentation between adults, adolescents and young children.
“For ADHD, hyperactivity is more prevalent when kids are younger. For the [kids] who have hyperactivity, by the time they’re teenagers a lot of time it’s [somewhat] mellowed out,” Waldman said. “So, in high school, [ADHD manifests] more in the day to day organizing and getting stuff done. Their problems become more like executive functions–things like keeping track of their assignments, organizing, studying for tests and time management.”
Executive functioning, according to Merriam-Webster, is “the group of complex mental processes and cognitive abilities that control the skills (such as organizing tasks, remembering details, managing time, and solving problems) required for goal-directed behavior.” Executive function can be impaired by ADHD, making it a severe struggle for those suffering, including Mertz.
“There will be days where I physically cannot get up and make myself eat food, or I will literally forget because it’s not at the forefront of my mind since it doesn’t give me dopamine–I’m forgetting to do all these really essential things because I just can’t remember to do them,” Mertz said. “That affects school, but more so my personal life. My mom will ask me to put the dishes away, but I will get sucked into something and get so hyper-focused on one thing and completely forget. I feel horrible about it, because I truly didn’t mean to do that; I really did want to help you, I just couldn’t do it. Not even that I couldn’t, I just didn’t remember.”
Along with outside misconceptions of the disorder, oftentimes people close to those with ADHD aren’t fully aware of the disorder and its effects–including parents.
“A big misconception about ADHD in general is [parents] will say ‘My child can’t pay attention when they’re doing homework or in class, but they can build Legos for hours.’ The thing about ADHD is it’s a problem with the attention system–it can [act as both] paying attention or disengaging your attention. That’s why if kids get hyper-focused, it’s hard for them to switch tasks,” Waldman said. “Same thing for high schoolers doing their homework. It might be hard for them to start their homework so [they do] a lot of procrastination. They might get distracted, do other things and then get into another less important activity. Then they [become] so hyper-focused that they’re not doing their schoolwork.”
Although ADHD and ADD have become more widely recognized and diagnosed, especially in younger generations, it remains a fairly new field of study and treatment. Academic and social accommodations continue to develop, although access to them are not always realistic options for those who may need them.
“I wouldn’t take back anything though, [ADHD has] made me the person that I am. I think that the experiences I’ve had, even though they were pretty rough, have made me who I am and developed the ideas that I believe,” Mertz said. “I’ve become more understanding of teachers and other students, and how other people work and learn because now I know that not everyone functions the same.”
OCD
by Scarlett Mische and Marlena Van Pelt
“Oh, I’m so OCD, I need to organize my pencil case:” A phrase which may be said without even understanding what “OCD” means. OCD stands for Obsessive Compulsive Disorder, with the most common effect being “compulsions,” which are urges to do things, usually against conscious wishes. The compulsions can take a variety of forms, which are often put into five categories: contamination and cleaning, hoarding, symmetry, obsessions (such as numbers), and harm or checking compulsions.
Anonymous junior Martin was diagnosed with OCD at the beginning of his sophomore year. He got his diagnosis after many years of struggling with the idea of being seen by a professional for a prescription. Since getting his diagnosis, he has been better able to work through his mental health issues; however, he has seen problems with how the public views OCD.
“One of the biggest misconceptions is that OCD is all like ‘nice, clean, and tidy cleaning obsessions.’ But no, it’s not,” Martin said. “Sometimes I will have horrible obsessions where, for instance, someone bumps into me in the hallway and then I’ll obsess over the idea of brutally murdering them. It’s not fun, and it’s not something I want to think about, because it’s not true, it’s not my thought.”
This is a similar situation for anonymous junior Ivy, who was diagnosed during the COVID-19 pandemic due to her brain becoming “understimulated” and not having outlets of help due to the lockdown. She began getting intrusive thoughts that triggered her anxiety, leading to compulsions to admit these unwanted thoughts and find reassurance. This “reassurance seeking” would provide her with “temporary relief” but she would “need every detail to be reassured before [she] could let it go.” This however, isn’t what most people would consider when thinking of OCD. This idea by Ivy is echoed by the professional opinion of OCD expert Avery Garrett who led an informational meeting on OCD, with the intention of addressing common misunderstandings associated with the disorder.
“Some folks are really housebound because they’re spending so much time on their intrusions and their compulsions, but a lot of people actually move through the world in a really high functioning and then they’re just privately having this awful experience of being really plagued by these things,” Garrett said. “The biggest reason when people go undiagnosed is because of the media’s portrayal of OCD and the public perception of OCD is actually very different than how it shows up for most people. What I see is things that are really hard to talk about, like harmful thoughts or intrusive sexual thoughts, or experiences that cause clients a lot of shame and confusion, and they might be really nervous to bring it up to a therapist or they might not understand the source of it. I’ve spoken with a lot of people who thought maybe they were schizophrenic, or in their words ‘were going crazy.’”
As Garrett has explained, OCD is more than what many believe it to be, and senior Gavriel Olschwang can attest to this through his lived experience.
“When I suspect that something may be unclean, or out of order, I feel a mental unease and surge of anxiety to fix the issue. As much as I try to suppress the unease or anxiety or do other things in order to take my mind off of it, it does not go away,” Olschwang said. “I feel this unease until I do a compulsion such as washing my hands or reorganizing the thing I was worried about. This surrounds many aspects of my life and I feel this type of unease in many scenarios such as the classroom, while driving, while exercising, or even while trying to sleep.”
The most pressing issue for Olschwang is the compulsions which he deals with surrounding contamination and cleaning.
“My compulsions affect me heavily, I’ll be doing a calculus assignment for example, and I’ll be writing and then I’ll think of something dirty. So, I get up and I go wash my hands. I come back, and then I think, ‘Oh, I didn’t wash my hands long enough.’ So I have to go back and wash my hands again. I’ll get stuck in cycles, just washing my hands for 10-15 minutes,” Olschwang said. “These compulsions also affect me at work. I work as a math tutor, when I see kids just being kids, not being the most clean because kids aren’t that clean, and doing things like putting markers or their hands in their mouth, I’ll go and basically use as much hand sanitizer as possible. Just seeing actions that are dirty makes me feel like I’m dirty.”
Similarly, junior Sophie Bell got diagnosed with OCD in 2020, specifically with compulsions relating to symmetry and relationships; and describes it as “a paranoia mixed with having a mental disorder.” She is always focused on things needing to “feel right,” which can sometimes deviate focus from academic responsibilities.
“In school, I’d say I’m a smart person, but when I’m really anxious about something, I just put it off because I don’t want my impulses to be triggered so it creates this avoidance in me,” Bell said. “So I avoid these places and activities altogether. I just avoid school. I’ll avoid work because it gives me anxiety. Even though I know the material, even though I do the work, even though I know stuff for the test, I’ll avoid this stuff to the point where it negatively affects me and I’m doing bad in school.”
Generally, Bell’s compulsions can make her day-to-day life harder to navigate as it affects the relationships around her.
“Sometimes I’ll have to do [those compulsions] before I can do anything else and that can be very disruptive or with my relationship OCD, I’ll obsessively think about or worry about relationships that I have with people,” Bell said. “It becomes a spiral and I can’t stop thinking about it and I’m trying to calm myself down, but [eventually I’ll] give into that impulse.”
Similarly to Bell, Martin is often unable to think of anything other than his obsessive or intrusive thoughts.
“I know that there’s no such thing as ‘thought-crimes,’ [being in trouble for having bad (intrusive) thoughts] but I always struggle with my intrusive thoughts,” Martin said. “With OCD, you are not necessarily in control of your thoughts. Sure, you can think for yourself, but at the same time, there’s someone who will grab the reins or put something in there that you just can’t get out of your mind. And instead of being able to brush it away, it will repeat and repeat until you physically can’t think of anything else.”
As Martin expressed, having OCD isn’t something “you choose to do” and Ivy has struggled with explaining the condition to others that don’t understand the disorder.
“The social aspects [are the most challenging] because you don’t feel seen because OCD is so taboo. People think they understand it but, in reality, if you try to describe less-discussed things, like for example, I’ve tried to explain harm OCD to people,” Ivy said. “I don’t even have harm OCD, which is where you get intrusive thoughts about hurting people you care about, but obviously, it’s not what you want or desire and people with harm OCD are actually safer to be around than the average person because they put so much effort into making sure that their intrusive thoughts aren’t don’t become reality.”
When Ivy explained harm OCD to someone, they “looked at [her] like [she] was crazy.” According to Ivy, “OCD targets the things [people] value most and tries to make them hate themselves” which is why people “end up going undiagnosed.” These fears of judgment and opening up along with feelings of loneliness and insecurity is what Bell experienced before getting her diagnosis.
“There was a time in my life, especially during the pandemic because I was all alone and it was a scary time, I got into trichotillomania [hair pulling] really badly,” Bell said. “It’s a very isolating, very lonely disorder because there’s a lot of time I don’t want to leave the house or like I’m trapped in a cycle. My trichotillomania is paired with my OCD and I will sit there and I’ll pick up my hair and be like okay, this is the last one, it’s the last one, it’s the last one and it’ll go on for hours.”
Just as there are different types of OCD, Garrett attested to the different forms of treatment available to help cope with and lessen the impact of the disorder.
“The gold standard or the really common one is called exposure and response prevention, which essentially means that in a titrated way, working from least theory to most scary, you and a therapist will work on exposing yourself to the things that you’re afraid of and not doing your rituals, and that can be really helpful in changing people’s relationship to their anxiety and alleviating some of the fear that comes from constantly avoiding those situations,” Garrett said. “There is also one called Acceptance and Commitment Therapy, which is a lot about mindfulness, getting out of your head and more into your body and your senses and taking values and really aligning with your values rather than your fear. [From these treatments] a lot of people with [OCD] can go from [OCD being] this really debilitating thing to it being just so quiet in the background, almost like it’s not there.”
Martin has taken advantage of these options as he has used both the medicinal route, therapy and Exposure and Response Prevention (ERP) treatment.
“Medication has really helped me, it’s truly been the difference of night and day. It caused a few complications at first. But now, it makes everything much more manageable. In general, I feel less terrible and more in control,” Martin said.
In regards to ERP, Martin has to take a different approach due to having Tourettes’ Syndrome, a condition which causes a person to make involuntary sounds and movements called tics. He has undergone ERP for both of his disorders; however, he finds it less effective for OCD.
“ERP really stresses me out, my therapist will often ask me why I am not able to do something, and honestly, I have no idea. It just makes me feel like I am failing at something, and that is for both OCD and Tourettes,” Martin said.
Bell has also done a form of ERP by taking part in NOCD through Kaiser, which is a program that gives access to licensed OCD-trained mental health providers and peer support communities. Through this program, she has practiced exposure response therapy which, according to Bell, is where her OCD is triggered and she has to “sit there and not do anything” and she described the peak of anxiety as a “roller coaster.”
“OCD teaches your brain that it’s okay to [give in to the compulsions] but that could become destructive and so with exposure response therapy, you sit there, no matter how uncomfortable it is,” Bell said. “It’s literally the worst thing in the world [but] OCD gets worse over time. If you don’t treat it, you’re letting your body know it’s okay to do this. So if you get help earlier, you’re less used to doing the impulse.”
According to Bell, she works from “small to big” so that she can practice handling the compulsions. Although OCD is something which cannot be fully cured and can be bothersome even through medication, to people such as Ivy, the disorder has taught a valuable lesson.
“My diagnosis reminded me of how I wanted to be seen even though OCD is a three letter word, [prior to being diagnosed] it was life-ruining and made me feel like I deserved to die because of the things that were going through my head. OCD reminds me not to be desensitized when people say ‘I have this diagnosis,’” Ivy said. “Even if you’ve never experienced OCD, even though it’s just a word that may be common, it can affect every second of somebody’s day. What’s just a word to someone else is my entire existence.”
Autism
by Claudia Turner and Victor Simoes
Autistic students form a distinct part of the diverse mosaic of students in Redondo’s population. The autism spectrum, typically characterized by a range of physical and verbal responses to social communication, is defined by the National Institute of Mental Health as a neurological and developmental disorder that affects how people interact with others, communicate, learn, and behave.
Autism itself is a relatively new diagnosis, with the first individual diagnosed as autistic in 1948. From being considered a separate disorder called Aspergers (named after the notorious Nazi scientist Hans Asperger), to being categorized in terms of low to high functioning on the spectrum, to now most commonly being defined based on the amount of support needs an individual requires, the language surrounding autism has gone through an evolution of definitions in the medical field.
It is impossible to know how prevalent the disorder really is since the diagnosis process is very expensive (between $2,000-$5,000, according to the Center for Disease Control) and it is under-diagnosed in women and girls.
When testing for autism, proctors typically use a combination of observing physical and verbal responses to social communication to make a diagnosis, such as lack of eye contact, stimming, rigidity in behavior, the following of conversational overtones, being stuck on a specific topic, echolalia and social withdrawal. However, not all autistic people check all of these boxes, and the disorder can present itself in a variety of unique ways.
The expression of autism can also change over a lifetime, such as in the case of anonymous source Lee, diagnosed with autism at age four, who describes how autism has impacted his social skills.
“When I was young I had a really hard time making friends and feeling like I fit in,” Lee said. “I’ve gotten better at those things as I’ve [grown older] with the help of therapy, but I still struggle with social cues sometimes. When everyone’s in a group together, I sometimes feel like I’m not on the same page with my friends, like there’s something going over my head that I can’t pick up on.”
Lee’s experience mirrors that of anonymous source Jake, who shares Lee’s struggles with social isolation and navigating conversation.
“When it comes to social accommodations, I know there’s nothing that can be done [within the IEP/Individualized Education Plan], but I just wish people were more clear with what they had to say,” Jake said. “I often have people frustrated with me for making incorrect assumptions or not being able to read the subtext of the conversation, and I wish my teachers were more direct and logical in their instructions.”
Despite Jake’s experiences aligning more with “a stereotypical autistic person,” as he displays attributes the CDC classify as autistic traits (such having an obsessive interests in one subject and being isolated from other kids), both he and Lee, who’s disorder manifests in less noticeable ways, share the same official diagnosis of Autism Spectrum Disorder [ASD]. Just as no two brains are the same, no two brains with a neurodevelopment disorder are, and often outdated assumptions about what autism “should look like” causes those perceived as “high functioning,” most often women who have been socialized to mask their more noticeable traits, to be overlooked by doctors and psychiatrists.
“I think it is important for us to continue to educate ourselves as a society to just recognize more of the nuance [of the disorder] and not be so rigid in our conceptualizing the spectrum,” psychologist Dr. Kaycie Deane, who specializes in psychotherapy and testing for neurodivergence, said. “I tend to work with a lot of people whose autism often goes undetected. You’re not going to get noticeable physical behaviors, but you will find a lot of trouble with transitions and unexpected changes. The girls that I work with tend to be these high functioning individuals, who usually avoid drawing attention to themselves, and therefore are overlooked a lot by professionals and have a hard time getting the help they need.”
As autistic people have to live in a neurotypical world not designed with accommodations for the autistic experience in mind, it is easy to see why feelings of loneliness and isolation permeate the autistic community. According to Deane, there’s a lot of comorbidity between ASD, anxiety and depression, often stemming from internalized negative social feedback from peers.
“I did have periods in my life where I was struggling with depressive feelings,” Lee said. “I’ve worked on getting better by doing [emotional support therapy] all my life, and of course my family is very supportive. But I’d say the biggest thing that’s helped me feel like I’m accepted has been my close friends. I don’t have to mask my autism around them, and we all joke about it together in a way that’s really fun and makes me feel less alone.”
And while jokes shared between friends can be lighthearted and even work to normalize autism, sometimes things can be taken too far and lead to real harm. A survey conducted by the organization Ambitious about Autism found that 75% of autistic youth have experienced bullying in some form, a trend Jake partially attributes to “harmful stereotypes” surrounding neurodiversity, perpetuated by popular culture.
“The trend of calling people ‘acoustic’ when acting dumb, or people saying they’re autistic for having interests is really harmful and leads to a lot of misconceptions,” Jake said. “There’s also this idea that autistic people are either incredibly dumb or socially inept geniuses, which just isn’t accurate to the experience of most autistic people. Overall, people need to learn not to stigmatize mental health disorders and actually listen to us instead of being defensive when getting called out for being problematic.”
The willingness to shun ableism and harmful stereotypes is one of many ways neurotypical people can try and be more accommodating to their autistic peers. Forgiveness of behavior that does not align with what’s socially acceptable, leniency when it comes to stressful situations, and an understanding attitude towards behaviors and responses that might seem confusing at first, like a specific sensory issue or emotional trigger, can go a long way in a world not built with neurodiversity in mind.
“I think [society’s] gotten very quick to judge and very quick to shame, and that’s not fair when we’re all just trying our best. Giving your friends on the spectrum some leniency, just because they don’t want to go to a big party doesn’t mean they don’t want to spend time with you,” Deane said. “We, as a society, need to be more forgiving, accepting and understanding. We all say things we’re not supposed to say, and giving people the opportunities to clarify what they really mean and being a little bit kinder would help everyone, neurodivergent and neurotypical alike.”