A big problem that I think plagues many ADHDers is self-identifying what is the disorder and what is us. Even at 22 and medicated, I still have a lot to learn about myself and the disorder. Where it stops and I begin is a nonexistent line, both personally and medically.
A long-held theory behind the disorder's etiology is that a person with ADHD has a chemical insensitivity in the dopamine-reward system. This chemical insensitivity in the DRS lends a hand in the inattentiveness, impulsiveness and hyperactivity because it is/we are under-stimulated and these actions "hit the button" hard, allowing us to feel good/pleasure/accomplished. This may explain the high prevalence of drug addiction, eating disorders and self-injuring behaviors in the ADHD population since all those things have a way of immediately and strongly stimulating the pleasure and reward centers of the brain. Controlled amphetamine drugs (like Adderall, Ritalin and Concerta) up-regulate the DRS, sensitizing it to dopamine, and allowing for "normal" behaviors in medicated ADHDers. However, when an ADHDer is medicated with a controlled amphetamine there is still a strong chance the person is going to present with symptoms still.
Recently published long-term studies indicate that for whatever reason, ADHD brains develop on a vastly different timeline or at different rates than non-ADHD brains. The NIH indicates that on the most part these regions start and stop developing later than neurotypical children with one notable exception: The motor cortex, which develops 2-3 years sooner/faster in ADHDers than neurotypicals. The motor cortex controls gross- and fine-motor control, and the adjusted timeline for its development means that a 5 year old child with ADHD has the motor control of a 7 or 8 year old neurotypical child. There are a lot of sociological implications for this, but it would derail the further explanation of ADHD brain development.
As a whole, however, the ADHD brain is around 3 years "behind" neurotypical brains, and the individual breakdown of each region of the ADHD brain can be on average of 1 to 5 years behind the neurotypical timeline. The most notable region that takes 5 extra years (if at all) is the frontal lobe that controls executive function. It should be fully developed by 25, but it is not fully formed until at least 30 for the ADHD brain.
Keep in mind that these are numbers derived from longitudinal studies and are averages. Since I don't have the ability to dig up the original research article I can't tell you if these are means, medians or modes, but a basic understanding of statistics means that there were probably outliers in these studies, which means that there could have been a small number of the 231 participants that fell on extreme sides of these timelines - ADHD individuals with NO delay in brain development (which would indicate that they may have had just a dopamine-reward system problem or weren't ADHD to start with but had a different behavioral disorder) and ADHD individuals who took much longer to develop in certain regions than where most of the data fell. And since most research articles correct for these extreme outliers, the data can be very skewed without knowing its p-level or CE and how it relates to the outliers. And since these studies had around 231 ADHD individuals in an estimated population of 300 million people world-wide with ADHD, the actuality of these findings may be good but there is still a strong shot at the numbers being off.
It DOES show, however, that (A) ADHD can't just be fixed by medication until you are at the very least 30 when the brain is finished developing structurally and actual neural connections are present in similar numbers as the neurotypical population (B) It can be very hard, if impossible, to see the difference between what is the disorder and what is the person.
Are we dotty or is it the lagging neural connections leading to "immature" statements? Are we forgetful or is it the delayed frontal lobe development? Am I creative or are they segues caused by abnormal neural activity? And then keep in mind that while the cerebral cortex seems to be developing differently, the other parts of the brain are right on schedule with everyone else. This means that this delayed schedule can mean bizarre things for our brains when the hormones of puberty come in to play, as the hypothalamus is beholden to no one in this case. It's not just that we are somehow delayed a few years in these areas of executive function, but the actual development may be occurring in a soup of endocrine craziness that it was never intended to be in.
And it is still not fully studied! There seem to be a whole bag of neurological differences in the ADHD brain, since it appears that how our hemispheres "talk" to each other differs in ADHDers, despite controls for age. Even though we're however-many years old and "3 years" behind, our brains may still be different than our developmental cohort.
All this data makes me wonder about myself. This across-the-board difference in structure means that it's not just ONE "flaw" but many, and some of them are resistant to medical intervention. I have ADHD. My brain is fundamentally different from anyone without the disorder. I not only struggle with interacting with people who are neurotypical, I actually get on best with ADHDers than any other type of neuroatypical individual. I am under the impression that this isn't necessarily common in all neuroatypicals. Do autistics understand and feel satisfied by companionship with other autistic individuals? Do clinically anxious people feel relieved and refreshed by communicating with groups of other anxious people? Do schizophrenics feel like they can "speak their native language" with other schizophrenics?
Maybe they do. Maybe because I'm not reading and consuming blogs and articles written about, for and by these people I'm not seeing that they are feeling a similar way about themselves, their cohort and their disorders that I do about myself, my cohort and my disorder. Maybe all neuroatypicals feel that intense relief and freedom when meeting someone of the same "type" like I do when meeting other ADHDers. Maybe all us neuroatypicals feel a little shafted that the thing that makes them so different is so a part of who they are that no matter what treatment you attempt it won't clear up like bacterial pneumonia does when taking antibiotics. Maybe all us neuroatypicals resent that their whole self is pathologized while realizing that this "disorder" is negatively affecting how we engage and achieve in society as a whole, and damaging our chances for long-term relationships that resemble any sort of happy and health. And maybe that duality in thought has all us neuroatypicals chasing our tails, trying to figure out who we are, and the faint distinction between that and the disorder.
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