How the 'high-functioning' label masks ADHD at a high cost

Grace Yeoh (0:02)

This is a podcast by The Straits Times.

I'm Grace Yeoh, features correspondent at The Straits Times. October is ADHD Awareness Month. That's why with me today is Dr. Ong Mian Li, a clinical psychologist who specializes in ADHD. He's also the founder of private practice Lightfull Psychology and the recipient of an ADHD diagnosis in adulthood. Mian Li, welcome to In Your Opinion.

Ong Mian Li (0:30)

Hello, hi. So glad to be here.

Grace Yeoh (0:33)

Okay, before we go any further, I think the general public knows that ADHD stands for Attention Deficit Hyperactivity Disorder. But how would you describe it?

Ong Mian Li (0:43)

I would say that ADHD is really misnamed for a few reasons, but the biggest one being that it stands for Attention Deficit Hyperactivity Disorder, as you said. But the problem here isn't really a deficit with attention. In fact, I think many people who might know with ADHD, including myself, our attention is ferocious. We can get into something that goes in really, really hard. The problem has always been regulation. Meaning, I have to think of it as like a...

The attention is there, but the problem is with the steering of it.

And this does not just apply to attention per se, but also applies to things like our appetite, mood, and I think your emotions as well. So I think that fluctuation is what we see in that sense.

Grace Yeoh (1:36)

Yeah, I also find the word deficit really a misnomer because I don't have a deficit in attention, but my deficit is in the regulation mechanism almost to regulate my attention.

So with this framing of ADHD, do you think a lot of people get overlooked due to a lack of awareness about what to look out for? I think whether it's in others or even in oneself.

Ong Mian Li (2:00)

Yeah, I think the short answer to this is yes. And I think we have come a long way with this. The issue here is with the framing, I think. So we are looking at, we are looking at, when we think of ADHD, we are looking at this, we are thinking of this boy, who's moving around a lot, jumping around all over the place.

And when we do that, then we are missing, so take for instance, hyperactivity.

If we are looking at external hyperactivity, then we are missing the internal hyperactivity that can happen. So consider, instead of a boy that moves around a lot, the boy, or girl, whose mind just keeps running in lots of ways internally. And so with that, I think, more knowledge can be helpful there. And the more knowledge we can get, similar to how we have treated different things, like gambling, like shingles, I think more education, be it in the form of stats, public education, that can help. So that's what I would say.

Grace Yeoh (3:08)

Yeah, I think the things that you look out for, yeah, very external, right? But so when you were talking about hyperactivity, someone once asked me, but you're not very hyperactive, well, like I see you're able to sit still, but like right now, I'm wriggling my toes under the table. And I always do that also, like at work or when I'm on a Zoom call, just to keep myself focused.

And you were one of those people who were missed, I think, as a child, since you got your diagnosis in adulthood, right? Looking back, I want to know how did the symptoms show up in your life from a young age?

Ong Mian Li (3:40)

So for me, mine wasn't quite the classic. So what we would classically look at would be the focus, right? Lack of focus. For me, it really came out in the needing approval bit and the novelty bit. So I'm what you would classify as twice exceptional. So defined as, so you have a pretty high IQ and I have ADHD as well. So I think I started doing well in school. And when the grades started to drop, because I couldn't just close my way through, my attention went to things like games, Starseed Stripes, not to date myself, or like Counter-Strike.

Not because games were the cause or an issue, but that was where I could still be seen. That was where the reward was at. And as my grades sort of, it was still okay, good enough. But as that went away, the approval from that went away, I started seeking out different sources to have that validation.

As a clinician now, I would say that there was a boy sort of like seeking validation and approval from different places where he could shine. But frankly speaking, looking back, I really just experienced it as, oh, there are just these new fun things that I want to do. So I think it's important to make that distinction. Now I can look at it this way, but back then, I experienced it quite differently.