I sometimes hear people talk about having “mild” ADHD. On one hand, I understand what these people mean: they have symptoms of ADHD, but their symptoms are less severe than the symptoms many other people experience, at least as far as they can tell.
At the same time, the idea of “mild ADHD” always seems like something of a contradiction to me. By definition, ADHD is a disorder that interferes with multiple areas of life. What does it mean to have a mild disorder?
To put it another way, what does it mean to have more ADHD symptoms than the vast majority of the population, but to have fewer ADHD symptoms than most other people who have more ADHD symptoms than the vast majority of the population?
Researchers and medical professionals sometimes talk about subsyndromal ADHD. People with subsyndromal ADHD have elevated symptoms of ADHD, but they don’t have enough to qualify for an official ADHD diagnosis.
These people fall into a diagnostic grey area created by our incomplete understanding of where exactly normal impulsivity and inattention ends and ADHD the disorder begins.
But there’s ample evidence that while they may not meet the threshold for an ADHD diagnosis, people with subsyndromal ADHD still experience many of the impairments and negative outcomes that people with diagnosable ADHD do. Most recently, a study of 1,931 children with ADHD found that the 140 with subsyndromal ADHD had all of the following when compared to children without ADHD:
- Lower overall functioning
- Lower social adjustment
- Higher rates of needing extra help in school
- Lower scores on neuropsychological tests
- Higher rates of other psychiatric conditions
In other words, even though these children had a “mild” form of ADHD that didn’t qualify them for a full diagnosis, they still faced an array of challenges in school and in everyday life.
This study is a good example of why I’m not entirely comfortable with talking about “mild” ADHD. Even when ADHD is so “mild” that it’s not completely diagnosable, it can still interfere with multiple parts of people’s lives. Furthermore, “mild” ADHD is not something that’s self-diagnosable – people with ADHD often don’t have insight into the full extent of how ADHD affects their lives.
Ultimately, I recognize that we have to have some way of talking about different levels of symptoms. Not everyone with ADHD is the same, and some people’s symptoms do interfere with their lives more than others. If we want to make that distinction by using the terms “mild,” “moderate” and “severe,” OK. The important thing is to remember that labeling someone as having “mild” ADHD does not mean they don’t need treatment or that their symptoms don’t still have a real impact on their life.