Five years ago, after consulting a private psychiatrist, a woman in Singapore was diagnosed with attention deficit hyperactivity disorder (ADHD), a revelation that reframed her lifelong experiences. Previously attributing her intense emotional swings, impulsivity, and difficulty with focus to personality traits, the diagnosis clarified persistent struggles that had been misunderstood, including episodes of hyperfocus alternating with debilitating executive dysfunction.
ADHD, often misunderstood as merely an attention deficit, is increasingly recognized by clinicians as a condition relating more broadly to difficulties in regulating attention and emotions. Ong Mian Li, clinical psychologist and founder of Lightfull Psychology in Singapore, discusses this perspective, noting that individuals with ADHD may demonstrate intense focus when engaged but struggle to control or steer their attention effectively.
The woman’s diagnosis as having "high-functioning" ADHD reflects a category used for individuals who achieve academic or professional success despite their condition. However, this terminology is contentious. While it underscores the ability to meet conventional expectations, some experts and those diagnosed argue that it minimizes the significant internal challenges they face. Ong cautions against relying solely on outward performance to assess the impact of ADHD, comparing it to evaluating a company’s health by revenue without considering the underlying costs. He explains that high-functioning individuals often expend considerable effort to maintain productivity, which is frequently followed by severe exhaustion or meltdowns.
The experience of this woman illustrates this cycle. Prior to diagnosis and treatment, she described enduring guilt and frustration over managing tasks during typical working hours, only to enter intense bursts of productivity late at night to meet deadlines. These patterns, common among people with ADHD, can reinforce a need to mask difficulties, especially when external achievements meet or exceed expectations.
In recent years, perspectives have shifted toward describing such cases not in terms of rigid functioning labels but by “support needs.” This approach focuses on the practical assistance required, which may fluctuate depending on the environment and task demands. For instance, clear agendas and explicit deadline assignments can ease cognitive burdens for those with ADHD, benefiting not only the individual but the broader team.
Despite these insights, individuals with ADHD—especially those considered "high-functioning"—often encounter skepticism about their diagnosis and needs. This can create barriers to obtaining accommodations or understanding from others, contributing to a “double erasure” that compounds the challenges of living with an invisible neurodevelopmental condition.
Ongoing efforts by clinicians and advocates aim to improve awareness and support structures, emphasizing that ADHD is a complex, dynamic condition that requires more nuanced recognition beyond traditional stereotypes.