Distracting Thoughts

Do you ever wonder whether some of your group's player characters have ADHD? Actually, let me put that another way: are there any PCs in your group who you DON'T think act like they have ADHD?

Dr. Eric Lis is a physician, gamer, and author of the Skirmisher Publishing LLC sourcebook, Insults & Injuries.

Do you ever wonder whether some of your group's player characters have ADHD? Actually, let me put that another way: are there any PCs in your group who you DON'T think act like they have ADHD?

I'm going to tell you a little bit about my life. Recently, I've downloaded the mobile game, Injustice: Gods Among Us, on my iToy, and more shockingly, I've started playing it. I should really say that I've started playing it "again," since I was hooked on it briefly around this time last year. In part, I downloaded it because a couple of friends of mine just got back into it. In part, I downloaded it because they released a new update and I was curious what it looked like these days. If I'm being honest with myself, though, one of the big reasons that I downloaded it now, as opposed to last week or next week, is because I've been working my way through a particularly dense medical textbook in my off hours, and Injustice gives me an excuse to let myself get distracted. I'm a terrible studier, you see, never been any good at it, and I can barely stand to look at a textbook for more than about fifteen or twenty minutes at a time. In medical school, I used to joke that the only time my apartment was ever clean was right before an exam, because as soon as I start studying, I immediately find other things I need, or want, to do instead. This has definitely made it harder for me to pass exams during my life, as a string of failed math classes back in my college days will attest. Clearly, my attention and concentration aren't always where I'd want them to be, so the question becomes, should one say that I have ADHD?

Attention-Deficit/Hyperactivity Disorder is an interesting clinical syndrome because it's a very controversial one. It's by no means rare for ADHD to be in the news, often accompanied by one group or another expressing concerns about it being nothing more than an excuse for drug companies to sell pills to vulnerable kids. The groups who are opposed to the diagnosis often make some good points, and the truth is that ADHD is probably often diagnosed poorly, which isn't at all the same as saying that it's diagnosed "too often." Speaking from my own experience working with both kids and adults, I definitely believe that ADHD describes a real problem which impairs the lives of many people, and based on what I've seen, it's one of the relatively few disorders of mental health that probably really does respond better to medication than to psychotherapies or social interventions, although a lot of physicians don't necessarily know how to best prescribe the medications. Having diagnosed and treated a fair number of people, I'm continually struck by the same thing: at least half of all player characters in games that I've played in or GMed seem to have very similar problems as the patients that I meet and treat. Notice, please, that I said "player characters," and not players, since the phenomenon that I routinely observe is that players who have no attentional problems keep playing characters who do.

In spite of the similarity, almost none of the characters in question actually meet clinical criteria. Let's think about that.

According to the DSM 5, the list of commonly-accepted mental disorders that dominates in North America, someone can be said to have ADHD if they have a " persistent pattern" of problematic behaviours at least six (five, for adults) out of nine items on one of two lists.

The first list describes problems with attention, and the items on it are:

1. makes careless mistakes in work
2. difficulty remaining focused
3. does not seem to listen when spoken to directly
4. does not follow through on instructions and fails to finish work
5. has difficulty organizing tasks
6. avoids or dislikes tasks that require sustained mental effort
7. loses things necessary for tasks
8. easily distracted by extraneous stimuli
9. often forgets daily activities

The second list describes problems with hyperactivity, and includes:

1. fidgets or squirms
2. unable to remain seated
3. runs about or climbs in situations where it is inappropriate, or feels restless
4. unable to engage in leisure activities quietly
5. unable to be or uncomfortable being still for extended time
6. talks excessively
7. blurts out statements or ideas
8. has difficulty waiting his or her turn
9. interrupts or intrudes on others

If someone only has 5 or 6 from the first menu, we say they have a "predominantly inattentive presentation," and if they only have from the second menu, we call it a "predominantly hyperactive/impulsive presentation." Quite a lot of kids and adults meet criteria only for the inattentive type, and they tend not to get diagnosed as kids because, even if they fail right out of school, at least they aren't making the teacher's life more difficult. All problems have to be present in at least two areas of life, so the child who only misbehaves in school, the college graduate who gets bored doing data entry, and the father who doesn't help out around the house usually don't qualify. As with most mental disorders, there also has to be a clear impairment of functioning, so a kid who acts out in class sometimes but is still passing and still has friends also shouldn't be said to have ADHD.

Have you guessed why it is that most PCs couldn't actually be given the diagnosis, despite mountains of apparent evidence? Our games rarely depict how our characters manage when they're required to fill in paperwork. A player might consistently forget their sheet every week, but their character doesn't have to remember to pack arrows because the game makes it happen automatically. We usually can't see if our characters are fidgety, and few storytellers require us to specify that we're paying our bills once per month. Nobody's actually sitting and watching the mage to see how long it takes to study; we just assume the job is done eight hours later. Even if we could actually observe the minutiae of our characters' lives, most fighters and rogues wouldn't have their lives disrupted enough by their symptoms to qualify for a diagnosis, and a lot of people who grow up with the symptoms probably naturally avoid becoming mages or clerics or other careers that require a lot of patient study.

All that being said, a good player can certainly arrange to give a character a bit of pathology by roleplaying any number of items from such lists. Whether you use this information to craft realistic NPCs or simply to irritate your storyteller is entirely up to you.