It’s safe to say that Simone Biles’s life is almost entirely different from mine, but our daily routines overlap in one distinct, important way. Every morning, Biles and I both swallow a pill. The medication we both take, methylphenidate (commonly known in the United States as Ritalin or Concerta), is a controlled substance nearly identical in its chemical composition to methamphetamine. If Biles’s experiences as an adult with ADHD are anything like mine, she’ll be taking it for the rest of her life.
I’m going to briefly break up my flow to clarify that I am not a mental health professional, and that a lot of this is speculation about Biles’s experiences based on what many adults with ADHD experience. She’s generally reticent about the details of her ADHD and how it affects her, and hasn’t discussed it much since 2016, when Russian hackers leaked WADA medical data that included Biles’s doping exemption for her ADHD meds. Biles’s ADHD also intersects with her experiences as a Black woman and as a sexual abuse survivor in ways that I can’t speak to or address adequately.
As people with ADHD go, Biles and I are lucky. We both have a version of ADHD that responds well to stimulant medication, find the side effects tolerable, can financially afford our meds, live in a country where ADHD meds are available and accepted as effective ADHD treatment, and have access to health care providers who will prescribe it for us. Most of the time, my meds work well enough that I’m able to wake up at a respectable hour of morning, do my job competently, and pay my bills on time. Although Biles hasn’t spoken in detail about how her ADHD affects her ability to navigate the day-to-day, I would imagine that her meds boost her executive function much as mine do: enough to meet social expectations for focus, persistence, motivation, short-term memory, and task separation. But not enough to feel normal.
ADHD, which stands for Attention Deficit Hyperactivity Disorder, has a reputation that’s far from its reality. When most people picture a person with ADHD, they imagine a little boy goofing around in class and being given medication to control his behavior. While some people do grow out of their ADHD, or learn to compensate for their symptoms enough that they don’t require active treatment, ADHD is usually a lifelong condition and one that can become more disabling for some as the independence and responsibilities of adulthood increase. Children perceived as boys are more likely to be diagnosed in childhood than children perceived as girls, although evidence increasingly suggests that all genders are equally likely to have the condition.
Contrary to its name, ADHD doesn’t just cause antsiness and trouble focusing, although it does both of those things to most people who have it. Increasingly, ADHD is recognized as a disability of executive function, the blanket term for a bunch of higher-order cognitive processes that help humans manage the complexities of interacting socially and surviving as intelligent creatures. Executive function is the front desk of the human brain. It allows people to prioritize tasks, plan for the future, distinguish when tasks begin and end, initiate tasks and follow them through to completion, and break tasks down into more manageable sub-tasks. It tells you which outside stimuli are important and which you can ignore, keeps important thoughts in your head long enough to encode them in memory while ditching the irrelevant ones, and regulates thoughts so you don’t lose track of what you’re doing and go on wild mental tangents. It contributes to your sense of time, your sense of direction and placement in space, and your hunger-satiety and sleep-wakefulness cycles. If executive function is working typically, it’s mostly unconscious.
No human being has perfect executive function, and everyone has experienced a wandering mind or an overwhelmingly complicated task. But for people with ADHD, life is like this all the time. We have to manage and regulate a lot more of our executive function consciously than other people do. We notice everything around us, because our brains aren’t efficient enough at telling us what to focus on; I had to stop writing for a few minutes because my fiancée was cleaning the kitchen, and my brain kept yelling SINK DISPOSAL every time I tried to form a sentence. Our minds constantly race with thoughts and ideas: relevant and useful ones if we’re lucky, pleasantly off-topic ones that feel good but interfere with our goals if we’re less lucky, or intrusive and painful ones if we’re unlucky – especially if we’re under stress or recovering from trauma. Because our consciousness turns on a dime, we’re often forgetful and scattered (that “Why am I in this room and why am I holding a towel?” feeling is constant), and we struggle to maintain healthy routines and habits. By adulthood, most of us have learned – usually through trial and error, but sometimes through therapy or special ed support – how to compensate for the things our brains won’t do for us automatically. Folks with ADHD who appear to be normal or handling things well are often paddling very hard to keep ourselves afloat.
One of the problems with well-managed ADHD is that medication doesn’t make the ADHD go away. Our brains still work the way they work; the meds just make it much easier to override those tendencies. Sometimes, ADHD is a superpower as a result. When I’m on my meds, I can observe a busy preschool classroom in two simultaneous languages while taking detailed and accurate notes and catching all kinds of things that a neurotypical evaluator would miss. I see similar calculations going on when Biles seems completely focused on her routines and skills while radiating effortless joy and positive energy. Most people with ADHD also experience hyperfocus, a state of intense engagement that explains how I wrote this essay in a couple of hours on the same day I finished a work report. But hyperfocus is impossible to invoke willingly or to direct toward the task of one’s choice, which also explains why I wrote this essay instead of making headway on that other work report.
The biggest downside is the bad days, of the sort that Biles was clearly having on Tuesday when she scratched three of four events at the women’s artistic gymnastics team final at the 2021 Olympic Games, and continuing to have the following day when she withdrew from the all-around final. Adults with ADHD often experience chronic anxiety or depression, and these mental health conditions often arise from the added difficulty of managing life independently when your executive function doesn’t function. Biles’s comments to the press on Tuesday illustrate this: “It’s been really stressful, these Olympic Games, just as a whole… It’s been a long week, it’s been a long Olympic process, it’s been a long year.” Biles has been managing her executive function for a longer time than she’s used to, and faced with the high pressure of leading her team to gold, her brain said “no.”
ADHD means that sometimes, no matter how capable our bodies and intellects are of completing a task, we just can’t do it. I’ve seen other folks with ADHD refer to this as the “ADHD blue screen,” alluding to the ominous bright blue screen that comes up on a Windows computer that has locked up too badly to proceed. Severe blue screens, even brief ones, have disabled and exhausted me enough that I’ve had to take a sick day from work in order to recover. The blue screen works in different ways for different people and circumstances. Sometimes, it can keep you from doing a simple but undesirable task for weeks or months. Sometimes, you get so overwhelmed that you can’t do anything at all – including eat, go to the bathroom, or even move your extremities. Biles seemed to be in another related state, where you can do some challenging things with great polish (such as talk to the press) but are blocked on other activities that are normally a breeze.
Tuesday, it was clear that Biles was experiencing that kind of block on her vaults, as she repeatedly set up for an Amanar with 2.5 twists and opened in the air to complete only 1.5 twists, both in warmup and in competition. On the Gymcastic podcast recap of the event, they discussed “the twisties,” a mental block where you lose a sense of your body’s rotation in the air. They said that most gymnasts experience this from time to time, and sometimes for long stretches before they can break out of it; it’s a common phenomenon for figure skaters as well. Rotating quickly messes with proprioception, the body’s sense of its position and orientation, in much the same way that loud noises disrupt your hearing in the moment but can also make your ears ring for the rest of the day. A bad ADHD day will often interfere with my proprioception: I’ll be clumsier, and I’ll have trouble completing yoga and stretching routines that are normally easy because it’s harder to discern the relative placement of my limbs and the limits of their movement. If Biles is having an ADHD crisis, it’s very plausible to me that her mental health is dampening her proprioceptive sense and making it difficult for her to rotate in the air.
Another factor that could be affecting Biles is rejection-sensitive dysphoria, or RSD. People with ADHD are hit harder by negativity than neurotypical people: not only an outright insult but a well-meant piece of constructive criticism or a low but fair score from the judges can crash our self-worth disproportionately and recur as an intrusive thought for decades to come. It’s unclear how RSD relates to executive function, but research has shown that almost all people with ADHD experience it to some degree. I’m very introverted, so when RSD hits me, I protect myself by getting away from other people and meditating to prevent the intrusive thoughts from sticking in my memory. (Yes, meditation is way harder when you have ADHD, and yes, it’s impossible for a lot of people with ADHD to learn it well enough to use it as a tool, and yes, it is the only thing more effective for me than medication in preventing ADHD-induced acute anxiety.) But when my more extraverted friends with ADHD struggle with RSD, they often need to be bathed in affirmation and positivity from others to help get their perspective and motivation back. The Gymcastic hosts have discussed the eerie feeling of isolation at the Tokyo Olympics, with no spectators in the stands and severely restricted movement for athletes. Biles said in her NBC interview that the lack of an audience was one of the factors throwing her off her groove and increasing her stress. With no one cheering for her, Biles loses a powerful mechanism for controlling her RSD, and therefore for protecting herself from anxiety and depression.
Biles hasn’t brought up her ADHD as a factor in her mental health challenges this week, and that makes sense. With the widespread negative cultural perception of ADHD and lack of understanding of its effects on adults’ daily lives and reactions to extraordinary events, she’s avoiding making it sound like an excuse. However, for me as a fan and sports writer who seems to have a similar kind of ADHD to Biles, it’s important to bring ADHD into the conversation about her mental health. So much of the positive press and social media discussion about Biles has focused on the universality of her experience, and how stress and pressure can bring down even the people who seem most composed. But Biles has a disability that makes it harder for her to negotiate stress and pressure, and we need to figure that into the equation when we talk about our respect and admiration for her decision to protect her mental and physical well-being. Biles’s journey this week has illustrated the extent to which the brain is a body part. Like any other vital organ, it sometimes needs rest in order to heal. Acknowledging that makes Biles – and all of us – stronger in the long run.