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Adult ADHD: An Overlooked Problem

According to the National Institute of Mental Health, ADHD is "one of the most common mental disorders in children and adolescents, [and] affects an estimated 4.1 percent of youths ages 9 to 17 in a 6-month period." What is not as well known is that ADHD has been estimated to affect 2-4 percent of our adult population. However, this adult ADHD statistic may even be higher, given the fact that many adult ADHD cases may be undiagnosed or misdiagnosed because ADHD characteristics can mimic other disorders, such as anxiety disorder or the manic phase of bipolar disorder. Most often, an adult is only diagnosed with ADHD when, as a parent, (s)he finds out that his/her child has ADHD and, in thinking back over his/her own life, the prevalence of ADHD characteristics can be seen as well.

According to CHADD (Children and Adults with Attention Deficit Hyperactivity Disorder), growing up with undiagnosed ADHD can cause devastating effects in adulthood. For some, the recognition of ADHD and the understanding that follows an evaluation can be a source of healing, can put things in perspective, and can offer a better understanding of the reasons for a variety of lifelong symptoms.

This was true in my own case. I was 35 years old, a mother of four boys, and had gone back to college to get my degree in Respiratory Care. My 11-year-old son, CJ, was diagnosed with ADHD. He was placed on medication, and I saw a complete turnaround in him-not just academically, but emotionally and behaviorally as well.

At that time, I had been struggling with my college courses, failing and frustrated. I went to the college dean to quit but, instead, he sent me for a battery of psycho-educational testing. At the same time CJ was diagnosed, I was told that I had ADHD myself.

My first reaction was, "You've got to be kidding! I am the most tired person I know!" But as the therapist explained things to me, I realized that ADHD explained so many things about my life. One of the tests was an IQ test. When she told me how smart I really was, I actually cried. I had kept it a secret and suffered in silence all those years in school, thinking I was so stupid, having to work twice as hard as any of the other students, always so scared that someone would find out how dumb I really was and make fun of me.

School was always so hard for me. I couldn't ever seem to concentrate, and no matter how much I studied, I just couldn't remember anything for very long. Every single little obsessively repetitive pen click, pencil tap on desk, absent-minded humming, murmuring under their breath, whispering to each other, passing of notes, page turning, yawning, sneezing, coughing, foot tapping, or other incessant, repeated, unconscious behavior by another student would not only drive me to distraction, it would drive me absolutely crazy!

Taking tests was awful for me-for, more often than not, I'd find my mind drifting to the clock, the window, the teacher…anything but the paper on my desk. Those repetitive behaviors of the other students would make me so angry I couldn't concentrate on the test at all. In fact, I ended up with what they call "Test Anxiety." I didn't do any of this on purpose-it just happened-no matter how hard I tried! And all of the "You could do better if you just applied yourself" comments in the world only made me even more frustrated and depressed.

Later, as an adult, I had trouble making decisions. Either that, or they would be rash decisions. I was just so impulsive! Rushing into things head-on, not taking time to consider the consequences. And talk? Gosh, you couldn't get me to shut up at times! And I interrupted people all the time. Work was a near impossible situation for me. I could never complete a project I had started, either being enthusiastic at the beginning and becoming too easily distracted by something else, or getting too caught up in details. I hated the way I was, but I couldn't seem to help myself, either.

At the time I took the battery of psycho-educational testing, I had fallen to the bottom of my college class. I was halfway through my respiratory care program, and had made the decision to quit school. With the diagnosis of ADHD, however, I was put on medication and, per ADA (Americans with Disabilities Act) guidelines, accommodations were made for me. One year later, I graduated in the top of my class, with a college degree in Respiratory Care. In fact, I was hired as a Respiratory Therapist even before I actually received my degree, based on my high grades and recommendations of my clinical supervisors.

The most amazing thing of all, though, was this: After receiving their college degree, Respiratory Therapists are then required to pass a National Board Exam in order to be a professional therapist so, along with hundreds of other people, I had to take that exam. With the help of medication and test-taking accommodations, I was not only able to take the exam (in spite of my test-taking anxiety), but I passed the exam with flying colors!

The difference the diagnosis of ADHD made in my life was not only academic, however. My self-esteem improved parallel with my ability to focus. As I started being able to complete projects, I started feeling better and better about myself. Having a clean house for the first time in my life was such an accomplishment! My whole world turned completely around. The only thing I felt bad about was that I had not been diagnosed earlier, and that I had had to suffer so many years in silence, believing that there was something fundamentally wrong with me.

In my research I found out that it is common for adults with ADHD to think of themselves negatively-to believe that they are lazy (not trying hard enough), stupid, or even crazy. But, just as I myself found out, the right diagnosis and effective treatment can help improve your self-esteem; your ability to learn and perform at work; your relationships and home life.

Adults with ADHD are protected under the Americans with Disabilities Act (ADA), which "prohibits discrimination in employment and public school settings against any individual who has a physical or mental impairment." It also says that employers and schools have to make certain accommodations for the disabled. I used this act to have the college make accommodations for me so that I was better able to focus, to learn in a way that I could learn, to take tests separate from my classmates so that I would not be distracted, etc. I also used it to help CJ get the accommodations he needed in school.

Because ADHD can have such a significant impact on ability to function at home, school and work, the first step is getting properly diagnosed. A correct diagnosis of ADHD can help explain many things. When I was first told I had ADHD, it was as if the psychologist had been living in my home herself! My mouth hung open as she described how I would start to clean my living room, pick up a dirty glass, take in into the kitchen, find a dirty towel, take that to the laundry room, think to start the laundry, go through the house picking up laundry, then get distracted again so that neither the laundry nor the dishes ever get done…well, you get the picture!

Points to consider that will help ensure a correct diagnosis of ADHD include the following:

• Ruling out other disorders such as depression, anxiety disorder, bipolar disorder, substance abuse, learning disabilities, etc.
• School, work, and social experiences.
• Information from family, friends, significant others, and employers.

Since ADHD cannot be determined by a simple blood test or physical evaluation, the definitive diagnosis of ADHD should only be made after symptoms of ADHD have persisted over an extended period of time, and also that symptoms of ADHD interfere with a person's ability to function. At that point, a thorough evaluation by a doctor experienced in ADHD diagnosis and treatment may be necessary. Also, a psycho-educational evaluation can rule out associated learning disabilities and other illnesses.

The following is the diagnostic criteria contained in the publication of the American Psychiatric Association known as the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) for ADHD:

A. Either (1) or (2)

1. Six (or more) of the following symptoms of inattention have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level:

Inattention

• often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities
• often has difficulty sustaining attention in tasks or play activities
• often does not seem to listen when spoken to directly
• often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to Oppositional behavior or failure to understand instructions)
• often has difficulty organizing tasks and activities
• often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework)
• often loses things necessary for tasks or activities (e.g. toys, school assignments, pencils, books, or tools)
• is often easily distracted by extraneous stimuli

2. Six (or more) of the following symptoms of hyperactivity-Impulsivity have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level.

Hyperactivity

• often fidgets with hands or feet or squirms in seat
• often leaves seat in classroom or in other situations in which remaining seated is expected
• often runs about or climbs excessively in situations in which it is inappropriate (in adolescents or adults, may be limited to subjective feelings of restlessness)
• often has difficulty playing or engaging in leisure activities quietly
• is often "on the go" or often acts as if "driven by a motor"
• often talks excessively

Impulsivity

• often blurts out answers before questions have been completed
• often has difficulty awaiting turn
• often interrupts or intrudes on others (e.g. butts into conversations or games)

B. Some hyperactive-impulsive or inattentive symptoms that caused impairment were present before age 7 years.

C. Some impairment from the symptoms is present in two or more settings (e.g. at school or work and at home).

D. There must be clear evidence of clinically significant impairment in social, academic, or occupational functioning.

E. The symptoms do not occur exclusively during the course of a Pervasive Developmental Disorder, Schizophrenia, or other Psychotic Disorder and are not better accounted for by another mental disorder (e.g. Mood Disorder, Anxiety Disorder, Dissociative Disorder, or a Personality Disorder).

Characteristics of ADHD in adults differ in some ways than ADHD in children. For instance, adults aren't necessarily bouncing off the walls. But there a lot of impulsive behaviors - frivolous spending, impulsive driving, rash decisions, and difficulty focusing.

Problems of adult ADHD can also include:

• chronic lateness and forgetfulness
• anxiety
• low self-esteem
• employment problems
• difficulty controlling anger
• substance abuse or addiction
• poor organizational skills
• procrastination
• difficulty completing projects
• difficulty concentrating in general
• difficulty concentrating when reading
• mood swings
• depression.

Although there is currently no cure for ADHD, there are effective treatments that can help manage ADHD symptoms. The greatest improvement in the symptoms of ADHD results from treatment with stimulant medication combined with counseling. However, just as there is no single test to diagnose ADHD, no single treatment approach is right for everyone. A treatment plan should be tailored to the individual. In addition, an individual can develop coping skills adapted to his/her own needs.

About the Author

Michele Soloway has dealt with bipolar disorder from a very young age. Her grandmother, mother, herself, and her teenage son all have the disorder. She also lost her sister to suicide because of bipolar disorder. Michele has a blog for bipolar survivors at http://bipolarsurvivor.blogspot.com, and is also a contributing writer to www.bipolarcentral.com.

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