Raising Awareness of ADHD-Having Adults
Until 2000, we didn’t really believe adults had ADHD. It turns out that as people get older, they typically become less hyperactive. Since this is the key symptom that people use to diagnose ADHD – attention deficit hyperactivity disorder – we used to believe adults didn’t have it.
But it turns out they do. Around 5% of adults have ADHD, but most don’t have physical hyperactivity, but rather a sense of restlessness or need to always be doing something new/exciting. They have ADD, or attention deficit disorder. We used to believe that adults outgrew ADHD. Again, this was because the typical hyperactivity symptom diminishes with age. It turns out that up to 50% of kids who have ADHD will also have it in some significant form as an adult.
Importantly, people think they stop being ADHD. If asked at age 20, a very significant amount of people who had ADHD as kids will say they no longer have it. When asked again at age 27, many of those realize that they still have it, and only thought it was gone. Doctors don’t know how to diagnose adult ADD/ADHD. In one study of 400 primary care physicians, they referred patients to a specialist for depression only 2% of the time. So 98% of the time, they were confident in diagnosing depression. In contrast, half didn’t feel confident in diagnosing adult ADHD, and 66% of the time the doctor referred people who they thought had it to specialists.
Now, this isn’t to say that a primary care physician’s role is that of the psychiatrist. Society, unfortunately, due to economic and social constraints, have them play that role for many sociological conditions. So they are doing so, and are comfortable diagnosing ADHD in a kid, when, arguably, there is a lot more at risk. They aren’t comfortable diagnosing adult ADHD because of there still aren’t clear guidelines for doing so. The DSM, which is “the book” in diagnosing psychiatric conditions, is written for kids. The diagnostic criteria simply do not work in adults for multiple reasons, as discussed earlier in this booklet.
Adults with ADHD don’t get help. Only around 10% of adults with ADD/ADHD received treatment in the past year. This is important because up to half of the people with ADHD also experience depression and/or serious anxiety issues. Because the treatment works fairly well, quickly and can be life-changing for those who get it – and those who live, work and spend time with them – this is a serious public health issue.
A lot of people believe, If someone is successful, they can’t have ADHD. Or, if someone is at Harvard they obviously don’t have ADHD. This simply isn’t true. Adults can learn to compensate behaviors that shield their symptoms. For their chronic disorganization, for instance, they may rely on an assistant or their spouse. In fact, when able to control the negative aspects, people with ADHD can be extremely successful. They make great entrepreneurs, artists, and visionaries because they don’t focus on the small details but rather what excites them – the big picture, helping people, drawing an amazing picture.
We don’t have a good “testing ground” for ADHD in adults. For kids, everyone has to sit through many years of school, which requires extended concentration in stuff that, frankly, isn’t always interesting. This environment is perfect for making people with ADHD struggle. Their problems cause noticeable issues, so they get help. Adults, however, don’t have that. If a job is getting boring or takes too much concentration, you can always switch. And you don’t have parents to judge or force you to take a socially accepted road. This means that, rather than deal with the underlying ADHD problem, adults with it might just find compensating behaviors that may or may not be helpful to some degree (switching jobs, probably not so good. Having an assistant, probably good – for anyone!)
The symptoms of ADHD can be very subtle. People with prominently inattentive symptoms may simply just seem too much of a pushover or eager to please. Someone with ADHD might be doing just fine at their job, but never get round to passing a certification test for a promotion. A key thing to look at is, is someone performing significantly worse than they should for no reason? For instance, has an adult with an IQ of 143 been stuck for several years at an entry-level position? (Or does a student with great smarts and desire to do well get C’s and D’s in college?)
ADHD seems to go away sometimes. When you have one day to finish a proposal, you might seem like you have incredible focus. When you’re selling to a new prospect, you might be able to talk and listen perfectly – as if all your concentration is fully engaged with understanding them by relating to them so you can sell. When you are under a lot of pressure, highly caffeinated, or simply really enjoy something, it probably doesn’t seem like you have any attention issues at all. Unfortunately, most of life is relaxed and not high pressure, and it is in non “do-or-die” situations that your problem emerges.
Denial and overconfidence. Some people exhibit the negative lifestyle outcomes of ADHD (underperformance, mild to serious depression, anxiety at performing extended periods of concentration, too many friendships/relationships, inability to settle down, follow a directed path – and so on) but don’t believe they might have it. They may feel that in general, they are doing too well to have that disorder, or that ADHD is a savvy creation of marketing wizards. (Now, their skepticism is for very good reason. Drug companies do spend a significant amount of money on marketing conditions to indirectly sell their drugs, and we simply must not ignore the influence they have on how we think about health and conditions). Making it harder, people with ADHD are, like most people, but perhaps a little more so, inclined to be overconfident. This may in part be caused by a short memory, high energy level, and strengthen resilience. Unfortunately, they may be firm in their belief that they don’t have issues to deal with – even as they go through friendships, relationships, and jobs at a quick rate, or suffer from anxiety, depression or other problems.
They might, for instance, if you forced them to take an ADHD self-diagnostic test (and got truthful answers!) respond positive to many of the symptoms – but then quickly argue that it’s just normal. As we will discuss, yes, the symptoms of ADHD are arguably all normal – but not when they’re present as a cluster, persistent, chronic, and present significant life problems. Additionally, trying to talk about a difficult subject with someone with ADHD can backfire. They might throw the idea out offhand, not even thinking about it.
In conclusion, people don’t know what ADHD in adults looks like. If you happen to worry about the problems in your life, you may hit the web and look up the symptoms. “ADHD” – needs to have, XYX. “Well, I’m not that hyper, really.” Or you may justifiably be concerned that the condition is based off normal human experiences. If you discuss your concerns with their primary doctor, he is much more likely than not to not realize what it is. And people aren’t always very ADHD in the doctor’s office! If you see a shrink, and they don’t realize it’s ADHD, treatment may have little to no benefit. Your sessions may consist of conversations about irrelevant topics, or you simply might not think of anything to say. And you might get mood stabilizers because you may seem like you have bipolar disorder (with your mood and energy fluctuations) or antidepressants. Antidepressants are not a bad idea – when depression is a serious problem in and of itself. People with ADHD, however, tend to be depressed because of the failures and challenges in their lives. For many, to be happy they have to change those outcomes for the better.
The end result? Many years of frustration and way too many unexplained failures (“What happened to that project you were working on?” Excited look. “Oh, I started something much more interesting!”) You may get stuck in a life pattern that is simply not fun, enjoyable or productive.
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