Adult ADHD: Difficult to Diagnose and Often Misunderstood

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Allan Schwartz, LCSW, Ph.D. was in private practice for more than thirty years. He is a Licensed Clinical Social Worker in the states ...Read More

The National Institute for Mental Health (NIMH) working with Harvard Medical School released the results of a survey on the mental health of the nation. This survey points to the fact that children diagnosed with ADHD continued to have related symptoms as adults. I would add to that the fact that there are many adults who, as children, were never diagnosed with ADHD and that the percentages are higher than those reported.

Why do many adults go undiagnosed with this disorder?


Many children can have Attention Deficit Disorder but without the hyperactivity. The parents of these children are often told, by their school and their teacher that their child is not making enough effort in class. They are also told that if the child tried harder they would get better grades. Parents experience these youngsters as being resistant to and avoidant of doing homework. They do not want to go to school and complain that school is "boring." In class, they are quiet, causing no disruption or interference. It would seem that the old saying that the "squeaky wheel gets the grease"is true because these children are described as cooperative and quiet. Therefore, school officials tend to view them as being lazy and/or not caring. On the other hand, those youngsters with hyperactivity can cause so much disruption in class and at home that they are referred for testing, diagnosis and help.

It has been my experience in private practice that it comes as a surprise for adult patients to learn that they may have ADHD without hyperactivity. Often times, these are bright and motivated people who feel depressed, anxious and confused. They have difficulty achieving social acceptance and both academic and career success. Some go to college, achieve mediocre grades, or drop out of college very early, believing that they are very stupid and that College is not for them. Others have the ability to hyper-focus on those subjects of particular interest to them. Many times, these individuals are able to become doctors, lawyers or achieve other professional status. Yet, they are plagued by symptoms such as losing things, not being able to sleep and having success in their personal relationships.

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These patients often seek treatment for depression and/or marriage problems. In all cases these people miss the necessary social cues that demand they respond in ways that are appropriate and that show interest in the other person. Distracted by their inability to focus their attention, potential partners believe they are just not interested. In this way, many opportunities are lost.

For those who do marry, the relationship is often marked by chronic misunderstanding and arguing. The spouse who does not have ADHD misinterprets their partner’s forgetfulness, and the failure to get things done as laziness and unwillingness to cooperate. As a result the healthy partner feels ignored, disrespected, frustrated and angry. Since these same problems can interfere with work and the ability to make a living, all of these issues are magnified.

Of course, there are plenty of adults with the full ADHD, including the hyperactivity. Their lives are marked by continued impulsive behavior, such as drug abuse, drinking, overspending, extra marital affairs, and what may look like irresponsibility. They also tend to be irritable and quick to get into arguments. It should come as no surprise to learn that many people with ADHD end up having their spouses suing for divorce.

The diagnosis of ADHD among these adults is often met with great relief. Finally, there is an explanation for troubles that began during childhood and for which there was no explanation. People who have spent years feeling bad about themselves and believing that they were useless now have new hope for a better life.

One of the interesting facets of adult ADHD is that some individuals discover they may have the diagnosis by accident. Adderall is now one of the drugs used to treat both children and adults with ADHD. Because Adderall has strong stimulant effects, it has become a drug of abuse on college campuses across the nation. Some individuals with undiagnosed ADHD buy the drug in order to stay awake late into the night while studying for exams. What these individuals discover is that they can focus their attention far better than before they took the drug, in addition to having more energy to study later into the night. Of course, this is not a way to self diagnose ADHD. It is still necessary to be fully tested for the disorder.

Among adults, diagnosing ADHD is more difficult than among children. Its symptoms can be more subtle and can resemble other illnesses, such as anxiety, depression and Bipolar illness. Nevertheless, once correctly diagnosed there are many treatment approaches for adults. Among these are use of the correct medication along with cognitive-behavioral techniques that help the individual learn how to keep organized and efficient while at work and at home. In addition, anti depressant medications are sometimes used to relieve the feelings of depression that often accompany this disorder.

Treating the married couple is also important when a spouse has this disorder. It is important for the spouse to learn about the problem so that they no longer believe they are being ignored. This is not easy as it appears to the husband or wife who does not have the disorder as though it’s all done deliberately. It takes many marital sessions and reading to help the spouse fully understand and to join in helping keep the disorder under control.

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