“It’s ADHD, that’s what I have,” my friend Ann told me some years ago. She made the announcement with a combination of enthusiasm and relief, as if getting diagnosed with ADHD were the beginning of the end of years of anxiety and frustration — which, in fact, it was.
I had never heard of such a thing. I did know Ann was remarkably creative, that she often jumped from one idea to another, lost her house keys with regularity, frequently left things undone, pushed herself to achieve and was famous for juggling three or four projects at once. By now, almost everyone in the country knows someone (or is someone) with a similar combination of traits, and almost everyone has heard of ADHD.
The symptoms of adult attention-deficit hyperactivity disorder seem to describe half the people in New York City (and elsewhere): restlessness, impatience, impulsivity, procrastination, chronic lateness, and difficulty getting organized, focusing and finishing tasks.
How do you know you have ADHD, which experts compare to having a mind like a pinball, with thoughts flitting in multiple directions. Maybe you’re just overcaffeinated and overworked? And if you do have it, will there be a stigma? Should you try medication? Will it work?
Parents of children with suspected ADHD face a myriad of similar questions. But the concerns can be just as troubling for adults, whose ADHD often goes unrecognized.
An estimated 8% of U.S. children have ADHD, which is also known as ADD, for attention-deficit disorder, and some 50% of them outgrow it, according to government data. About 4.4% of U.S. adults—some 10 million people—also have ADHD and less than one-quarter of them are aware of it.
That’s because while ADHD always starts in childhood, according to official diagnostic criteria, many adults with the disorder went unnoticed when they were young. And it’s only been since the 1980s that therapists even recognized the disorder could persist in adults.
Even now, getting an accurate diagnosis is tricky. Some experts think that too many adults—and children—are being put on medications for ADHD, often by doctors with little experience with the disorder. Others think that many more people could benefit from ADHD drugs and behavioral therapy.
Ann considers herself one of the lucky ones. She was diagnosed relatively early (although the disorder undoubtedly caused a long list of problems that might well have been avoided) and settled into a drug regimen that has made life greatly more livable for decades. It does not appear she had other problems that often accompany ADHD, as Wall Street Journal health writer Melinda Beck explains in an informative ‘Personal Journal’ article this week.
Complicating the picture further, ADHD frequently goes hand in hand with depression, anxiety and bipolar disorder, and it can be difficult to untangle which came first. “It’s very common for someone to be treated for depression or anxiety for years, and have the therapist not notice the ADHD,” says Mary Solanto, director of the AD/HD Center at the Mount Sinai Medical Center in New York City. But adults whose ADHD is left untreated face a high incidence of substance abuse, automobile accidents, difficultly staying employed and maintaining relationships.
That said, some adults with ADHD are highly intelligent, energetic, charismatic and creative, and are able to focus intently on a narrow range of topics that interest them. David Neeleman, the founder of JetBlue Airways, and Paul Orfalea, founder of Kinko’s, have spoken out about how the disorder helped them come up with innovative ideas for their corporations, despite their having done poorly in school.
“It’s amazing how successful some people are able to be despite these symptoms, and some people are totally paralyzed—there’s a whole spectrum of outcomes,” says Ivan K. Goldberg, a psychiatrist in New York City who co-developed a commonly used screening test.
Generally, ADHD can make life very difficult. It’s thought to be an imbalance in neurotransmitters, the chemical messengers that relay signals in the brain, particularly in the frontal cortex that governs planning and impulse control. Children with the disorder, particularly boys, are likely to be hyperactive, with an intense need to move constantly, which can interfere with learning. (Girls tend to be talkative and dreamy, but they are often overlooked because they aren’t as disruptive.)
Adults more typically have trouble with paying attention, focusing and prioritizing. Managing time and money are particularly difficult.
“What it really is is a disturbance of the executive functions of the brain — it’s the inability to plan things, to initiate them at the appropriate time, not to skip any of the steps and to terminate them at the appropriate time,” says Dr. Goldberg. “An awful lot of these people are very bright but they can’t keep it together. They keep screwing things up.”
It’s that last line that gets the attention of us all. Some of us screw things up more often than others — and wonder if we could blame it on ADHD. Identifying, and treating, those who can is a bright-spot possibility of the future.