(DAVID GOODMAN, MD)
David W. Goodman, MD, is director of the Adult Attention Deficit Disorder Center of Maryland, director of Suburban Psychiatric Associates, and an assistant professor of psychiatry and behavioral sciences at Johns Hopkins University School of Medicine.
Q: My child was just diagnosed with ADHD and I notice that I have similar symptoms. Should I get checked out?
A: Yes. ADHD does run in families, and about 75% of the cause is genetic. If you have a child with ADHD, theres a 30% to 40% chance that either parent has it. Often, this is when adults first realize they have ADHDtheyre able to finally pinpoint whats been at the root of their lifelong difficulty of getting things done like everyone else.
Q: How common is ADHD in adults? I thought it was just something you grow out of after childhood.
A: According to the largest U.S. survey, 9 to 10 million adults have attention deficit hyperactivity disorder (ADHD). Onset of symptoms only starts in childhood, meaning it cant just develop when youre older. If you werent diagnosed as a child, in order to have the condition as an adult, you should be able to recall consistently suffering from symptoms, like an inability to focus or constant disorganization, throughout most of your life. We know from following ADHD children for 10 to 20 years that up to 65% will continue to have ADHD symptoms to an impairing degree into adulthood.
Q: But is this really a medical condition? Can't some people just be more fidgety or less motivated than other?
A: As with clinical depression, it is easy to discount psychological symptoms because, "Dont we all have a little of this?" It is important for the public to understand that when psychiatrists are discussing these disorders, there are a specific grouping of symptoms and that extensive medical research supports the validity of these conditions. In regards to adult ADHD, the research has only developed over the last 20 years after following ADHD children for 10 to 20 years to see how they develop.
Physicians generally have not been formally trained on adult ADHD in medical school, and many have difficulty identifying the disorder in patients. Because there are no blood tests or X-rays that can make psychiatric diagnoses, the criticism is, "Its all made up". But I'm hopeful that with other medical diseases, in due time psychiatric disorders will be better defined by genetics and brain imaging.
Q: What are common symptoms of ADHD?
A: Chronic inattention, distraction, and disorganization that impair your ability to function on the job or at home. As an adult with ADHD, you may often show up late to office meetings, have poor time management skills, or often misplace paperseven though you are genuinely trying to keep it together. In a staff meeting, you might zone in and out of the conversation, get up every 10 minutes, and constantly fidget with your pen. At home, maybe you frequently lose your keys, get your kids to school late, and forget to give them their lunch, sign off on papers, or pick them up at school.
Q: Im not succeeding at work. Is this because of my ADHD?
A: Coworkers or supervisors may brand you as lazy or unmotivated because you dont get your work done on time. Despite intelligence, if youre an adult with ADHD, you find that it takes you much longer to get tasks completed. Or, you may race through a project just to get it done and make a lot of careless mistakes.
Adults with ADHD are more likely to lose their jobs. In fact, they hold 50% to 75% more jobs over a course of a 10-year period than average. And, they make on average $10,000 a year less. Seeking proper treatment will likely improve job performance.
Next Page: But is ADHD actually dangerous?
[ pagebreak ] Q: But is ADHD actually dangerous?
A: We know that teens and young adults with untreated ADHD have higher risks of driving accidents and unwanted pregnancies. They also are more likely than non-ADHD adults to have anxiety disorders, obsessive-compulsive disorder, bipolar disorder, and depression. Because structured schoolwork requires intense concentration, high school students with ADHD are less likely to graduate, go to college, or to graduate college if they do go. And about 50% of ADHD adults will have or have had a history of substance or alcohol abuse.
Q: My friend says that she occasionally forgets things or gets distracted, too. When do I know its serious enough to see my doctor?
A: Everyones forgetful or scatterbrained on occasion. Adults with ADHD experience it so consistently that it creates ongoing problems in their lives. Essential to the diagnosis is the existence of these symptoms since childhood and the persistence of symptoms every day of your life. If you have a lifelong history of inattention, disorganization, and inability to complete tasks at the same level as your peers, then you should see your doctor.
Q: How will my doctor diagnose me?
A: You and your physician will have a conversation about your current symptoms and will also establish if you had them as a child. Then youll talk about your family psychiatric history to determine if any immediate family members have or show signs of the condition. If youre curious about what your physician may ask or want to learn more about your symptoms, many doctors use the World Health Organizations Adult ADHD Self-Report Scale as part of their evaluation.
Q: People are always telling me that I should be on meds. Are drugs necessary?
A: It depends on your lifestyle. If, for example, youre an accountant and need to maintain a sharp focus all day, then meds would be critical. Usually we prescribe long-acting, once daily stimulant medication, which alter your brain chemistry so that you can sustain attention, be better organized, and have better recall, making daily tasks much easier. The difference is similar to wearing glasses when you have blurred vision. Its a night and day difference.
Of course, there are pros and cons to all medications. Trying out a med will give you the chance to see how much of an improvement it can make on your life. The drugs are also long-acting, allowing you to take one dose that lasts 8 to 12 hours. However, they do have side effects, like dry mouth, difficulty sleeping, decreased appetite, and cardiovascular risks. Your physician should monitor your blood pressure and pulse while taking them.
Next Page: What other treatments are available?
[ pagebreak ] Q: What other treatments are available?
A: Behavioral therapy will help you learn how to deal with symptoms. For example, we teach organizational techniques using day planners, list-making, and visual reminders (like Post-its), in order to allow you to manage work tasks and household chores better. I find that combination therapywith medication and behavioral techniquesworks best.
Q: My spouse and I are having marital problems. Could this be related to my ADHD?
A: Yes. The rate of divorce is two times higher than the general public when one partner has ADHD. Your spouse may complain that youre unreliable, inattentive, and constantly distracted, causing a host of conflicts. In treatment, well bring your spouse in and explain the condition so he/she can understand it. Well also teach you how to organize and run the household more productively, which often helps to dissipate tension and improve the relationship.
Q: Will treatment really help me?
A: Adult ADHD is one of the most responsive disorders to treatment, and patients are generally very receptive to the program. ADHD sufferers may have very low self-esteem because the environment has always been critical of their unsatisfactory performance. In only six to nine months of treatment, many notice their self-image has improved tremendously. They identify themselves as smart, not lazy, and find out that they can be productive. They dont have to muddle through life anymore. Thats when we see them blossom.
Q: I never had attention problems growing up, but recently Ive been restless, unable to finish my work, and suddenly forgetful. Could this be ADHD?
A: Probably not. One of the main characteristics of ADHD is that it appears in childhood; most people can remember symptoms dating back to age 7 to 12. Its not something you can catch or grow into later in life. However, you may have undiagnosed ADHD and muddle through life until your environment changes and you are presented with greater demands and responsibilitiesa new job, increased academic demands, getting married, having children.
There are other considerations in evaluating a change in mental abilities: Could you be depressed about something? Are you taking any medications that may be causing these unwanted side effects? If you cant pinpoint the cause that easily, talk to your doctor to rule out more serious medical issues.
Q: Am I ever too old for an ADHD diagnosis and treatment?
A: In our practice, we see ADHD patients ages 16 to 65. Most, if not all, patients elect to try medications to evaluate their benefit and comfort. For adults, there are medical considerations to prescribing ADHD medications that I discuss with patients. Commonly patients are taking other medications and a review of safety is needed whenever combining medications.
Why bother treating older patients who have lived their whole life with ADHD? Because everyone is entitled to see how much better they can function when relieved of ADHD symptoms.