Are you an adult with ADHD?
Sept. 9, 2004
By Jane Weaver, Health Editor, MSNBC
Many grown-ups with attention deficit disorder don't realize it
Evelyn Green was in her mid-30s when doctors told her that her young son, Perry, had attention deficit disorder. The real surprise came, however, when she began to research the condition. She recognized not only the 7-year-old boy's inattentive and disorganized behavior: She saw herself.
“I realized the symptoms and characteristics he had, I had gone through,” she says. “A lot of what I was seeing in him were things I had experienced.”
Green began to realize that her lifelong difficulties with paying bills on time, her inability to balance her checkbook, and her habit of losing her keys were connected to a brain malfunction called attention deficit/hyperactivity disorder, or ADHD.
Despite being a mother juggling a full-time job while earning two master’s degrees, Green couldn’t handle the normal little things that other people do every day. Her household was "chaotic."
'I just thought I was a failure'
“I didn’t know I had ADHD,” she says. “I just thought I was a failure."
After Perry's diagnosis, she knew she was living with a neurological condition that affected her son, herself and mostly likely her father, now deceased.
Long thought to be a condition of childhood that kids grow out of, recent research shows that up to 60 percent of children with ADHD continue having symptoms after they become adults.
It's a common chronic disorder that affects about eight million grown-ups, or an estimated four to five percent of the U.S. adult population, according to researchers from Harvard Medical School and the World Health Organization. What's surprising is that only about 20 percent of them realize it, experts say.
In an effort to draw attention to the disorder's impact on adults, the Attention Deficit Disorder Association and the U.S. Congress declared Sept. 7 a national awareness day for the condition.
"There are still a lot of medical professionals who think it doesn’t extend into adulthood," says Michele Novotni of the ADDA.
Like Green, a number of adults now in their 30s and 40s had ADHD growing up, but because there wasn't as much awareness of the condition their symptoms weren't recognized.
"There are some people who did not have the classic symptoms as children; they didn't have problems in schools, but they have problems multi-tasking [as adults]," says Dr. Joseph Biederman, chief of pediatric psychopharmacology at Massachusetts General Hospital in Boston and professor of psychiatry at Harvard Medical School.
Problems with work and relationships
Untreated, ADHD can interfere with job performance, personal relationships and social functioning, experts say.
"We know there are many adults out there who were not diagnosed in childhood," says Dr. Lenard Adler, a psychiatrist who teaches at New York University and heads its ADHD program. "They can cope with the symptoms, but it's often at a personal cost."
People with ADHD are more likely to underperform in their jobs, more likely to divorce, abuse substances and have more driving accidents, studies show. Because ADHD is often accompanied by depression or other psychological problems in adults, many psychiatrists consider it a serious, under-treated condition.
ADHD wasn't acknowledged by psychiatrists as a disorder affecting adults until 1987 when screening tests were adapted for grown-ups. Even now, more is known about how the condition affects children than adults. It's unclear why some children grow out of it, although as a person gets older, the brain and the central nervous system mature and develop, doctors note.
Hyperactivity strikes boys three to 10 times more than girls, but adult ADHD affects men and women equally, studies indicate, although doctors are as yet unsure why. Because girls are more likely to have problems paying attention than hyperactivity, they're not as disruptive in classrooms. As a result, the condition is often overlooked in young females, but it's possible that as they grow up, more women seek treatment.
"We're doing studies now to know whether more women are more likely to get treatment than men," says Dr. Ron Kessler, professor of health care policy at Harvard Medical School.
Condition runs in families
As more children are being diagnosed, more parents parents are recognizing the characteristics in themselves and getting screened. Because ADHD runs in families, if a child is diagnosed there is a 40 percent chance one parent has it, says Adler.
Genetics account for 80 percent of ADHD cases, with factors such as exposure to alcohol and tobacco during pregnancy also linked to the condition, says Biederman.
Adults with the disorder are easily distracted, frequently forget appointments and constantly lose things, say experts. Hyperactivity symptoms tend to decrease with age, but adults who may have experienced it as children may fidget frequently, talk excessively and feel an internal restlessness.
Other symptoms can include failure to follow through on instructions or finish tasks, difficulty organizing and inability to pay close attention to details.
"One of the tell-tale signs is when someone has a hard time staying in the conversation with you without interrupting," says Carol Gignoux, a Boston-based executive coach who specializes in working with people with ADHD.
Adults with ADHD often become workaholics, using deadlines as a motivation to get through complex projects.
"The structure and routine of work helps them," says Dr. Lawrence Greenhill, a New York psychiatrist. "It's their free time they can't manage."
The busier the better
That's true of Perry Green, Evelyn's 19-year-old son who manages a long day as a student and member of a nationally ranked university debating team.
"When I’m not busy, that’s when I lose focus," he says. "I get depressed when I don’t have anything to do. The busier I am, the more work I get done."
Being a workaholic who forgets appointments? Difficulty organizing schedules? Isn't that a description of a typical modern, stressful life?
Some doctors caution that people shouldn't get caught up in thinking that being easily distracted means they have the disorder.
"Anyone without much trouble can pronounce themselves having ADHD," says Greenhill. "Some people have a deficit if you put them in a situation that requires sedentary learning tasks. But is it impairing to them in another setting?"
There is a distinct difference between having a few stress-related organizational problems and the lifelong, chronic disorder, experts note. Adults with ADHD began having symptoms while they were children and are affected in all areas of their lives.
David Giwerc, a former New York advertising executive, was the kid who couldn't sit still in class, couldn't read a book sitting down and kept getting kicked out of school until age 9 when a teacher suggested he exercise in the gym before school every morning.
But Giwerc didn't know what his problem was until he was in his late 30s and tried to start a business with his father. He couldn't handle daily tasks like planning schedules and handling receipts.
"Things that had been taken care of in the corporate world weren't being taken care of in my own business," says Giwerc. "It affected my relationship with my father."
New treatment options
After being diagnosed and given treatment, Giwerc, 48, became a professional coach for other adults with ADHD and is now president of the Attention Deficit Disorder Association.
"It took years to realize that my inability to focus was [related to the condition]," he says. "After medication, I wasn't as jumpy or impulsive. It was like I could pause."
With improved screening tools, there is growing awareness of the condition in adults. Furthermore, the Food and Drug Administration has approved adult use of drugs such as Adderall, a stimulant similar to Ritalin, which is widely prescribed to children diagnosed with the condition. In early 2003, the FDA approved Straterra, the first non-stimulant medication for adults with the disorder.
The success rate for treatment for adults is considered very good, particularly when accompanied by coaching that provides organizing strategies and techniques for adults with the condition, researchers say.
"The chance of improvement with treatment is significant," says Adler. He describes a participant at the N.Y.U. adult ADHD program who couldn't play with his children because he got too bored.
"After treatment, his interactions with his children were much richer," says Adler. "Those kinds of changes are meaningful."