Adult ADHD

Most of the talk and research about ADHD has been directed towards children with little more than passing reference to adult ADHD. Most adults with ADHD do not look like the typical depiction in childhood. Typically, but not always, as kids with ADHD mature into adolescence, the hyperactive symptoms diminish. But, for some people, adult ADHD continues to cause significant adult problems. 

Unfortunately, many adults were never diagnosed early in life. I've seen a number of cases where parents were simply told that their children were “just very active” or that they were doing poorly because they were suffering from childhood depression, or that their children could do better if they just "applied themselves.” Furthermore, some adults were not recognized because they simply flew under the radar. This can happen if superior intelligence allows them to learn — even to the point, sometimes, of doing quite well in school. However, ADHD does strike people of all IQs. 

As a child psychiatrist, I have seen a number of adults who diagnosed themselves virtually by accident after their own children were diagnosed. Once parents become familiar with what the disorder looks like in their own kids, they sometimes say to me, “Hey, I think I might have that, too.” Do not underestimate how damaging adult ADHD can be, even though sometimes such an adult may seem to be functioning reasonably well. Some with ADHD even function at a very high level without treatment. 

Mr. T was a 40 year-old man who came to see me for depression and marital problems. He was an executive in a research company and was earning $500,000 a year before his treatment with me. We worked together on problems for which he had come. But early on, I told him that I thought he also had ADHD. Mr. T chose not to treat ADHD even though he agreed that he had it. After a year together, he said to me, “Let’s treat it.” Soon afterwards, he came into the office, smiling. “It’s really amazing,” he said, “Two-hour meetings now take half an hour.” Today Mr. T no longer works for that company. He owns his own company. 

Tom came to me as a senior in college with a 4.0 grade point average (straight As). He, too, had achieved this without any treatment. The major problem he identified was that he could be difficult in relationships with others. Tom had enough symptoms of distractibility and impulsivity to make the diagnosis of ADHD. We treated it. He went on to marry and now has a good job. However, if you broach the subject of Tom’s stopping medication, his wife will fight with you. She knows that he is much easier to live with on medication. He has more patience and better frustration tolerance. One day, I received a frantic call from Tom’s wife that Tom was at the airport about to leave on a business trip. He had called her because he couldn’t find his medicine. Now, you might think that with straight As in college, without medication, he would be able to handle a 5-day business trip, also without medication. But both Tom and his wife know the difference when Tom is off medication. By the time I returned his wife’s call, Tom was already in the air over the Atlantic Ocean. I asked that Tom speak with a doctor in London and ask for a short 5-day supply of medicine. He did that, and all turned out well. What is impressive is how clear it was to both of them - that Tom would have an entirely different experience without medication. 

Roy entered my office, well-dressed, wearing a tie and sports jacket. He said his mother was a psychologist and that he had graduated from college with top honors - summa cum laude. He also suspected that he had ADHD. He explained that he always knew he was very smart. But as he advanced in school, the work became more demanding. He invented his own system, a kind of 'lazy Susan', in which he could get himself to do math for five minutes, then history for five minutes, then English, and so on. Eventually he would get back to math and, in sequence, each of the other subjects. He managed to complete his work. He did very well. After graduation he obtained a good job and did well. The reason he sought help was that he had recently been promoted, and he couldn’t find a 'lazy Susan' to keep track of the increased responsibilities that accompanied his promotion. I agreed with his diagnosis, and we treated Roy. He went on to succeed and received yet another promotion. 

Mrs. M also flew under the radar. She was a 29 year-old woman who has had a successful career as a fundraiser in addition to previously having held an administrative position in state government. Her charm, beauty, and intelligence personality had carried her far. She had never manifested behavior problems and was generally thought of as a lovely, kind, and generous woman. However, she manifested subtle symptoms. Although quite intelligent, she had never completed college, finding it difficult to apply herself to serious studying. Her loving husband described her as maddeningly distractible. He would be talking with her, and she would notice a spot on his clothing or some aspect of his appearance, which would catch her attention, often leaving him feeling that she wasn’t paying attention to him. Actually, she was paying attention, but focusing on to what caught her attention - not necessarily on what he was saying. He understood from our sessions that her focus on what caught her attention did not mean he was unimportant to her. But despite this knowledge, he couldn’t help feeling rejected every time she seemed distracted by something while he would speak with her. Friends and acquaintances, too, sometimes commented that she seemed to ignore them. Her seeming inattention created the mistaken impression that Mrs. M didn’t like them or that she was stuck-up.

Her husband adored Mrs. M. He held her on a pedestal for her beauty and kind and considerate nature. But he found her paradoxical. He reported one incident in which she was driving behind someone who slowed before a fork in the road. Normally very considerate, Mrs. M aggressively honked at the driver. This took Mr. M aback. “Give him a break,” her husband said. “He’s probably just not sure which fork to take.” This was an example of her impulsivity and difficulty waiting. Another example involved her waiting for red lights to change. She would sometimes conclude the light was broken. In a moment, however the light would turn green. “She really has a problem with patience,” he said. “She can't just wait. It causes problems.” At bedtime, Mrs. M had difficulty sleeping. But she had discovered that having the television on made it easier for her to fall asleep. Without the television, her mind would flit from thought to thought, keeping her awake. Commonly unappreciated is that stimulant medication may, but does not necessarily, keep someone with ADHD awake. In Mrs. M’s case, the medication resulted in being able to lie quietly in bed and fall asleep without racing thoughts. She also now had more patience, and, to her husband’s delight, was less distractible when they spoke. 

The foregoing are all stories of high-functioning adults with ADHD who had still managed to do well in life. But adults with ADHD sometimes do not do well. Adults with ADHD often find it difficult to organize and plan ahead, and they easily forget appointments and deadlines. Many struggle to hold down traditional 9 to 5 jobs. Problems generally occur when they cannot find something to hold their interest, which can lead to distractibility, sometimes to substance abuse, and even depression when they fail to fulfill traditional responsibilities. ADHD is not something you only have only as a child. If you have ADHD, you have it all day, seven days a week – and probably all your life. It can severely undermine the quality of life.

Adults with ADHD have higher rates of divorce and marital problems. ADHD adults can be fine, upstanding citizens. But they tend, often, to hold two jobs in their effort to support their families. ADHD undermines functioning, education, attention to detail, patience, and income. Adults with ADHD also have more accidents and wind up in the emergency room more. They are more likely to have driving violations such as being cited for speeding, having their licenses suspended, and being involved in more crashes. They are also more vulnerable to drug and alcohol problems. However, when properly diagnosed and treated, much of this functional impairment can significantly improve.