In my years of practice, many adults who suspect they have ADHD only seek assessment and treatment after years of struggling with the problems caused by the condition. Many come for treatment when they are in their late 30s and early 40s. There are also others who were diagnosed decades ago but never received adequate treatment. Why do so many wait so long, and why does ADHD remain largely unassessed and untreated in the adult population?
The purpose of this post is to address this issue by:
- Discussing, and hopefully correcting misperceptions about assessment methods and available treatments.
- Outlining the advantages to getting your ADHD condition assessed and treated.
Factors and mistaken beliefs preventing people from getting assessed and treated for ADHD:
- The false belief that ADHD affects only children. It used to be thought that ADHD was a condition largely confined to children. However research over the past two decades has demonstrated that over half of children with ADHD grow up to be adults with ADHD. It is even more recent, that this fact has reached the consciousness of the general public, as has awareness on how ADHD affects adults and children differently.
- The erroneous assumption that since there is no cure, nothing can be done and hence no use doing anything. Many adults do not come for assessment because they mistakenly believe that nothing can be done to help the condition. This of course is completely false. While it is true that at present there is no complete cure, a great deal can be done to reduce the problems associated with ADHD so that those among us with this condition can live productive, fulfilling, and meaningful lives.
- Not wanting to be "labelled" with a psychiatric diagnosis. A very important reason why some people do not get assessed for ADHD is that they do not want to be labelled as having a psychiatric disorder due to the associated stigma. Thus, they shun having a formal diagnosis. Some may fear that somehow this information will become public knowledge or even made known to the company they work for. After checking with a leading psychiatrist in this field, let me assure you that this is certainly not the case. Moreover, with adults, it is usually not even necessary to make a formal diagnosis but rather to assess quantitatively the problematical behaviours e.g. distractibility, emotional dysregulation etc.
- The mistaken assumption that assessment is very expensive. Unlike assessement for children where schools etc may require a formal written diagnostic report, this usually not necessary for adults. Therefore the cost for adults can be much lower than for children and possibly even included as part of treatment. As such, there can be little additional cost, if any, for the assessment.
- Symptoms of ADHD obscured by symptoms of more common disorders. Sometimes ADHD goes unrecognized by both the individuals with ADHD and the professionals who are providing treatment. This can happen because symptoms are obscured by a variety of conditions that often accompany ADHD e.g. anxiety disorders, addictions, and/or bipolar disorder. This can lead to treatment that addresses these conditions ignores the underlying main cause. Problems contributed by ADHD such as not getting projects done on time at work may actually be causing the anxiety. Quite often adults come for an assessment only after a child of theirs has been diagnosed with ADHD thereby crystalizing the realization for the adult that they too have similar problems as their child.
- Emotional/psychological resistance to assessment. After a lifetime of trying to manage the difficulties caused by their condition, a number of people may retreat into denial. Unfortunately this repression creates more problems than it solves.
Advantages to getting Assessed and Treated
- Assessment techniques and questionnaires have improved. Research on adult ADHD has become much more intense over the past 20 years and there are now questionnaires which have been standardized using huge samples from the population. Standardized test such as the Conners Adult ADHD Rating Scale (Conners et al 1999) or the more current Barkley Adult ADHD Rating Scale-IV (Barkley 2011) are widely used. The Conners questionnaire contains "Observer" forms meant for the family and friends of the person suspected of having ADHD.
This is very important because a person with ADHD may not realize the extent of their behavioural difficulties. It can be a revelation to them to have the perspective of these other important people in their lives. Obtaining such information can be useful in decreasing marital/couple stress that can be severe for both parties.
The Barkley questionnaire has a feature not offered by the Connors in that it measures a potential new type of ADHD (Becker et al, 2014) called Sluggish Cognitive Tempo (SCT). SCT is characterized by several intriguing new symptoms one of which is dreaminess. These are not included in previous assessments but can be associated with ADHD. Having incorporated SCT, the Barkley questionnaire may prove useful for assessing someone who may have ADHD but did not meet the previous assessment criteria for ADHD.
Improved assessment information, specifically of one's strengths and weaknesses means that the clinician can provide much more specific treatment strategies for each particular client.
- Improved treatment modalities. Through years of studies and research, there is now an increased variety of effective treatments. A therapist is able to select a treatment most suited to the characteristics and preferences of the person with ADHD. Here is a list of just some of the possible approaches to helping persons with ADHD:
- Psychoeducation. Gaining knowledge of the kinds of problems that someone with ADHD are particularly vulnerable to e.g. addictions, difficulties in intimate relationships, anxiety and mood disorders.
- Cognitive Behavioural Therapy (CBT). CBT is helpful in teaching a variety of coping skills e.g. how to regulate excessive emotions; how to be patient e.g. waiting for the other person to finish speaking before replying.
- Interpersonal, family oriented approaches
- Mindfulness meditation for training the brain/mind so that the person is better able to manage symptoms such as distractibility. Mindfulness meditation designed for increasing self-compassion can be especially helpful for individuals with the low self-esteem which often accompanies ADHD.
- Support groups and self-help groups. These groups are specifically created to help anyone with ADHD and provide informational, practical, and emotional support. Such groups are at least as effective as individual psychotherapy in helping individuals feel better about themselves, attain life goals and dreams, and live fulfilling lives.
- Electronic gadgets and Mobile Apps can help the person with ADHD better organize and manage his/her life or provide mental exercises the person can perform when the condition is particularly bad. e.g. electronic organizers, digital recorders, and a great variety of apps for smart phones are now available although none has been certified or studied sufficiently .
- Medication. Approximately 2/3 of adults with ADHD can improve their ability to stay focussed through taking appropriate medications. A formal diagnosis of ADHD which can be obtained from a psychiatrist is required in order to get these prescription medications for ADHD.
- Career advancement. Treatment for ADHD, beginning with better understanding and management of your strengths and weaknesses, can greatly improve your performance at work.
- Improved interpersonal relationships. One of the most frequent causes of human suffering in the general population is problems with interpersonal difficulties. This is especially true of adults with ADHD because of certain behavioural deficits that makes it difficult to fulfil personal responsibilities and expectations. These problems can extend to the most intimate of interactions including affection and sexuality.
- Decreased self-blame and increased self-esteem. Knowledge that you have a condition which is largely genetic in origin can stop you from blaming yourself for being "Lazy, stupid or crazy" (Kelly et al, 2006).
- Increased meaning in your life. Understanding how your ADHD behaviours have affected your choices throughout your life enables you to finally integrate and make sense of your entire life history.
If you are an adult who suspects you have ADHD or was previously diagnosed, I hope the information provided here can convince you to get assessed or re-assessed so that you can open yourself up to the possibility of treatment utilizing the newest approaches. This way, you will be better equipped to achieve your goals and live a fulfilling, meaningful, and positive life unrestricted by ADHD.
Becker, S. P., Marshall, S. A., & McBurnett, K. (2014). Sluggish Cognitive Tempo in abnormal child psychology: An historical overview and introduction to the special section. Journal of Abnormal Child Psychology, 42(1), 1-6.
Barkley, R. A. (2011). Barkley Adult ADHD Rating Scale-IV (BAARS-IV). Guilford Press.
Conners, C. K., Erhardt, D., & Sparrow, E. (1999). Conners Adult ADHD Rating Scales: Technical Manual. Multi-Health Systems Incorporated (MHS).
Kelly, K., Ramundo, P., and Hallowell, E.M. (2006) You Mean I'm Not Lazy, Stupid or Crazy?!: The Classic Self-Help Book for Adults with Attention Deficit Disorder.
Copyright © 2014 Brian S. Scott