Tuesday, October 4, 2011

ADHD in Adults: A Hidden Malady?

I was sitting having my morning cup of (way too strong) coffee, reading The Globe and Mail, Canada’s national newspaper, when I glanced at an article on ADHD. I scanned the first paragraph, and thought I’d scream. I can’t begin to count the number of times I have heard people, including my mother, give, what the article refers to, as The Case Against Adult ADHD:

“ Attention deficit hyperactivity disorder is a dubious condition promoted by Big Pharma to push stimulant drugs; the small number of children with true ADHD (rather than lax parenting) will outgrow it by their teens, so adults have no business using the diagnosis  as an excuse for failing to meet their commitments as employees, spouses and parents.”

Not so fast.

ADHD is a neurobiological disorder that interferes with executive functioning – an umbrella term for thinking processes that include planning, attention, working memory and impulse control.

According to researcher Dr. Russell Barkley, as quoted in  The Globe, the disorder persists in adulthood for as many as two-thirds of children with ADHD, and 4 to 5 per cent of all adults have ADHD. It’s one of the most impairing disorders Barkley sees in his psychiatric outpatient clinic in North Carolina

One-third of people with ADHD never finish high school, he says. As adults, they tend to have a checkered work history, money problems, broken relationships and inconsistent parenting skills. They are at high risk for depression, anxiety, substance abuse, eating disorders, dangerous driving and impulsive behaviour.

I have been hearing part, if not all of the Case Against Adult ADHD along with the Case Against ADHD In General since we decided to give our son meds for the ADHD diagnosed at the same time as his Fetal Alcohol Syndrome (FAS, now part of the Fetal Alcohol Spectrum Disorder, FASD).  He was six. After the ADHD diagnosis at The Hospital for Sick Children here in Toronto, Michael was put through a rigorous three-week, triple-blind study to see whether his behaviour and ability to learn might improve on Ritalin, and if so, on what dose.

Triple-blind means no one knew what Michael was being given each week: not us, his parents; not his teacher, not Michael himself, nor the doctor at Sick Kids. The only person who knew whether he was receiving a placebo or drug was the pharmacist.  At the end of each of the three weeks, my husband and I as well as Michael's teacher had to fill out forms describing Michael’s behaviour, mood, attention, ability to learn, etc. Michael's opinions were delivered directly to the doctor.

The results were blindingly clear to all of us, including Michael. The first day of the week he was on the dose of Ritalin thought to be the right one for him, he came home from school and said to me. “Mum, there’s a tunnel now between me and my teacher.”  I wasn’t quite sure what he meant until I realized it was his way of saying that he and the teacher were now connected. He also said “The pills make my ears pop.” That too dumbfounded me. Then I realized. He could now hear what people were saying.

Not everyone was happy with our decision to give Michael meds, though. My mother began sending me clippings from her local newspaper in Florida, relaying the following messages: ADHD enormously over-diagnosed. The invention of Big Pharma.  Boys being boys labeled with ADHD when  just full of energy. Lax parents can't keep kids under control so ask doctors to prescribe drugs. Doctors prescribe to keep parents happy. Cut sugar out and everything will go away.

The numbers of children diagnosed with ADHD is high.  It probably is overdiagnosed, particularly by family doctors who aren’t specialists in what may be a more complex, undetected neurobiological disorder.  ADHD may only be a symptom of something else. But not in our case, the pills Michael was prescribed for the ADHD aspect of his FAS have been a godsend. With them, Michael  could stand still long enough to sing ‘O Canada’ at the beginning of school with the rest of the kids. But most importantly, he learned to read and write, both things he had been struggling with without success until the meds came into his life.

Michael didn’t grow out of his ADHD when he became an adult. I can’t imagine he ever will, nor are doctors telling me he will. Years ago, before ADHD was well-studied, the theory was that kids would outgrow it when they got into their teen-age years. It was a temporary blip that would just disappear, people thought. Maybe some people do outgrow it, but it’s not what I hear from people who have it.

Unfortunately, ADHD can plague people all their lives. I know several adults who were diagnosed with ADHD late-in-life. All believe the diagnosis explains why they’ve suffered all their lives with issues related to time management, organization, anger, money, low productivity and lack of success in school, work and relationships. Each of them wish they had been diagnosed earlier. Perhaps they could have done something to change their patterns, even turn their lives around. They'll never know.

I expect my son will be on the ADHD meds (Concerta is the long-lasting from of Ritalin he's now on) his whole life. It’s not something I relish. But I feel lucky we live in a world where the ill effects of ADHD are beginning to be understood, and glad that Big Pharma, not generally my friend, has found something to help my son.

The following books may be of interest to readers who’d like to learn more about adult ADHD and the devastating effects it can have on people’s lives. All three books are highly recommended and offer constructive, positive advice.

Driven To Distraction: Recognizing and Coping with Attention Deficit Disorder from Childhood Through Adulthood by Edward  Hallowel, MD

Delivered from Distraction: Getting the Most out of Life with Attention Deficit Disorder by psychiatrists Edward (Ned) Hallowell and John Ratey  This is a follow-up to  Driven to Distraction. Both books deal with the challenges of ADD/ADHD and offer advice on treatment and how to live successfully with the disorder.

And some couples might find this useful: The ADHD Effect on Marriage: Understand and Rebuild Your Relationship in Six Steps: Amazon.ca: Melissa C. Orlov. Ms. Orlov also has a website adhdmarriage.com that's worth checking out.

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