Can ADHD present in adults?

As a Psychiatrist who advocates for the appropriate diagnosis and treatment of Attention Deficit Hyperactivity Disorder (ADHD) in Adults, I am frustrated by the many misconceptions that linger like flies at a neighborhood BBQ. If you are one of many who have suffered from this disorder, perhaps you will find the story below relatable.

A Common Story

At some point in your life you came to the realization that something just wasn’t adding up. Throughout early schooling you struggled to stay organized and motivated. But on the rare occasion that you found the energy and courage to sit down on a Saturday (rather than Sunday near midnight) and attempt your weekend homework you were probably discouraged yet again:

“How many times do I have to read this sentence before I understand what it means?”

“Why did I just read 20 pages of this book but couldn’t tell you one meaningful thing about it?”

“Screw it, I’m gonna play sports or video games instead.”

This pattern gets old so you begin telling yourself that you’re just not smart enough, not good enough, not savvy enough to juggle life like everyone else. And of course the most encouraging and reassuring remarks you received were statements like “you just need to work harder” or “stop being lazy” or “do you even care about your future?”

Now that your self esteem was sinking into the cold, dark abyss like the Titanic in 1912, your contagious positive spirit began drowning too. If not already feeling like a failure, you sensed actual failure was imminent.

As time went on, you probably took one of the following routes: Either you said “f**k it” and started drinking and doing drugs out of anger and frustration or you continued to suffer in silence pretending you were okay only to feel more drained and guilty about not telling the truth. Or maybe you developed coping skills and compensated by being overly obsessive and overly worried about everything because you’ve been told repeatedly that in order to achieve goal X you just needed to work harder.

Then one day you heard someone talk about Attention Deficit Hyperactivity Disorder and you immediately felt something awaken inside you. You were so relieved to hear you weren’t the only one who relied on Spark notes to pass English class–not because you were lazy but because there wasn’t enough time in the day to read the same page more than 3 times. After all, 20 pages of reading meant 60 pages for you.

So you debated whether to go to the doctor and be evaluated. You felt vulnerable and worried about opening up to someone you’ve never met. You started to worry that you might sound like a “drug seeker” or a “cheater.” Once you finally built the courage to share your story you were met with your worst nightmare–immediate invalidation.

“We don’t prescribe those drugs in this clinic.”

This is followed by urine drug testing and a referral for a $1,500 Neuropsychological test that only worsens your preexisting anxiety and obsessive thinking. So you go to the testing center and sit there in a quiet room clicking buttons and solving puzzles for hours as if that accurately captures the work-life of someone struggling with ADHD symptoms. 

There are many points to this story. Humans are complex and the brain is by far the most complicated system in our universe. Neuropsychological tests for ADHD are NOT something I routinely order and the reasoning is simple: How does sitting at a computer in a quiet exam room or solving boring puzzles for hours in a controlled environment confirm that my patient really is experiencing distress and dysfunction? How does a neuropsychology test with inconsistent validity help my patient who can clearly articulate how they are feeling and what they are experiencing?

Science Speaks

Despite numerous attempts by the uninformed to delegitimize the diagnosis of ADHD, the science speaks loud and clear: Attention Deficit Hyperactivity Disorder (ADHD) is a real disorder that can occur in children and adults.

It isn’t uncommon to hear people offer opinions such as “ADHD is an excuse to medicate misbehaving children to appease parents” or “everyone has ADHD and would benefit from psychostimulants.” When I hear these things, I take a deep breath and remind myself that these opinions are just what they are…opinions.

The belief that ADHD is an excuse to medicate misbehaving children or the notion that adults seek an ADHD diagnosis to obtain stimulants to “cheat the system” is not supported by any legitimate scientific evidence. Do people abuse prescription stimulants? Yes, they do. Are some children misdiagnosed with ADHD? Yes, some are. Do some adults “fake” the diagnosis to obtain stimulants? Yes, some do. But let’s leave the blanket statements and unsubstantiated beliefs in the box labeled “99% of political arguments” (the label included). 

If anything, ADHD is not recognized nearly enough in adults. The possible reasons for this are beyond the scope of this post. But my next post will provide a more nuanced review of ADHD in adults and the common misconceptions that keep the stigma alive. 

Disclaimer

If you’re the one spreading rumors that street methamphetamine is just like adderall then you’re also the one who believes that illicit methamphetamine purchased on the street has the same pharmacokinetic and pharmacodynamic effects as prescription stimulants at therapeutic doses simply because both are amphetamines. In which case I’ll go ahead and whip up some methanol martinis for you. Don’t worry, ethanol and methanol are both alcohols. 

References

  1. Young, Joel. ADHD Grown Up: A Guide to Adolescent and Adult ADHD .(2007)
  2. Gil Zalsman & Tal Shilton (2016) Adult ADHD: A new disease?, International Journal of Psychiatry in Clinical Practice, 20:2, 70-76, DOI: 10.3109/13651501.2016.1149197
  3. Stewart, T. D., & Reed, M. B. (2015). Lifetime nonmedical use of prescription medications and socioeconomic status among young adults in the United States. The American journal of drug and alcohol abuse, 41(5), 458–464. doi:10.3109/00952990.2015.1060242
  4. Psychiatric Times. 7 Evidence-Based Insights About ADHD. https://www.psychiatrictimes.com/adhd/7-evidence-based-insights-about-adhd
  5. Higgins, E.S. & George, M.S. The Neuroscience of Clinical Psychiatry: The Pathophysiology of Behavior and Mental Illness. 3rd Edition. 2018.
  6. Blumenfeld, Hal., MD, PhD. Neuroanatomy Through Clinical Cases. 2nd Edition. 2010.
  7. Sadock, Benjamin J., and Harold I. Kaplan. Kaplan & Sadock’s Synopsis of Psychiatry: Behavioral Sciences/clinical Psychiatry. 10th ed. Philadelphia: Wolter Kluwer/Lippincott Williams & Wilkins, 2007. Print.
  8. Diagnostic and Statistical Manual of Mental Disorders: DSM-5. 5th ed. Washington, D.C.: American Psychiatric Association, 2013. Print.
  9. Stahl’s Essential Psychopharmacology, 4th Edition. Cambridge University Press. 2013
  10. Schatzberg & Nemeroff. The American Psychiatric Association Publishing Textbook of Psychopharmacology. 5th Edition. 2017.
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