Do You Have ADHD?
Often unrecognized in adults, especially women, the condition may be keeping you from reaching your potential
Tim Bilkey, M.D., is the co-author of Fast Minds: How to Thrive if You Have ADHD (or Think You Might) and the founder of the Bilkey ADHD Clinic for Women, one of the world’s first ADHD clinics for women.
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Over time, this wife and mother of two found her distractibility worsening. She works in an office, but is easily sidetracked. She takes too long to get tasks done, a concern that's been noted on her performance evaluations. Sometimes she has to go in on weekends to catch up.
At home, Angelina often procrastinates about paying bills; her husband has begun to take over these responsibilities. She tries to keep organized by making lists and using calendars, but it's hard for her to stay on top of any consistent routine. She often forgets about responsibilities and her house can become scattered and disorganized, which causes tension in her marriage. She chronically underestimates the amount of time tasks will take and often runs late.
As it happens, her eldest son recently received diagnoses of attention deficit hyperactivity disorder and a learning disability. (The two commonly go hand in hand.) When a pediatrician explained ADHD to Angelina, she wondered whether she could possibly have it herself. But she had always heard ADHD mostly affected hyperactive little boys. What was clear, though, was that her own traits were impacting her ability to function. The amount of effort she had to expend just to get through the day was exhausting.
What Is ADHD?
The core symptoms of ADHD are hyperactivity, impulsivity and distractibility. The majority of children diagnosed with ADHD do appear to be overly active. But as children with ADHD get older, much of their hyperactivity diminishes, as does some of the impulsivity. What remains into early and middle adulthood is distractibility.
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Scientific studies of ADHD have for the most part focused on boys, a reflection of how underdiagnosed the condition is in girls. In the largest study of ADHD and its treatments (the Multimodal Treatment of ADHD study), only 20 percent of the subjects were female. Little girls with ADHD typically are not as disruptive and overactive as boys, but they face the same challenges, including difficulty with short-term memory, organization, time management, decision-making and prioritizing. When assessing whether an adult has ADHD, an expert must consider whether such traits have been present since childhood. If they have been, there's a greater likelihood that the distracted adult indeed has the condition. To qualify for a clinical diagnosis, there must also be evidence that symptoms have caused a person to underachieve in their education or career over the course of their life. The challenge is that many adults may mistakenly assume that their behaviors are just natural facets of their personality.
Angelina, for example, remembers underachieving in college. In lectures, it was hard for her to block out external noise and activity. She often left studying to the night before exams. She barely graduated.
Family and friends offered support, telling her, "We know you have great potential." But this only compounded Angelina's confusion about why she couldn't fulfill it. The reason, she now understands, was ADHD.
ADHD in Adults
We know that ADHD is a highly heritable condition, almost as much as height and more so than either breast cancer or asthma. Some adults, like Angelina, become aware of their own condition only when they see it diagnosed in their children and learn about its genetic aspect.
ADHD affects almost 5 percent of adults worldwide, a greater prevalence than schizophrenia and bipolar spectrum disorder combined. Today many adults get their first diagnosis in midlife. Yet only 1 in 10 adults with ADHD will ever actually receive an assessment and diagnosis; and while awareness of ADHD in females continues to grow, the vast majority of women with the condition continues to go without help.
The undertreatment of ADHD in adults has major societal costs. An important World Health Organization study found that underachieving workers with untreated ADHD may lose as much as 22 days of productivity over the course of a year, as compared to other employees.
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Adults with untreated ADHD have a higher incidence of motor vehicle accidents, more problems in marriages and relationships and a tendency toward impulsive decision-making. Anxiety and mood disorders are common among children, teenagers and adults with ADHD; impulsive experimentation with alcohol and drugs is also a risk for people with the condition.
Fortunately, when we can diagnose ADHD in an adult, we can often treat it successfully. Few other conditions that remain undiagnosed for 30 or 40 years respond so well to medical intervention. Rigorous scientific studies have demonstrated the effectiveness of ADHD medications for adults. A trial of a medicine can be a very helpful first step in the treatment of adult ADHD.
Non-drug interventions include cognitive behavioral therapy, ADHD coaching, mindfulness therapy and training in developing new habits to create a more balanced life. The recovery process often involves a combination of interventions for each individual patient, which should give hope to adults with ADHD.
If you have wondered whether your work or home habits are holding you back, and whether ADHD may be the cause, diagnosis and treatment can be game-changers. They can help you create a new trajectory and finally fulfill your personal potential, no matter your age.
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