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Allan Schwartz, Ph.D.Allan Schwartz, Ph.D.
Dr. Schwartz's Weblog

Adult ADHD: Difficult to Diagnose and Often Misunderstood

Allan N. Schwartz, LCSW, Ph.D. Updated: Apr 5th 2006

The National Institute for Mental Health (NIMH) working with Harvard Medical School released the results of a survey on the mental health of the nation. This survey points to the fact that children diagnosed with ADHD continued to have related symptoms as adults. I would add to that the fact that there are many adults who, as children, were never diagnosed with ADHD and that the percentages are higher than those reported.

Why do many adults go undiagnosed with this disorder?

Many children can have Attention Deficit Disorder but without the hyperactivity. The parents of these children are often told, by their school and their teacher that their child is not making enough effort in class. They are also told that if the child tried harder they would get better grades. Parents experience these youngsters as being resistant to and avoidant of doing homework. They do not want to go to school and complain that school is "boring." In class, they are quiet, causing no disruption or interference. It would seem that the old saying that the "squeaky wheel gets the grease"is true because these children are described as cooperative and quiet. Therefore, school officials tend to view them as being lazy and/or not caring. On the other hand, those youngsters with hyperactivity can cause so much disruption in class and at home that they are referred for testing, diagnosis and help.

It has been my experience in private practice that it comes as a surprise for adult patients to learn that they may have ADHD without hyperactivity. Often times, these are bright and motivated people who feel depressed, anxious and confused. They have difficulty achieving social acceptance and both academic and career success. Some go to college, achieve mediocre grades, or drop out of college very early, believing that they are very stupid and that College is not for them. Others have the ability to hyper-focus on those subjects of particular interest to them. Many times, these individuals are able to become doctors, lawyers or achieve other professional status. Yet, they are plagued by symptoms such as losing things, not being able to sleep and having success in their personal relationships.

These patients often seek treatment for depression and/or marriage problems. In all cases these people miss the necessary social cues that demand they respond in ways that are appropriate and that show interest in the other person. Distracted by their inability to focus their attention, potential partners believe they are just not interested. In this way, many opportunities are lost.

For those who do marry, the relationship is often marked by chronic misunderstanding and arguing. The spouse who does not have ADHD misinterprets their partner's forgetfulness, and the failure to get things done as laziness and unwillingness to cooperate. As a result the healthy partner feels ignored, disrespected, frustrated and angry. Since these same problems can interfere with work and the ability to make a living, all of these issues are magnified.

Of course, there are plenty of adults with the full ADHD, including the hyperactivity. Their lives are marked by continued impulsive behavior, such as drug abuse, drinking, overspending, extra marital affairs, and what may look like irresponsibility. They also tend to be irritable and quick to get into arguments. It should come as no surprise to learn that many people with ADHD end up having their spouses suing for divorce.

The diagnosis of ADHD among these adults is often met with great relief. Finally, there is an explanation for troubles that began during childhood and for which there was no explanation. People who have spent years feeling bad about themselves and believing that they were useless now have new hope for a better life.

One of the interesting facets of adult ADHD is that some individuals discover they may have the diagnosis by accident. Adderall is now one of the drugs used to treat both children and adults with ADHD. Because Adderall has strong stimulant effects, it has become a drug of abuse on college campuses across the nation. Some individuals with undiagnosed ADHD buy the drug in order to stay awake late into the night while studying for exams. What these individuals discover is that they can focus their attention far better than before they took the drug, in addition to having more energy to study later into the night. Of course, this is not a way to self diagnose ADHD. It is still necessary to be fully tested for the disorder.

Among adults, diagnosing ADHD is more difficult than among children. Its symptoms can be more subtle and can resemble other illnesses, such as anxiety, depression and Bipolar illness. Nevertheless, once correctly diagnosed there are many treatment approaches for adults. Among these are use of the correct medication along with cognitive-behavioral techniques that help the individual learn how to keep organized and efficient while at work and at home. In addition, anti depressant medications are sometimes used to relieve the feelings of depression that often accompany this disorder.

Treating the married couple is also important when a spouse has this disorder. It is important for the spouse to learn about the problem so that they no longer believe they are being ignored. This is not easy as it appears to the husband or wife who does not have the disorder as though it’s all done deliberately. It takes many marital sessions and reading to help the spouse fully understand and to join in helping keep the disorder under control.

Allan Schwartz, LCSW, Ph.D.

Readers who live in the Boulder, Colorado metro area, or in Southwest Florida may contact Dr. Schwartz for face-to-face consultation. He is also available for psychotherapy through Skype video for those who are not in Florida or Colorado. He can be reached via email at dransphd@aol.com for details.

    Reader Comments
    Discuss this issue below or in our forums.

    Dyslexia,ADHD, MDD, they are all so fun. - - Aug 1st 2014

    I am a survivor of the fifties, where children need to be seen and not heard. 

    Well, this is the first of strange behaviors which developes ADHD with fevor. 

    I am so tired of hearing how mentally ill folks could behave better so other folks can be happy. 

    I bet you never said that to a person without legs or a person with cancer.

    "Damn wish you had legs it's hard to get around with you?"

    "Or damn wish your cancer wasn't so damn inconvient we can't even go to the movies without folks looking at you?"

    Please note: I am sorry these sentences are seriously difficult to read, my point exactly.  

    I am sorry if there are words spelled wrong, I don't look up all the words i cannot spell. 

    By the nature of the beast, mental illness is about behavior, therefore other folks believe it is okay to express their need for you, to adjust, to the society of folks; without awareness of the disorder, disease, or syndrome. 

    My favorite line: "Mentally ill folks should be ordered by law to take their drugs."

    Wondering why people with mental illness feel ashamed. Stop and think of how mental illness is looked. Trust is one of the most basic of feelings, yet that one is mostly avoided, with mentally ill folks. People can trust you after your cancer is in remission? No one seems to want to trust someone, after a MDD episode, with much of anything? 

     

    (I am using mental illness as a very broad term, as apposed to a somatic event without the brain.)

     

    Re: Myth of Paradoxical Effect - - Apr 10th 2009

    It is in fact true that stimulants work differently for people with and without ADHD - I have ADHD, and Concerta does not keep me awake and working throughout the night.  It just gives me normal concentration levels (as in, some level of focus), and I can fall asleep while it's at full strength.  This sounds different from what non-ADHD college students experience when taking it.

    Issues getting worse - desert rose - May 9th 2007

     

      I believe my husbands has Add or Ad/hd symptons..  We have been married 13yrs. rather happidly.  Lately, since our move we have had a more stressful relationship.  I am just becoming familiar with this syndrome.

        The good stuff:

      I   have a steady in- come, while my husband is a tile-setter and work is not always consistent. This is just the nature of the beast.  However, he is a hard worker and provides as much as he can.  He is 58yrs. old and I am 68yrs. old.   (We are getting along in age the two of us.) I do believe we generally complement each other in strengths and weaknesses.  I also believe I am an encourager and like structure in our marriage.  My husband fights this (spontanaity is his choice) and so we compromise as much as we can.   We also attend church and a couples Bible study.

       The issues are:

    Problem # 1  Money has become a problem since we moved from one  state to another.  Getting established in a new area is not easy.  So alot of pressure in our marriage to keep the bills paid.  Complusive spending to some degree  (not too bad) recently bought a T.V. when he knows we are having a hard time.   I always seem to be the one putting a lid on how much we can afford.  I'm finding little patience with this thoughtlessness and am serious about divorce.  Leaving isn't my choice but the cards may be stacked against us.  Thank goodness my Trust is in my name only.

                 #2  Problems in intimacy,  problems with eye to eye contact, annoying tapping, humming, figetity, angers easily when confronted and is defensive.  I'm finally catching on that this could be congenital from his side of the family.  Other family members display similar traits.  His oldest son from a former marriage has many of the same issues only far more severe. My husband always thought it came from his wife who had mental problems.  I believe he has siblings on his side with alot of the same problems.  So this doesn't look that promising.

    My question to you is what hope can there be for a loving and thoughtful husband to care for me when I am older and more feeble?   I really don't know if that is humanly possible for him? I'm in very good health at this point but what if that should change and it most likely will?  Right now my son 41yrs.old is my power of health attorney and executor of my estate.

    Would appreciate your advice and is marriage counseling the way to go?

               Sincerely, Gail

     

             

                problems.

     

    When are the spouse's needs met? - - May 1st 2007
    This is one of the few articles I've read that even suggests that the spouse of an ADDer gets a raw deal. I'm so tired of reading that I just need to do more and take more and never complain (because, of course, to do so is counterproductive). I do take care of much more than my share--endlessly--to support the family, take care of the house and children, and take care of our marriage. My reward is that my needs are never met by a husband who is (as one writer encourages him to do) making sure to put himself first. The stress from living with his self-stimulating behaviors wrecks every morning in our home. I have arthritis--have since I was a child--be it is ADD that takes the front seat in our relationship, always. Cared for? Listened to? Forget it. He's too busy not paying attention. I understand that he can't control some of these behaviors (I also do the research and read up on the problem--not his job, either). I just wish he would care how it affects the rest of us.

    myth of paradoxical effect - Pearl - Oct 24th 2006
    Good points, but I feel your discussion of "diagnosis by accident" might be reinforcing the myth of stimulant medications "paradoxical" effect. Stimulant medications such as amphetamines do not have a different effect on ADD and non-ADD individuals, they will keep you awake and help you focus regardless. That is part of why people (college students included) abuse them, and why fighter pilots in wartime etc are legitimately prescribed them.

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