Health

Out of Focus: New Thoughts on ADHD

Attention Deficit Hyperactivity Disorder (ADHD) is a diagnosis that affects more males than females: three times as many boys as girls and twice as many men compared to women.

 “I was wondering, What the heck was wrong with me?”  says Montreal resident Duane Gordon who was diagnosed with ADHD at the age of 32, about the same time his then nine-year-old daughter was diagnosed, he explains. “There was stuff that everybody else seemed to do with ease, but I struggled with it.”

Today, he is a high-tech consultant in software research and development and president of the Attention Deficit Disorder Association (ADDA). As a teenager, he was accepted into a prestigious military college and though he struggled there, he graduated. After leaving the military, he couldn’t hold a job or help out at home. He had big expectations for his life that never came to fruition.

He and his wife, in an attempt to understand their youngest daughter’s ADHD diagnosis, read “Driven to Distraction” by Edward Hallowell and John Ratey. The ADHD symptoms detailed in the book sounded familiar to both of them.

“That was a rude awakening,” Gordon says. “A lot of people say your first experience is relief, because at least you know you haven’t been a failure. Or if you have, there’s a reason for it.”

The National Institute of Mental Health defines ADHD as A brain disorder marked by an ongoing pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development.

One of the most-diagnosed childhood neurodevelopmental disorders, ADHD is most commonly diagnosed in children. Approximately three to seven percent of children and about two to five percent of adults are diagnosed with the disorder. The gender ratio for children is three to one, boys to girls. More often than not ADHD continues into adulthood when the gender ratio falls to 2:1 or lower. Clearly, males outweigh females in this neurological category.

Duane found a research project studying adults diagnosed with ADHD. At that time, he was on the verge of being fired from yet another job. As a part of this study, he completed eight hours of written, computer, calculation, working memory and audio testing. In addition, there were tests to rule out other things that can mimic ADHD. The project offered a 12-week course, coaching and assisted in organizing a support group that continues today.

“I was so down at that point. I had completely given up any of the confidence I had as a young man,” he says. “I had gone from failure to failure to failure. We were financially in dire straits and on the verge of divorce.”

“The divorce rate is nearly twice as high for people with ADHD because of their increased distractibility, forgetfulness and impulsivity,” Dr. A. J. Marsden, an assistant professor of human services and psychology at Beacon College in Leesburg, Florida (the first accredited college to award bachelor’s degrees exclusively to students with learning disabilities and ADHD), explains. “There’s a lot of anger and resentment from the non-ADHD spouse.”

Early Diagnosis Brings Better Outcomes

The earlier an individual is diagnosed with ADHD, the better their outcome.

“Kids can really learn to become mindful to monitor their own symptoms, redirect and reinforce themselves,” says Sanam Hafeez, Psy.D, a New York State licensed neuropsychologist and school psychologist, says. “We want them to learn how to have some of these coping mechanisms in place at an early age so they grow with them.”

“The fate of boys who have been diagnosed with ADHD depends upon what treatment they receive, if any,” America’s Psychiatrist, bestselling author and psychiatrist Carole Lieberman, M.D., explains. “If a boy gets casually diagnosed with ADHD by a guidance counselor, school psychologist, or family doctor, without proper and thorough clinical evaluation, then he is unlikely to get appropriate treatment.”

She believes that boys should be thoroughly evaluated in clinical sessions and through psychological testing.  

“Many times behavioral problems are mislabeled ADHD, when they are actually the result of something else such as a dysfunctional home with abuse or an alcoholic parent or any undiagnosed physical issues such as poor eyesight or hearing,”
she says.

Not everyone sees their ADHD diagnosis as negative.

“Certainly, if you’re told you think outside the box and your brain is a bit different, they can come to really love the fact that they have this difference,” says Michelle Frank, Psy.D, a clinical psychologist and ADDA vice president. “I work with a lot of college students who say, ‘I wouldn’t trade ADHD. I just want to learn how to build some skills and feel better about myself.’”

She believes the term ADHD is a misnomer.

“ADHD research is keeping it as an executive functioning dysregulation,” she explains. “It’s not necessarily a deficit of attention, but rather an inconsistency or dysregulation in attention.”

In 1998, Doug Harris, an ADHD coach and ADDA volunteer in Ann Arbor, Michigan, was 39 years old when his 10-year-old son was diagnosed with ADHD. Like Gordon, he recognized himself while going through his child’s assessment questions.

Prior to his diagnosis, he finished three out of five degree programs, earning a bachelor’s and two master’s degrees. 

“I was in a master’s program at the University of Michigan in the neurobiology doctoral program and that’s where it was hard enough that I met my match,” he explains. “I had a semester where I got behind and kind of withdrew.”

At the same time he and his wife, an internal medicine doctor, found out she was pregnant with their second child. 

“I decided that it just wasn’t working,” he says.  “What I did was become a stay-home parent.”

National Institute of Health studies show that adults with ADHD are less likely to be employed full-time and have a lower household income than typical adults. Their work-related problems are often due to poor job performance, lower occupational status, lack of job stability and a high level of absenteeism.

Gordon’s daughter is overcoming these challenges.

“She is holding down a job, living in her own apartment and still in touch with us,” he explains. “She sits and thinks through things to be successful. It took her three different times to pass French and Math—two courses she needed to graduate. And she did as an adult, while she was working.”

Today, at age 28, she visits her parents every Sunday.

“We help her with getting organized, making sure she pays her bills and all that kind of stuff,” the proud father explains. “But she’s doing it and that’s fantastic.”

Treatment: Getting the Dosage Right

Medication is one of the best ways to help individuals diagnosed with ADHD. 

“It may take several months, or even years, to get the dosage right,” Dr. Marsden says. “The best ways to assist children so that their adult life will not be negatively affected is to: find the right medication and dosage; teach them organizational skills; and allow them to move—desk jobs are terrible for people with ADHD—in the classroom and eventually at work. Know the person’s strengths and play to them.”

“A boy who is exhibiting symptoms of what may be ADHD, should be seen by a psychologist or psychiatrist who will thoroughly evaluate him with clinical sessions and psychological testing,” Lieberman explains.“Although some medications have been found to be useful for ADHD, they must be prescribed very judiciously and are not effective without concomitant psychotherapy.”

Dr. Lieberman believes men who were diagnosed with ADHD as a child and received no treatment or only medication, do not finish well.

“They are more likely to: spin out of control the older they get; abuse drugs or alcohol; self-medicate or get into other self-destructive patterns,” she says.

Duane is a huge proponent of ADHD support groups.

“It is that connection with people who understand and can share their experiences,” he explains. “If you connect with people you can learn their strategies and see what works for you.”

“The longer you live with these challenges undiagnosed, the harder it is,” Dr. Frank says. “It becomes internalized as something that is wrong with you as opposed to how your unique brain wiring works.”

Duane’s worse symptom is his working memory.

“Once, my boss was looking for me to move up into a management position. He asked me to handle a department meeting because he was going to the dentist. I know he wanted to see if I was ready to step into that role.”

When it came time for the meeting, Duane forgot he was supposed to be in charge.

“You can imagine my boss’ reaction we he came in. I was demoted and given a cut in pay we couldn’t afford.”

“A boss is only going to put up with you for so long,” Dr. Hafeez explains. “You’re always running late, never turn in what you’re supposed to, forget meetings and never respond to emails. Eventually, I think a lot of them get found out.” 

Once, Gordon’s ADHD-related impulsivity lead him to accept a job as a teacher in Newfoundland after watching a movie and thinking it would be fun.

“I didn’t tell my wife until they offered me the job,” he explains. “I woke her up to tell her. We had just bought a house in Montreal and had to sell it at a loss. Also, she couldn’t move right away because she was seven months pregnant.”

A drastic change for many ADHD-diagnosed boys is that their hyperactivity becomes more subdued as they mature.

According to Dr. Frank, “It becomes an inner sense of restlessness, rather than external restlessness.”

“If adult men have learned to recognize the effects of their ADHD and use coping mechanisms to their advantage, they can be high achievers,” Dr. Andrea Brode, dean of student success and a learning specialist at Beacon College, says. “They are often creative thinkers.”

Today, Harris works part-time in his wife’s medical practice in bookkeeping and computer work. In addition, he works as an ADHD coach.

“Coaching is very satisfying,” he explains. “Most of my clients were diagnosed and had years of coping. To be with someone who knows what you’re going through? There’s no substitute for connecting with people that get you.”

“Let’s learn to build communities where difference is, not just accepted or tolerated, but celebrated.” Dr. Frank says. “If we capitalize upon different brain profiles, we can target these young people and help them thrive with difference. Not only would individuals with ADHD lead better lives, we’d be a heck of a lot better off as a world.”

According to Ashley Wroton, Ed.S., a licensed professional counselor with Genesis Counseling Center in Hampton Roads,  “Due to the neurological deficits that a diagnosis of ADHD refers to, there are deficits in executive functioning. These challenges impact the man’s development of problem-solving skills, social skills and self-concept. There is also a high likelihood that a male diagnosed with ADHD will receive other diagnoses such as a learning disorder, communication disorder, autism, conduct or oppositional/defiant disorder, anxiety and/or depression.  Without support, these diagnoses (particularly if untreated) can have significant impact on a person’s life and ability to function.”