Attention to Deficits

Adults are learning that ADHD is not limited to children

By Joan Tupponce

adhdMary Goldschmidt knew her courses in graduate school at the University of Virginia would be challenging, but the honors graduate never imagined she would have difficulty retaining information. By the time she reached the bottom of a page in a textbook, she was not sure what she had read at the top. “I had to read information multiple times,” she says. “I was frustrated and a little frightened that I wasn’t going to be able to keep up. I didn’t believe it was an issue with being able to understand information. I just couldn’t put all the pieces together.”

Goldschmidt was referred to Julia Frishtick, a licensed clinical social worker in Richmond, Va., who
specializes in adult attention deficit hyperactivity disorder (ADHD). Frishtick diagnosed Goldschmidt, who was 53 at the time, with ADHD. Instead of being alarmed, Goldschmidt found the diagnosis reassuring. “It boosted my confidence,” she says. “I realized it wasn’t an indication of my intelligence. It’s a deficit, pure and simple.”

Many adults like Goldschmidt are not aware they have the neurobiological dis order, which has been linked to everything from alcoholism and shopping addiction to obesity and marital problems. The Anxiety and Depression Association of America estimates that approximately 8 million adults in the U.S. have ADHD and that fewer than 20 percent of those receive the necessary medical attention. “The vast majority of adults with ADHD are undiagnosed and untreated,” says Dr. Lenard Adler, a professor of psychiatry and director of the Adult ADHD Program at the New York University School of Medicine. “It is the second-most common neuropsychiatric disorder in adults, following depression.”

Why are so many adults unaware they have an issue? For years, doctors have done a good job identifying children with ADHD but a poor job of identifying the adults. Some doctors are unaware that the disorder persists into adulthood, says clinical psychologist Ari Tuckman of West Chester, Pa.

“ADHD is a lifelong condition,” Tuckman says. “If you are 50 and you have it, you had it when you were

Symptoms of the dis order in adults vary and usually are not as pronounced as they are in children, especially young boys who are hyperactive and impulsive. Adults may find they have trouble starting and finishing routine tasks. “If something is interesting, they do very well,” says Tuckman. “The challenge is to pay attention to boring things with a far-off deadline.”

Money management — such as paying bills on time — and time management are difficult tasks for adults with the disorder. They also tend to be forgetful or unfocused and often procrastinate. They have trouble going to sleep and getting enough sleep “because they can’t turn off their brains,” says Frishtick. Some adults with the disorder are underachievers and have a tendency to self-medicate with alcohol, drugs or caffeine or overindulge in activities such as gambling or spending.

adhd2Undiagnosed ADHD can affect careers, relationships, health and confidence. Treated properly, however, “It can be associated with enormous success and joy in life,” says psychiatrist Edward Hallowell, co-author of Delivered from Distraction. Hallowell, who has ADD, says many mind-related treasures such as creativity, ingenuity, tenacity and vision can get buried under the negative symptoms associated with the disorder. “Unless the clinician recognizes the possibility of strengths, they may never be noticed and developed,” he says. “Having it is like having a Ferrari engine for a brain with bicycle brakes. If you strengthen your brakes, you can win races. If you don’t, a Ferrari with no brakes is very dangerous.”

When she looks back, Goldschmidt says, she remembers being fidgety and having difficulty staying focused for long periods of time. But she never linked that to the disorder. “Women may have been overlooked because their problems are attributed to anxiety or depression,” Frishtick says, noting that the disorder can have concurrent conditions such as bipolar disorder, learning disabilities, depression and anxiety.

The majority of people who have ADHD inherit the condition. “ADHD can be acquired, as through lack of oxygen at birth, but most ADHD is genetic,” says Hallowell. “If one parent has it, the odds for a given child having it are one in three. If both parents have it, the odds are two in three.”

Many adults discover they have the disorder during a life-changing event, such as a new job, a marriage or the birth of a child. “You can go your whole life without knowing you have ADHD if everything falls in place for you,” says Frishtick. “There is a problem when life presents challenges and you can’t meet those challenges. Then there are self-esteem issues.” Retirement can pose problems for adults with the disorder because they no longer have a routine. “When you do have ADHD and are retiring, you should consider part-time work or volunteer work to provide structure,” Frishtick says.

Many adults who have ADHD, like Goldschmidt, are treated with medications such as Adderall. Within a week after taking the medication, Goldschmidt could see a difference. “I didn’t drop the ball,” she says. “I stayed on top of details. I managed my life much more effectively.”

Other treatment options are beneficial as well. “We know for sure that education, exercise, meditation, proper nutrition and coaching can help,” Hallowell says.

The practice of coaching adults with ADHD started about 15 years ago, says psychologist Sam Goldstein, editor-in-chief of the Journal of Attention Disorders. “In the last two years in my journal,” – Goldstein says, “I have published two scientific studies clearly demonstrating the benefits of a coaching model for people with ADHD. The benefits, for example, translated into reduced impairment and improved perform ance for college students.”

Nancy A. Ratey, the author of The Disorganized Mind, became a life coach to help others who have ADHD. “I can relate to the struggles my clients have because I have them too,” she says. “The person has to want to make changes and accept help and be able to work in partnership with a coach.” People who are successful in dealing with ADHD develop self-discipline, learn how to solve problems and “find something that gives them purpose and identity,” says Goldstein. “Something that gives them some connection to the world.”

Goldschmidt, who finished her master’s degree and now is working on a doctorate, is glad she discovered she has ADHD and began treatment.

“It’s been pivotal,” she says. “It has changed the direction of my life completely.”