For Lew Mills, a retired marriage and family therapist in San Diego, CA, it was a cluster of events that led him to suspect 20 years ago that he might have ADHD.
First, his then-wife met another adult who had been diagnosed with ADHD. “There was a lot of discussion as to whether adult ADHD was even a real thing at that time,” Mills, who is now 62, recalls. And “she came home and said, ‘Oh my god, this guy was just like you.'” He was very talkative in a highly energized way.
Around that same time, Mills was trying to finish his PhD in organizational psychology, but he couldn’t get through the dissertation. “It was just impossible to finish up. I started a new draft about 20 or 30 times, so it took years to finish,” he says.
Then his daughter, age 10, got her ADHD diagnosis. “It was after my daughter was diagnosed that I started getting checked out,” Mills says. “I think it took a few years to convince myself that’s what this was.”
The Signs Were There
ADHD isn’t just for kids. About 60% of people who are diagnosed in childhood continue to have symptoms through adulthood.
But the vast majority of adults who have ADHD — 3 out of 4 — didn’t know they had it as kids. “The presumption that you don’t have ADHD because you weren’t diagnosed as a child is absolutely incorrect,” says David Goodman, MD, assistant professor of psychiatry and behavioral sciences at Johns Hopkins School of Medicine.
When Mills looks back on his life, he sees that the symptoms were there all along.
It wasn’t just his dissertation that was a struggle. Even as a kid in school, he had a hard time getting started on assignments, keeping track of what they were, and remembering when they were due.
This was a source of constant anxiety for him — a common symptom of ADHD. “Everything was more complicated for me than you would think it should be,” he says. “I woke up every morning and thought, ‘What am I going to screw up today?'”
The Tipping Point
ADHD doesn’t simply appear one day. “If you tell me that you didn’t feel this way 6 months ago or that you didn’t have these symptoms as a child, I don’t know what you have — but you don’t have ADHD,” Goodman says.
What does suddenly appear is a new responsibility in life that’s too much for someone with ADHD to handle. Maybe you managed to get through elementary school or high school, and it’s the demands of college or the expectations from a job or a relationship that you aren’t able to meet.
That tipping point depends on your particular symptoms and how well you deal with them. People who are more hyperactive and impulsive, for example, may be more likely to get a diagnosis in childhood because their behavior is disruptive in school.
“That explains in large part the male-to-female ADHD ratio of 3:1 in children,” Goodman says. Women, he adds, especially those with a higher IQ, tend not to be diagnosed until college or beyond. In fact, the higher your IQ, the later you’re often diagnosed because you’re able to make up for your condition.
Common Light Bulb Moments
It may be that taking your child to get checked out for ADHD raised your suspicion about yourself. ADHD is very often passed down from parents to children. Some studies say 75% of your odds for the condition is genetic. “Sometimes, the pediatrician — having diagnosed the child — turns to the parents and says, ‘Which one of you looks like this? Let’s see if we can’t get you some help, too,'” Goodman says.
Maybe the triggering event is when you enter the workforce and can’t meet deadlines. Or maybe your spouse threatens to leave because he or she can’t rely on you to follow through on commitments.
“At some point in your development — elementary school, middle school, high school, college, career, marriage — when your responsibilities and burdens exceed your ability to compensate, that’s when things start to fall apart,” he says.
The Next Steps
Does Mills’ story sound familiar? Do a little more research, Goodman suggests. Read up on the signs and symptoms of adult ADHD or watch a web video. If that hits home, look online for the Adult ADHD Self-Report Scale, which has a list of symptoms. If you check several of those boxes, see a doctor.
A regular doctor (you might hear them called a primary care provider) who has worked with adult ADHD or a psychologist, psychiatrist, or neurologist with expertise in the area can make a diagnosis. The battery of tests children go through in order to get a clear diagnosis aren’t usually needed for adults, Goodman says. You can describe your symptoms and experiences for doctors better than a child might.
When Mills was seeking his diagnosis, even doctors were skeptical. “It was during an interview with a doctor, and he paused and said, ‘You know, some people don’t even believe ADHD exists in adults,” he remembers.
Although a greater awareness of the condition has helped lessen its stigma, you could still run into people who think you should just “snap out of it” and pay attention.
That’s because we all get distracted sometimes, Goodman says. When medical conditions — such as depression, anxiety, and ADHD — have symptoms that everyone has felt to some degree before, it can be hard for people to understand the difference between what’s “normal” and what are signs of a disorder.
Arm yourself with information, he suggests. Study up on ADHD so when someone challenges you, you’re prepared and can explain what having it means and what it’s like.
Your doctor may recommend a prescription stimulant to help your focus, and you could see improvement in your symptoms very quickly.
It might take other people a little longer. “Family and co-workers usually notice in 3 to 6 months,” Goodman says. “They need to see consistent execution over time before they breathe a sigh of relief and say, ‘This a change that we can depend on.'”
Talk therapy can help you learn strategies to handle what challenges you most, whether it’s time management, organization, or follow-through.
Treatment isn’t one-size-fits-all, though. For some, medicine alone is enough to relieve symptoms and get along better in daily life. Other people might choose to have talk therapy for a few months or many years.
You finally have a name for your struggles and something that helps, but what if you had known 20 or 30 years ago? What about those missed opportunities or past mistakes that now seem like the results of untreated ADHD?
Therapy can also help you sort through your feelings — the relief and the regrets. “Then, you slowly come to the realization that ADHD is what you have, but it is not who you are,” Goodman says. “That experience is liberating and can help resurrect your self-esteem.”
Mills says, “It’s a lifelong process of learning how to make my life simpler.” He has found his strengths and come to accept his weaknesses: “I’m not going to raise my hand to be the person who takes the minutes at a meeting.”
Some people with a new diagnosis start couples’ therapy so they and their partner can learn how the condition has affected their relationship and how to navigate it together in the future.
“Another aspect of therapy is discussing how life has been and how much better it can be now, once you gain the confidence and mastery to participate in the world as you always hoped you could,” Goodman says.WebMD Feature Reviewed by Smitha Bhandari, MD on October 29, 2018
Lew Mills, PhD, retired marriage and family therapist, San Diego, CA.
Anxiety and Depression Association of America: “Understand the Facts: Adult ADHD (Attention Deficit Hyperactive Disorder).”
American Journal of Psychiatry: “The Prevalence and Correlates of Adult ADHD in the United States: Results From the National Comorbidity Survey Replication.”
David Goodman, MD, director, Adult Attention Deficit Disorder Center of Maryland; assistant professor, department of psychiatry and behavioral sciences, Johns Hopkins School of Medicine.
ADDitude: “ADHD, By the Numbers,” “Choosing a Professional to Diagnose and Treat ADHD.”
Journal of Attention Disorders: “Executive Function Impairments in High IQ Adults With ADHD.”
Journal of Child Neurology: “Attention-Deficit Hyperactivity Disorder (ADHD).”
Attention Deficit Disorder Association: “Adult ADHD Self-Report Scale (ASRS-v1.1) Symptom Checklist.”
Mayo Clinic: “Adult attention-deficit/hyperactivity disorder (ADHD).”
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