Not Mentally Mainstream Part 6: ADHD, the undertreated disorder

Read the Not Mentally Mainstream series.

Eleven percent of children in America have attention-deficit/hyperactivity disorder (ADHD). Yet, only 4.4 percent of the U.S. adult population has been diagnosed with the disorder.

There's a misconception that ADHD is a childhood disorder. But that doesn't make sense. I you turn 18 and all of the sudden, all of your symptoms vanish? Experts believe, with the number of adults with undiagnosed ADHD, the percent is actually much higher than 4.4, according to the magazine ADDitude.

Another misconception is that ADHD is over-diagnosed and over-treated. Again, experts say this is not true.

“The rates of treated ADHD continue to be lower than the rate of ADHD diagnosis, suggesting a pattern of under-treatment of ADHD — not of over-treatment, as commonly thought," said Dr. John T. Walkup, Professor of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine.

My boyfriend Sean Boughton is an adult (obviously) who has ADHD and was diagnosed around age 10. His ADHD is something he hasn't really opened up about to many people (I mean except for now. I guess that's what happens when you're dating a girl with a mental health blog).

Even though Sean has been there for me, painstakingly, through all of my anxiety attacks, after two and a half years of dating, I still didn't know much about what he was going through when it came to ADHD. That was until last week when, over beer and french fries, I told him I was going to interview him, and he agreed.

Sean said he thinks ADHD is under-diagnosed in adults because, "As an adult, there's no one in your corner, pointing it out to you. ... I think most people don’t understand. They just think I’m weird or being annoying and push me away.”

He found out he had ADHD because one of his teachers recognized the symptoms in him. He said, “I never did well in school. I was a huge daydreamer. In class, you couldn’t keep my attention for more than maybe five or 10 minutes."

“I remember one time in fourth grade, in the middle of class, I got up from my desk — not paying attention to the teacher — and walked over to the corner of the room and started looking at books. My teacher discreetly came over to me and said, ‘We were all talking. What happened?’ It wasn't because I didn't want to listen to what she was saying. My brain just couldn't focus."

ADHD Symptoms in Children and Adults 

Sean said he was able to gain some control over his ADHD in high school by channeling his energy into sports, and, in college, the learning style — taking classes he was interested in and having longer breaks in-between classes — helped him thrive and become an A and B student.

“After college, when I got into the workforce full-time, I started to see an increase in the amount of ADHD episodes. … Especially when I first lay down to go to sleep and when I first wake up, I think about 30 or 40 different things," he said.

According to PsychCentral, the symptoms of ADHD — hyperactivity, inattention and impulsiveness —manifest differently in children and adults.

For kids, the hyperactivity displays with them running, climbing on things, squirming and constantly fidgeting. For adults, they are more likely to feel on edge and agitated, easily bored, difficulty sitting still for long periods of time and an internal feeling of restlessness inside of them.

With inattention in children, it comes through mostly with their homework or chores, but, for adults, it affects daily life and work — maybe through misplacing things. becoming distracted in the middle of a task and difficulty with planning and time management.

Impulsiveness in children is most likely demonstrated by blurting things out in school before being called on, cutting in the lunch line or acting without taking into account the consequences, according to the website. For adults, it comes out more in their spending patterns, taking over conversations, risky behaviors and an inability to relax.

Sean said he, too, has seen some of these changes in his symptoms from when he was a child to now.

"As a kid, I had no control over it. I was all-energy, all-the-time. And now, I can control it, to an extent. It’s more jolts, three or four times a day," he said. "There are times when I let my ADHD out, when I’m talking about 10 things at once. There are other times where I’m able to keep it inside my head. ... I get frustrated with myself on being unable to focus or availability of my mind to communicate ideas.”

Why is ADHD under-treated and under-diagnosed

There is still a lack of understanding about ADHD, and there are negative stereotypes, just like with most mental illnesses, that may deter treatment.

Parents may misinterpret ADHD as their child just being hyper, instead of seeing it as a neurobehavioral disorder that requires medical attention. According to an article in the medial journal Front Psychiatry, some people interviewed said, because of information they gained from non-healthcare professionals or read on social media, they believe physicians and companies generate revenue from unnecessary use of pharmacologic treatments.

"Such findings speak to the need for community and parental education regarding the symptoms of and help available for ADHD in attempts to increase the timely diagnosis and treatment," the article states.

Sean said he thinks many people mistake kids with ADHD as being “dumb,” when this is obviously untrue.

“When a child doesn't have the capability of controlling their own brain, I think they are pushed to the side. There were times when I felt like teachers thought I was hard to teach so they just didn’t deal with me,” he said. “Many people with ADHD are visual learners and tactile. They have to touch and feel things to learn and need a more interactive educational environment.”

For adults, it's even worse. When Googling "Why is ADHD undertreated," most of the first page of search results is about adults.

One reason is because the difference in symptoms is not reflected in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Only the childhood symptoms of ADHD are noted, and only one-third of adults meet that criteria, according to the Mayo Clinic. It may also be because it's estimated that more than half of adults diagnosed with ADHD in childhood grew up to have one or more additional psychiatric disorders, which can mask the symptoms of ADHD.

Another reason may be because, as you probably know, ADHD medication (*cough* Adderall *cough*) is known to be abused, especially by college students, which may make providers reluctant to assess patients for ADHD.

There is help

While some mental disorders don't manifest until later in life, ADHD symptoms can begin to show as early as preschool. Therefore, the American Academy of Pediatrics (AAP) suggests that parents get their children screened for ADHD as early as 4 years old. 

"Treating children at a young age is important because, when we can identify them earlier and provide appropriate treatment, we can increase their chances of succeeding in school,” said Dr. Mark Wolraich in an article by AAP.

But what about those with symptoms of ADHD who have far missed this early detection, maybe by decades? And what about people who have late-onset ADHD?

No, you're not screwed. And yes, you should still seek treatment. 

Dr. J. Michael Bostwick, a psychiatrist at Mayo Clinic's campus in Rochester, Minn., recommends that anyone with the core symptoms of ADHD - even if they don't meet the full criteria - get tested for the disorder. He said the consequences of a lifetime of silently suffering from ADHD can be "devastating," with consequences including impaired quality of life, reduced employment, susceptibility to accidents and vulnerability to depression. 

"Little people, little problems; big people, big problems," he said. 

A combined pharmacotherapy and psychosocial treatment works best for those with ADHD, psychiatrists Josh Geffen and Kieran Forster wrote in the medical journal Therapeutic Advances in Psychopharmacology. 

They recommend ADHD-tailored cognitive behavioral therapy focusing on building routines, overcoming procrastination and increasing time management skills.

"There is good evidence for the success of these therapies alone or in addition to pharmacotherapy. They can be delivered by psychiatrists, psychologists or ADHD coaches," they wrote. "In clinical practice, maximum yield and therapeutic efficiency is obtained when psychosocial interventions are delivered in addition to pharmacotherapy as a part of multimodal treatment."

Stimulant drugs ease ADHD symptoms in about 70 percent of adults, and Geffen and Forster wrote that the tolerability and overall safety of these drugs are better than most psychiatric medicines.

There are three types of stimulants —short-acting, intermediate-acting and long-acting forms. For a list of common stimulants for ADHD, visit WebMD

The advice Sean would give to someone with ADHD: "Surround yourself with a good network of people. Talk with your friends about it. Talk with your doctor about it. Go to a free clinic." 

Seeking help for your metal health is just as important as getting help for your physical health. As Sean said to me, "Don't believe the naysayers who say the disorder doesn't exist. Just because they haven't experienced it themselves, doesn't mean it's not real."

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