Why Is Adult ADHD So Often Unrecognized?
Whatever treatments you decide, understanding you have ADHD makes a difference.
Many people with ADHD struggle with inattentive symptoms, such as distractibility, forgetfulness, disorganization, and poor time management.
ADHD can be a risk factor for marital dissatisfaction, poor health, reduced lifetime earnings, traffic accidents, and substance abuse.
Ari Tuckman, PsyD, CST, is the author of four books on adult attention-deficit/hyperactivity disorder (ADHD), most recently ADHD After Dark: Better Sex Life, Better Relationship. He is a psychologist and sex therapist in private practice in West Chester, PA, a former board member of Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD) National, and co-chair of the CHADD conference committee.
MB: Thanks for taking the time, Ari. I’m curious, before we start talking about treatment, what are your thoughts on where we are with adult ADHD today? How common is it, and how often is it recognized and diagnosed?
AT: The irony about ADHD in adults is that we know a lot about it—the problem is in getting that information out to clinicians and the general public. We're doing a pretty good job of identifying ADHD in kids, but most adults with ADHD have never been diagnosed and are therefore going through life untreated (which doesn’t just mean medication, of course). Most kids with ADHD retain at least some of those struggles into adulthood, but we stop looking for it when someone graduates. Probably about 4 percent of adults have ADHD, which is not a small minority.
MB: What does adult ADHD typically look like? A lot of the recent research talks about the health implications of under-managed ADHD, and time management is core to adult ADHD, too. Are there adults, from your point of view, who are struggling with health or chronic stress who could unknowingly have ADHD?
AT: Some people think of ADHD as mostly the hyperactive boy type, but many people with ADHD struggle mostly with inattentive symptoms, such as distractibility, forgetfulness, disorganization, procrastination, and poor time management. Also, hyperactive kids tend to settle down as they become adults, so it's less visibly obvious.
For many people, it’s the inattentive and impulsive symptoms that continue to be a struggle, which can lead to additional stress as they try to keep up on all their responsibilities. This can also affect how they take care of their physical health, from forgetting to schedule follow-up appointments or tests to sticking with a generally healthy lifestyle of sleep, diet, and exercise. But if their ADHD isn't addressed, then it will always be harder for them to be more consistent about these good habits. Therefore, people who chronically struggle with inconsistency may want to consider the possibility of ADHD—it's certainly not the only cause of poor follow-through, but it is a common one.
MB: Understanding what’s going on with ADHD can make a huge difference, in my experience, separate from any treatment choices. What impact have you seen as people begin to understand what executive function means in day-to-day life, and how it relates to living with ADHD? It’s often a way to let go of a lot of self-blame and judgment, for example, when working with families.
AT: Just the act of getting diagnosed can be a real game-changer in how someone sees themself and understands their past struggles. I say that it's like reading the last chapter of a mystery novel, where everything comes together and all of a sudden their life makes much more sense—such as, "no wonder I kept shooting myself in the foot like that, despite knowing better."
Understanding those struggles as a neurologically based information-processing weakness can feel less moralistic than all of the other prior explanations they had used or been told. Also, understanding how ADHD impacts how you navigate through your days, why it makes some tasks harder but doesn't affect other tasks, enables you to approach demands in ways that are more likely to be effective. There's no need to re-invent the wheel if other smart people have figured out good ADHD strategies before you.
MB: What role does the research say medication can play in adult ADHD? Is it any different from pediatric ADHD?
AT: The medication we use today for ADHD is the same medication that has been used for decades, so we know a lot about the benefits and side effects. Medication isn't magic, but the stimulants can be very effective for many people with ADHD, regardless of age, and tend to have manageable side effects.
I say that stimulant medication closes the gap between intentions and actions and helps people with ADHD to be more consistent, planful, and efficient in what they do. We know that untreated ADHD can be a significant risk factor for marital dissatisfaction, poor health, reduced lifetime earnings, traffic accidents, substance abuse, etc.—pretty much all the outcomes that most of us want to minimize.
I can understand that some people don't like the idea of taking medication, but we also need to consider what are the risks that come from not taking medication. Trying harder and using good systems and strategies is always going to be a requirement for a happy and effective life, but untreated ADHD makes it much harder to use those good habits in an enduring way. A little bit of the right medication can bring it all together so those good intentions work out more consistently.
MB: So how can people work with the rest of ADHD, all of the organizational and time-management stress, and the health implications?
AT: Most people need good systems and strategies to live well and stay on top of obligations. People with ADHD perhaps need it a little more. Good systems work much more reliably than just trying harder. This could mean strategies like really committing to using a calendar system with reminders, creating a less distracting work environment, reducing clutter, and checking in regularly with your romantic partner/coworkers on who is doing what.
Perfection is not at all necessary—even just using these systems a little more often will probably lead to an improvement you can feel. Also, regardless of what you did yesterday, put in the effort to make today a good day and to use those strategies again.
MB: What’s something practical people can try out, starting today?
AT: Get enough sleep! Everyone does better with a good night's sleep, but it can be a challenge to come by, especially if you have ADHD. But make it a priority. Resist distracting activities that you get stuck in that keep you up too late. Maybe even set an alarm to tell you to go to bed. And don't believe yourself when you say that you can stay up "just a little bit later" since often that becomes a lot later. Even if you aren't perfect about it, doing somewhat better on sleep is another one of those differences that you will feel.