Stigma and misconceptions about ADHD have been particularly persistent. Misinformation and disinformation can perpetuate stigma and add to the suffering and health burdens of affected individuals and their families. I encourage you to read and share the information I share here.
Attention-deficit/hyperactivity disorder (ADHD) is a highly prevalent neuro-developmental condition, which means it’s associated with the development of the nervous system.
Up to 7% of children and 4-5% of adults meet the diagnostic criteria for ADHD. For most people, their ADHD symptoms persist into adulthood, although they usually change with age, sometimes becoming less severe, but the symptoms can still negatively impact functioning, overall health and quality of life.
It’s important not to pathologize normal variations in human functioning and behavior, including differences in attention or motor activity. Everyone occasionally feels more easily distracted, inattentive, or restless. There are people who meet the diagnostic criteria for ADHD in terms of symptoms – they are inattentive, impulsive or hyperactive – but they are able to function normally. I’ve had people tell me, “My ADHD is my superpower.”
In fact, like every psychiatric disorder, you don’t actually have the diagnosis if your symptoms aren’t clearly interfering with, or reducing the quality of, your social, academic or occupational functioning.
Just about every person diagnosed with a mental illness has personal attributes that make them valuable members of their family, workplace and society. However, mental illnesses are not enjoyable, pleasurable, desirable or empowering. Enduring a mental illness can build resilience, demonstrate courage and lead to immeasurable good, through advocacy, for instance. But no one would ask to have a mental illness, because every diagnosis is associated with personal distress, broader health risks and functional impairment.
The stigma associated with all mental illnesses continues to be a barrier to diagnosis and treatment.
This is despite mountains of scientific research, gathered over decades, demonstrating the structural and functional brain changes associated with psychiatric disorders, and the negative mental and physical health outcomes associated with missing a diagnosis or failing to appropriately treat these disorders.
The stigma and misconceptions about ADHD have been particularly persistent, perhaps because a diagnosis often results in treating children with medication.
However, some random person’s lack of medical knowledge and personal discomfort with medication shouldn’t matter one bit to an individual who is suffering from ADHD. These objections should be ignored by the family of a smart kid who is failing in school or has no friends, or the adult who couldn’t finish high school, can’t keep a job or maintain a relationship, because of their ADHD.
There are two major clusters of ADHD symptoms – inattention and hyperactivity/impulsivity.
To be diagnosed with ADHD, several typical symptoms must have been present before the age of 12 (even if you weren’t diagnosed as a child), and symptoms must currently impair functioning in at least two settings (at work, school, home, or socially).
There are many ADHD symptoms, so each individual may present differently. Some people are obviously hyperactive or impulsive, while others are highly inattentive, and many have a hefty dose of both. There must be a constellation of persistent symptoms, not just one or two, to meet the diagnostic criteria.
In psychiatry, we have no objective tests – no lab test or brain scan – that can help me make any psychiatric diagnosis. However, I do have clinical scales – scientifically validated questionnaires – that I use when making a diagnosis and following my patient’s response to treatment.
When diagnosing children, ADHD assessments usually involve gathering questionnaires from parents and teachers, as well as a professional evaluation of the child.
For adults, an assessment includes clinical scales and, if possible, I usually give the same scale to someone closest to them, so I have collateral information. Commonly, adults understate their ADHD symptoms – their spouse or close friend usually provides a more accurate assessment (or at least adds some valuable insights) regarding the impact of their symptoms.
Adult ADHD commonly co-occurs with other psychiatric diagnoses, called comorbidities, including mood, anxiety and substance-use disorders, complicating the diagnosis.
Additionally, some ADHD symptoms are difficult to distinguish from the symptoms of other diagnoses, such as bipolar disorder (BD).
It’s critical to screen for all comorbid conditions to ensure they are considered when planning treatment. For instance, BD and ADHD commonly co-occur, but BD must always be treated first, before ADHD treatment is considered.
Untreated or undertreated ADHD is associated with many serious negative outcomes, including the increased risk of serious accidents, lower educational attainment, and a greater risk of divorce, incarceration and illicit substance use.
ADHD runs in families. In fact, it’s one of the two most heritable (genetic) psychiatric disorders – the other is bipolar disorder. Most people with ADHD have a parent, child, sibling or another close relative who has the same diagnosis – whether they know it or not!
New research has discovered specific genes responsible for ADHD. Unlike some disorders, like cystic fibrosis or Huntington’s Disease, which are due to the presence of one specific gene, psychiatric disorders have “polygenic” inheritance, which means there are many genes involved in the development of the disorder. The more genes you inherit, the more likely you are to have ADHD.
However, even though we now have strong evidence about the genetic bases of ADHD, we know that, like all psychiatric disorders, other factors are important in its development. It’s estimated that up to 40% of ADHD risks are related to “environmental” factors, like maternal smoking, but clear causative links have never been established.
Every psychiatric diagnosis presents diagnostic and treatment challenges, but ADHD is the most rewarding disorder I treat. That’s because the treatments are usually extremely effective, they’re very safe and, almost always, they’re very well tolerated.
The decision to take any treatment is deeply personal. Some might feel treating their ADHD is unnecessary– they feel they’re coping well or that the symptoms are less impactful than the cons of treatment. Whether they don’t like the whole idea of medication or how medication makes them feel or they’re fearful of taking medication, that decision is theirs to make.
Medications for the treatment of ADHD have been available for nearly a century. Their safety and efficacy has been studied so rigorously because, until the last few decades, they were used almost exclusively for children.
While there are many myths regarding ADHD treatments, they remain the most effective class of medications I prescribe – they work well for almost everyone. There has been a mountain of data supporting their use, especially regarding their benefit in avoiding the negative outcomes of untreated ADHD.
Because we have no objective tests to guide our choices, finding the right treatment for any psychiatric disorder is a process of trial and error. Fortunately, the two major ADHD treatment groups (dexamphetamine and methylphenidate) are both highly effective and most people with ADHD will respond well to both. However, if one treatment isn’t working well or it’s causing unwanted side effects that aren’t improving, trying the other class is an important next step. For many reasons, long-acting stimulant medications are recommended in all evidence-based treatment guidelines for ADHD.
Unlike almost any other psychiatric disorder, talk therapies are not a top option for ADHD. Sometimes, especially when there are comorbid conditions, like depression, anxiety or substance-use, talk therapy can be extremely valuable. But the core ADHD symptoms are generally highly responsive to medication treatment.
Despite decades of evidence on the presentation, brain changes, genetics, harms and burdens associated with ADHD, and the availability of safe and effective treatments, most people are still undiagnosed, untreated or undertreated. It’s so important to know the facts! Misinformation and disinformation can perpetuate stigma and add to the suffering and health burdens of affected individuals and their families.
I look forward to hearing your thoughts on this blog post. Send me your thoughts on my Contact form or through LinkedIn.
Dr. Diane McIntosh is a psychiatrist, innovator, educator, author and speaker. She is a passionate advocate for better mental health care, and a champion for all who suffer from mental health challenges.
This blog post is part of a series looking at the state of our mental healthcare system and ways we can create sustainable change to improve quality and outcomes for anyone impacted by mental illness.
Epigenetic changes related to loving and nurturing parenting can be passed to children, helping them be loving, nurturing parents. Growing up in abusive, non-nurturing environments can provoke changes to a child’s genome that can be passed to offspring, heightening risk of generational abuse and family chaos. My explanation of epigenetics.
Epigenetic changes related to loving and nurturing parenting can be passed to children, helping them be loving, nurturing parents. Growing up in abusive, non-nurturing environments can provoke changes to a child’s genome that can be passed to offspring, heightening risk of generational abuse and family chaos. My explanation of epigenetics.
Having two or more psychiatric diagnoses at the same time occurs for at least half of those diagnosed with a mental illness. As with other illnesses, it’s important to understand the full picture in order to find the best treatment.
Dr. Diane McIntosh is a psychiatrist, innovator, educator, author, and speaker. She is passionate advocate for better mental health care, and a champion for all who suffer from mental health challenges.
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