ADHD – or Attention Deficit Hyperactivity Disorder – can throw you a curveball. With the right medication and support, people with ADHD can thrive.
Robert remembers dreading Sundays as a child. “Sunday evening was a day of mourning and sadness,” he recalled. He disliked school because he struggled to focus and had trouble with social cues and impulsivity. “I was a little bit more impulsive, more rowdy, and would sometimes say something stupid,“ he remembered. Robert shared that he lost marks at school because he constantly forgot to follow simple rules, like including the date on a report, and made endless unnecessary mistakes. “Those little things started to add up,” he explained.
Constant negative experiences led Robert to hate school. He felt increasingly deflated, which inevitably affected his grades and his confidence. “I felt that because I was struggling at school that meant I wasn’t good at school.”
Robert’s story is a common one for anyone living with ADHD. Most people spend years undiagnosed, trying to deal with the negative impacts of this neurodevelopmental condition that affects how their brain grows and matures. Without a diagnosis, people don’t see their challenges as being related to a brain disorder – they just feel like they’re a failure.
People living with ADHD commonly have significant difficulty paying attention, especially to things they find boring or really challenging. They often struggle with procrastination and they’re disorganized, as well as having poor impulse control. Others are hyperactive – they feel chronically restless and fidgety and can’t sit still. Even during times when they should be able to relax, they often feel as if they’re driven by a motor. Some have just the attentional symptoms, some just have hyperactivity/ impulsivity, but the majority of people with ADHD have a hefty dose of all three, says Dr. Diane McIntosh, psychiatrist, and founder and CEO of Rapids Health.
“Young people with untreated ADHD are much more likely to abuse substances, drop out of school, have unwanted pregnancies and get into trouble with the law. Later in life, new problems can arise with maintaining relationships or employment due to inappropriate or impulsive behaviors or comments, or failing to complete work or follow through on commitments,” she says. Adults often struggle with their finances, drive erratically, and are more prone to serious accidents. “In short, untreated ADHD can come with very serious consequences.”
As Dr. McIntosh explains whenever she’s speaking about mental illness: “In psychiatry, we have no objective tests, no brain scans or blood tests to ensure we have the right diagnosis or to guide our treatment choices. We do have clinical scales, scientifically validated questionnaires that I use when diagnosing and following my patient’s response to treatment.”
“Assessing ADHD in children usually involves gathering feedback from parents and teachers, as well as a professional evaluation of the child. When I’m assessing an adult for ADHD, with their permission I also like to gather input from someone who knows them best, whether it’s a friend or family member. That’s because adults with ADHD have lived their whole life with their symptoms – they see themselves as being a failure or flawed, rather than recognizing that the disorder is causing their challenges. As a result, they commonly understate the presence or impact of their symptoms, even though the disorder is completely undermining their success.”
For Robert, it was only when he was just entering his teens that he accidentally came across a pamphlet on Attention Deficit Hyperactivity Disorder (ADHD). Something clicked. He recalls thinking, “That seems like me!” And that’s where Robert really was lucky. “Because my mom (yes, Robert’s mom is Dr. McIntosh!) is a psychiatrist, she agreed.”
“I knew ADHD was present on both sides of our family. But, like most families, I had to bring everyone along to be comfortable with the possibility of this diagnosis. Fortunately, Robert was able to speak for himself and that helped to get everyone on board,” recalls Dr. McIntosh. ”It’s important never to diagnose your family members, so a colleague did the assessment and started Robert on treatment, which changed his life.”
But for individuals without a psychiatrist for a parent, there are good places to go for help and many options for treatment.
Dr. Randy Mackoff, a Vancouver-based clinical psychologist, talked about the ways he supports individuals with ADHD. “People often want to attribute their symptoms to a lack of discipline or intellect. With parents, there’s often a reluctance to give medication to their children, which is understandable, nobody wants to take medication unnecessarily.”
Continued Mackoff, “But what people often don’t realize is that ADHD isn’t a matter of ‘pulling yourself up by your bootstraps.’ Medication is extremely beneficial. There is some educational component to getting to a treatment plan for ADHD, where I work with them to understand their fears, inform them, and let them make the decision.“ Dr. Mackoff then encourages them to speak to their healthcare provider to be assessed and consider treatment options.
“One of the best things about ADHD is that the treatments are among the most effective in medicine. They work very well for most people, and they’re extremely safe,” Dr. McIntosh explains.
There are two groups of medications used to treat ADHD: psychostimulants (methylphenidate or dexamphetamine types) and non-stimulants. Most people respond extremely well to a psychostimulant and they’re usually very well tolerated, which means the side effects are usually mild and often short-lived.
Getting the medication right is a process. Dr. McIntosh shared her approach: “I try one psychostimulant type first and if my patient isn’t having an excellent response or they’re struggling with side effects, we try the other. You’ve got nearly a 70% chance the first will work well for you, but if not, don’t give up. Given their incredible potential benefits in managing ADHD symptoms, it’s worth taking the time to find the one that works best for you. If neither works well or is well tolerated, I then look to the non-stimulant group of medications.”
“My child is already hyperactive! Why would you prescribe a stimulant?” Did you know, people with ADHD experience a calming effect when taking a stimulant? They are really effective for reducing hyperactivity and impulsivity, improving focus and attention and can actually improve sleep quality in individuals with ADHD.
Along with medication, reassurance that the person with ADHD is not a failure is key to ensuring parents and kids don’t blame themselves. Often, people with ADHD have above average intelligence but see themselves as not being smart because of their inability to perform like others.
“My patients and their families need to be supported. A lifetime of frustration often accompanies an adult with a new diagnosis of ADHD. Relationships might need to heal. Reframing negative thoughts about themselves takes time. However, it’s very gratifying when I can help them to find a new, more positive path in life,” says Dr. McIntosh.
When families learn the facts about the disorder, it’s not uncommon to discover that other family members also have ADHD, McIntosh says. “ADHD is our most heritable disorder. I often have one—and sometimes two—parents who also have ADHD trying to parent a kid with ADHD,” she says. In such cases, having a parent navigate treatment alongside their child can foster acceptance and understanding.
As Dr. Mackoff explained, there’s work to do just getting a patient to the point where they are ready for treatment. He spends time with patients, “talking about how we can work together and how we get the best treatment.”
It was once believed that children outgrow ADHD, but this notion is largely inaccurate. Decades of scientific research show that for the majority of people ADHD persists into adulthood, at least to some extent.
For Robert, being diagnosed and appropriately treated helped him to complete his education, including a university degree, and build a happy, productive life. He now has a job that plays to his strengths, a close-knit group of friends and he leads an active, healthy life. He encourages the newly-diagnosed to not give up until they find tools that help.
“Something will work—it really can be life-altering,” he says.
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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.
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