Adult Attention Deficit Hyperactivity Disorder: Underdiagnosed, Undertreated

Article excerpt

William Collins is 35 years old. He has been married and divorced three times. He has difficulty keeping a job. Minor things irritate him; he loses his temper and impulsively makes remarks that get him into trouble. Such constant, irritability has cost him 20 jobs and three marriages. At times he has been so angry that he stalks his wife, and whenever he loses his temper with his boss, he gets fired. The excuse he tells people is that he became bored with the job and quit. None of his jobs has ever amounted to much anyhow because he has trouble concentrating on work. People constantly remind him to pay attention because he forgets easily. Because of this he did poorly in school and hated every minute of it. His teachers thought he was either "slow" or "lazy" or "unmotivated," and they all thought his major problem was "poor self-esteem." As a teenager he found himself drinking to excess, and the only time he ever felt "normal" was when a friend gave him some "speed" (amphetamines).

Bill blamed his problems on his parents. His father was chronically unemployed, alcoholic, and his mother was always depressed and suffered many anxiety attacks. The therapist Bill consulted after his second divorce reinforced the tendency to blame his parents by claiming his problem came from a dysfunctional family and that he could never learn adequate coping skills. At one point the therapist wondered whether his anger wasn't the result of sexual abuse so early in life that he could not remember. However, despite a year in therapy, his behavior did not change. Bill came to believe that nothing would ever be better for him.

Bill's problems are not the result of dysfunctional family or sexual abuse. He has a genetic disorder that caused a chemical imbalance in his brain that interferes with how his brain works. He has adult attention deficit disorder with hyperactivity (ADHD). Ironically, it is a very treatable disorder. But because it was never diagnosed, Bill in essence lost the first third of his life. Bill is not alone.

ADHD in Children

Attention deficit hyperactivity disorder, commonly known as ADHD, is the most common behavioral disorder of childhood. It occurs in 4 to 8 percent of boys and 2 to 5 percent of girls. It was first described in the early part of this century and was initially thought to be the result of some type of brain damage, thus the name minimal brain damage, or MBD. By the 1960s, it had become clear that only a minority of children had any evidence of brain damage and the name was changed to "hyperkinetic syndrome" or "hyperactivity."

In 1980, with the publication of the third edition of the psychiatric bible, the Diagnostic and Statistical Journal of Mental Disorders (DSM-III), the name was changed again to Attention Deficit Disorder, or ADD. This correctly emphasized that the major problem distinguishing these children from their peers was an inability to pay attention, especially in a crowded, noisy classroom. In 1987, when the DSM-III was revised, the name was changed again to Attention Deficit Hyperactivity Disorder-ADHD.

It is a common misperception that children with ADHD always grow out of it by the time they are adults. This is incorrect. Approximately 50 percent of the time the symptoms persist into adulthood. However, the diagnosis is often missed for three reasons:

First, the symptoms of motor hyperactivity tend to disappear as children grow older. As a result, affected adults appear more normal, in that they are not constantly running around like most children with ADHD. However, they are still restless inside and have great difficulty sitting still for very long.

Second, adults are no longer in school and it is in school that ADHD subjects have the most difficulty. For example, if a person with ADHD, who was unable to sit still and concentrate in class, takes a job outside as a construction worker or a salesman, the restless need to be in constant activity may be perceived as an advantage rather than a disadvantage. …