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ADHD Treatment

What they don’t tell you about ADHD: Facts and Myths

ADHD Treatment and Symptoms in Adults – We all seem to think we know what Attention Deficit Hyperactivity Disorder (ADHD) is when we see it but can’t seem to put our finger on its diagnosis, symptoms, and treatment. Part of the problem is that there is no conclusive scientific way to measure it—there are no specific causal factors, metabolic or neurological markers, and no medical tests for ADHD. Another problem is that the range of ADHD symptoms vary from inattention, distractibility, lack of focus and procrastination, to lack of planning and organization, low task persistence, sloppiness, impulsivity, fidgetiness, and poor emotional regulation. Other factors include lack of sleep, hurried lifestyle, work and family pressures, social media distractions and other comorbidities such as anxiety, loneliness, depression, and substance abuse. No wonder people feel overwhelmed and unable to focus!  

 

Adult ADHD is a real condition, but its suffering is largely “invisible”

It is a common misconception that ADHD only affects children, or that adults who are struggling with task completion, forgetfulness, focus, and mental fatigue are “lazy or stupid”. Many Adult ADHD sufferers are highly accomplished, some with advanced degrees, who, nonetheless, can’t remember where they parked the car,   They are anything but dumb. Even though the scientific evidence is not conclusive, some even argue that there is a high correlation between ADHD and giftedness because many of the symptoms of each overlap (poor sense of time, hyperfocus, easily bored, daydreaming, lack of interest in everyday tasks) . ADHD seems to affect both men and women about equally, though women are often underdiagnosed because they tend to be less behaviourally disruptive. They are often the “lost ones” in class.

Despite the confusion, there is good evidence based on brain imaging that ADHD patients show the following features: 1) disrupted reward circuitry 2) deficit in response inhibition 3) impairment in working memory. This can lead to patients seeking immediate rewards to soothe their need for stimulation while simultaneously forgetting what they are doing. Sound familiar?

ADHD diagnoses are imperfect, but they are the best tools we have so far

As Churchill once said: “Democracy is the worst form of government, except for all the others.”  ADHD diagnoses rely largely on subjective self-reports, teacher and parent perspectives, cultural norms, societal norms, and personality factors. Symptoms can be categorized through the careful completion of ADHD questionnaires combined with a thorough and detailed clinical interview by a trained clinician who can then integrate the findings into a report that summarizes the overall functioning of the individual in the context of their life. ADHD generally falls into 3 types:

  • Inattentive/Distractible Type (daydreaming, failure to pay attention)
  • Hyperactive/Impulsive Type (classic presentation of “hyper” symptoms, interrupting others)
  • Combined Type (features of both types)

In addition, we know that ADHD affects our Executive Functioning ability and vice versa. Executive functioning refers to the way our brains organize, plan, initiate, persist, and complete activities. Are we cognitively flexible or rigid? Do we tend to “hyperfocus” at the risk of ignoring other stimuli? In other words, do we have too many tabs open and how well do we organize them.  Our assessment process also probes for 16 aspects of executive functioning. Finally, we assess for overall mood and external factors. Are there social, work, or financial stressors?   What is the quality of the individual’s support network?

 

 ADHD is less about getting a diagnosis than managing a condition

ADHD is best diagnosed along a continuum of severity—it can change over time and circumstance.

Many ADHD skeptics fail to recognize that just because you may have some but not  all the symptoms that meet the formal criteria of an ADHD diagnosis, you don’t have ADHD. Rather, the symptoms you do have may be equally debilitating. For instance, you may find that you can function well on a golf course, yoga class, piano lesson, or Excel spreadsheet, but find that you can’t recall what you have studied, are too impatient to follow instructions, wait in line, or wait your turn to speak at work.  Equally frustrating, is the knowledge that you may be functioning at a very high level in other areas of your life—a loving parent, a kind spouse, a great storyteller, a terrific problem solver—that you can easily lose hope and lapse into self-blame.

 

ADHD Treatment Medication—useful for some but not for all

It is tempting to search for the “magic pill” for ADHD treatment. If only… If only. The reality is that stimulant medication (Adderall, Ritalin, Vyvanse, Concerta) may be effective for some patients whose underlying neurochemistry is receptive to these stimulants, but they should be approached with caution and whose benefits must be weighed against the severity of symptoms and side effects (dry mouth, headache, loss of appetite, disrupted sleep, etc.) and risk of drug dependency. Stimulant medication, contrary to what college students say, does not make you” smart”, though it can keep you up for hours. Medical practitioners are equally cautious in their prescribing in consultation with their patients.

 

Behavioural intervention—living with ADHD

Building habits and routines, learning how to relax and meditate, developing coping strategies, using apps and technology, educating yourself and others, building social supports, developing better work strategies—all of these complement any ADHD treatment and help you improve your overall functioning and not just reduce your ADHD symptoms. With success, your confidence and self-esteem will improve. Others will see you in a more positive light and react accordingly.  

 

ADHD is a Gift – A Positive Psychology Approach

Given the elusiveness and pervasiveness of ADHD, perhaps what we are dealing with are not deficits in attention, but strengths in over attention. Gifted and creative individuals are typically quick to see connections that others miss, have many interests, are impatient for results, don’t like to do the same things the same way, can be emotionally reactive, and risk loving—in other words, they see ahead of the curve. They can become great scientists or writers, musicians or actors, entrepreneurs or inventors. People with ADHD often become  extremely successful with their careers in later life. This list would include Richard Branson, Michael Phelps , Simone Biles, Michael Jordan, Bill Gates, Paris Hilton, Justin Timberlake, and Solange Knowles. It also includes past Presidents of the United States, as well as Will Smith, probably could have benefited from some impulse control training. 

 

While we can’t control everything about our life situations, we can make small adjustments to boost our mental health. If you’d like to talk about opportunities to support your mental health or ADHD Diagnosis,  please contact our Care Team.

About the Author

Jack Muskat

Senior Psychologist
Dr. Muskat is a Toronto-based organizational psychologist with significant consulting experience working with Fortune 500 companies. His clinical practice focuses on issues relating stress, anxiety, and depression, as well as interpersonal relationships.