Sharing a Diagnosis: When You and Your Child Have ADHD

From the WebMD Archives

Your son or daughter was just diagnosed with ADHD, or attention deficit hyperactivity disorder. And as you sat there in the office, listening to the doctor tick off the symptoms - the attention problems, the disorganization, the fidgeting - you recognized yourself. Suddenly, you wonder: Could I have adult ADHD?

You very well might. ADHD runs in families, and experts say that for any child with ADHD, there’s a 30% to 40% chance that one of the parents has it.

But for many adults, the idea never occurs to them until their children get diagnosed.

It’s a common pattern, says David W. Goodman MD, assistant professor of psychiatry at the Johns Hopkins University School of Medicine. “I might treat a 16-year-old with ADHD,” Goodman tells WebMD. “The next thing you know, his 40-year-old father gets diagnosed, and then his 43-year-old uncle. ADHD becomes part of the family tree.”

Since adult ADHD can have a profoundly negative impact on your life, it’s important to get help, especially since you’re not the only person in the family who has the condition. Here’s what you need to know.

ADHD in Children vs. Adults

If you think of ADHD as a childhood condition that kids grow out of, you’re hardly alone. But you’re wrong.

While ADHD always starts in childhood - symptoms appear before age 7 - it usually doesn’t end there. “Two out of three children with ADHD will continue to have ADHD as adults,” says Lenard Adler MD, a professor of psychiatry and director of the Adult ADHD Program at the New York University School of Medicine.

Many adults with ADHD were never diagnosed as kids - their symptoms were just missed. That’s especially common in girls, says Adler. Teachers and parents are more likely to focus on the noisy, disruptive boys than the inattentive girls.

Other people with undiagnosed adult ADHD were actually diagnosed as kids. But back then, pediatricians told people they’d grow out of it, says Goodman, who is also director of the Adult Attention Deficit Disorder Center of Maryland in Baltimore. It may have seemed that way. A first grader with ADHD who used to get in trouble for standing on his chair and shouting during story time might seem a lot calmer by the time he gets to college. But in many cases, the ADHD isn’t gone. The symptoms have changed.

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That’s one of the key reasons that ADHD in adults is so often missed, experts say. Adults may not have much of the “H” in ADHD -- hyperactivity -- at least not overtly. “You don’t see ADHD adults in graduate school standing on their chairs,” says J. Russell Ramsay, PhD, assistant professor of psychiatry at the University of Pennsylvania and co-director of the Penn Adult ADHD Treatment and Research Program in Philadelphia. “But the hyperactivity has just gone underground.”

So what are the telltale adult ADHD symptoms?

  • Attention problems. Many adults with ADHD say that they’re easily distracted by noise or activity. But it’s not really that adults with ADHD actually have a deficit - a lack - of attention, says Adler. They may focus intensely on certain things that interest them but are less able to pay attention to tasks that are dull or too complex.
  • Disorganization & procrastination. Adults with ADHD often have trouble starting tasks and put them off until the last minute, regardless of the consequences. They run late and lose track of time.
  • Forgetfulness. Some adults with ADHD lead obviously chaotic lives, forgetting and misplacing everything. Others may do well in most ways but get tripped up by details. An employee might do good work on a project, but then get in trouble for not filling out her timesheet. A college student might spend all night on a paper, but then forget to bring it to class.
  • Restlessness & impulsivity. Adults with ADHD may not be jumping around like hyperactive kids, but they could have other problems. They might make rash decisions or blurt out things without thinking. They might interrupt people because they have trouble waiting their turn to speak. They might fidget or bounce their knees when sitting.

Keep in mind that not everyone with ADHD will have all these symptoms. There’s also a lot of variation in the severity. Some people just have mild ADHD symptoms and do all right, while others will be severely impaired.

Impact of Adult ADHD

The consequences of adult attention deficit disorder are numerous. “ADHD has a ripple effect,” says Ramsay. “It impairs many aspects of your life, from your relationship with your spouse, to your role as a parent, to your job.” The results can be serious.

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“ADHD is not a benign disorder,” says Adler. He points out that adults with ADHD have higher rates of divorce, unemployment, substance abuse, and even car accidents.

“The effects of ADHD even extend to the pocketbook,” says James McCracken, MD, director of Child and Adolescent Psychiatry at UCLA’s Semel Institute in Los Angeles. “When compared with people who have the same type of jobs, adults with ADHD make significantly less money.”

But most of these adults never get an ADHD diagnosis. Many don’t consider the possibility, so they never ask about it. Doctors may not help much, either.

“Unfortunately, more or less the entire medical and professional community - internists, adult psychiatrists and psychologists - have almost no background in the diagnosis or treatment of adult ADHD,” says McCracken. As a result, the majority are never diagnosed, and fewer than three out of four adults with ADHD are getting any treatment.

So what happens to these people? They may try to get help, but wind up misdiagnosed. They may be prescribed antidepressants or anti-anxiety medicines. In some cases, these drugs may help a bit -- many people with ADHD have overlapping depression or anxiety. Others might be told by their doctors to go into counseling - maybe for job skills training or couples therapy. But in all of these cases, the core underlying problem is missed.

The ADHD Household

Of course, if you and your child - or children - all have ADHD, that can interfere with the functioning of the whole family. Life can be terribly chaotic.

One particular problem, Ramsay says, is that adults with untreated ADHD may not be able to provide the ideal care for their child with ADHD. Kids with ADHD require a lot of structure. They need schedules. They need to get their medicine on time. They need firm and consistent discipline. That’s exactly the kind of help that a parent with untreated adult ADHD may not be able to offer.

“If you’re a parent with ADHD, you lose track of time, you’re disorganized, and you put things off,” says McCracken. “A parent with ADHD and a child with ADHD can be a terrible match.”

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Not only is this bad for the child with ADHD, but it can put a huge burden on the non-ADHD spouse, who has to take on all of the responsibility.

So sometimes, the best thing you can do as a parent of a child with ADHD is get treatment yourself.

“Parents with ADHD need to see that getting treatment isn’t only for their own well-being,” says McCracken. “It’s doing the right thing for the whole family.”

Adult ADHD: Getting Help

If you think you might have adult ADHD, what should you do next? Here are some tips.

  • Take a self assessment. Adler recommends taking the ADHD Adult Self-Report Scale Screener developed by the World Health Organization. It won’t give you a diagnosis. But it might give you and your doctor some sense of how likely it is you have adult ADHD.
  • Talk to your family. Often, it’s the people around us who have the best impression of our behavior. Talk to your spouse or kids or close friends. Show them some information about adult ADHD and get their take. In their opinion, do the ADHD symptoms describe you?
  • Research the condition. Start reading about ADHD. Ramsay recommends web sites such as CHADD (Children and Adults with Attention Deficit/Hyperactivity Disorder) and ADDA (Attention Deficit Disorder Association). Or you could check out any of the numerous books on adult ADHD written for the public.
  • Research your own history. To make a diagnosis of ADHD, your doctor will want to establish that you had symptoms as a child. So delve a little into your past. Talk to your siblings or parents and get their impression of what you were like as a kid -- your doctor might even want to speak to them, if possible. Start digging around in old files or your scrapbook. Doctors often find documentation - like old report cards or notes from teachers - helpful in confirming a diagnosis.
  • See a doctor. You can always start with your family doctor, but it’s quite possible that he or she won’t know much about adult ADHD. If you happen to live in a big city or near a university, see if there’s a local clinic that specializes in adult ADHD. If not, the best bet may be to talk to a child psychiatrist or psychologist - maybe even your son or daughter’s doctor. Experts say that they’re often much more knowledgeable about ADHD than those who specialize in adult mental health. Your child’s doctor might have the best advice about where to go for a diagnosis and what sorts of resources are available locally.

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Once you’ve seen a doctor, you can talk about treatments for ADHD. The standard treatment for adult ADHD is medication - often stimulants - which could be coupled with therapy.

If you suspect you might have adult ADHD, don’t ignore the signs. See an expert and get an evaluation.

“The good news about ADHD is that our treatments are so effective in adults and we have a lot to offer,” says McCracken. “And since ADHD really is a family condition, so many different lives can be helped with treatment.”

WebMD Feature Reviewed by Brunilda Nazario, MD on September 04, 2008

Sources

SOURCES:

Lenard Adler MD, associate professor of psychiatry and child & adolescent psychiatry, director of the Adult ADHD Program, New York University School of Medicine, New York City.

Attention Deficit Disorder Association web site: “WHO’s Adult Self-Report Scale (ASRS) Screener.”

David W. Goodman MD, assistant professor of psychiatry and behavioral sciences, Johns Hopkins University School of Medicine; director, Adult Attention Deficit Disorder Center of Maryland, Baltimore.

James McCracken, MD, director of child and adolescent psychiatry, Semel Institute, UCLA Medical Center, Los Angeles.

National Resource Center on AD/HD web site: “Diagnosis of AD/HD in Adults.”

J. Russell Ramsay PhD, assistant professor of psychology in psychiatry; co-director, Penn Adult ADHD Treatment and Research Program, Hospital of the University of Pennsylvania, Philadelphia.

© 2008 WebMD, LLC. All rights reserved.

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