The case against adult ADHD goes something like this: Attention deficit hyperactivity disorder is a dubious condition promoted by Big Pharma to push stimulant drugs; the small number of children with true ADHD (rather than lax parenting) will outgrow it by their teens, so adults have no business using the diagnosis as an excuse for failing to meet their commitments as employees, spouses and parents.
Judging by its public face, you’d think ADHD was a loser’s gambit.
But Sarah Blyth, a Vancouver parks board commissioner who was diagnosed with ADHD as a child, begs to differ.
Although the 39-year-old politician and manager of a Vancouver housing shelter had to overcome years of poor grades and low self-esteem, she eventually developed the skills that people with ADHD are known to lack, such as attentive listening and time management, she says.
Ms. Blyth, who is up for re-election in November, recently “came out” as having ADHD in Vancouver’s Georgia Straight newspaper to encourage acceptance of others with the disorder, she says. “There’s so much stigma attached to it.”
But when people with ADHD learn coping strategies to work toward their goals, “you really can do it.”
The challenge is that the vast majority of adults with ADHD don’t know they have it, says Russell Barkley, a clinical professor of psychiatry at the Medical University of South Carolina in Charleston, and author of Taking Charge of Adult ADHD.
ADHD is a neurobiological disorder that interferes with executive functioning – an umbrella term for thinking processes that include planning, attention, working memory and impulse control.
Dr. Barkley says the disorder persists in adulthood for as many as two-thirds of children with ADHD, and 4 to 5 per cent of all adults have ADHD. “It’s one of the most impairing disorders we see in an outpatient clinic.”
One-third of people with ADHD never finish high school, he says. As adults, they tend to have a checkered work history, money problems, broken relationships and inconsistent parenting skills. They are at high risk for depression, anxiety, substance abuse, eating disorders, dangerous driving and impulsive behaviour that can land them in jail, he says, noting research showing that one in four prison inmates meet the criteria for ADHD.
Nevertheless, society continues to dismiss it as a harmless condition, Dr. Barkley says. “This is the Rodney Dangerfield of disorders because the name, unfortunately, makes it sound so trivial.”
Despite misconceptions, adult ADHD is a legitimate diagnosis included in the Diagnostic and Statistical Manual of Mental Disorders and recognized as a disability by government bodies such as Revenue Canada. (ADD is a misnomer used to describe people who are inattentive but don’t have other characteristics of ADHD. It’s a separate condition known in medical circles as “sluggish cognitive tempo.”)
Since expertise and services for adult ADHD are in short supply, however, getting a diagnosis can be a Sisyphean task.
British Columbia’s only adult ADHD clinic had an 18-month waitlist when it closed in 2007 after government cuts. In Ontario, the Toronto-based ADHD Clinic stopped seeing new adult patients about 18 months ago because it was overwhelmed by the demand, says medical director Doron Almagor.
Several private clinics have opened recently in Ontario, but assessment is only partly covered by the provincial health plan. At Toronto’s Springboard clinic, for example, a full assessment costs patients $1,200 out of pocket.
For those who do get an ADHD diagnosis, Dr. Barkley recommends stimulant medications such as Concerta, as well as Strattera, a non-stimulant drug. Although behaviour modification therapy can help, over 80 per cent of adults with ADHD will need medication, he says.
But meds aren’t the only answer, says Pete Quily, a Vancouver-based life coach for people with ADHD.
