Director Michael McNamara decided to make a documentary about attention deficit hyperactivity disorder (ADHD) in adults after learning that a friend and colleague was diagnosed with it at the age of 56.
His friend's diagnosis had upended McNamara's assumptions about the disorder, which is most commonly diagnosed in school-aged children. Until then, he didn't know it could affect individuals into adulthood. But as he began researching and conducting interviews for the film, McNamara found the main symptoms, including inattentiveness, procrastination and impulsiveness, seemed all too familiar.
It turns out McNamara has ADHD himself.
His film ADHD: Not Just for Kids, premiering on CBC's The Nature of Things on March 16, examines why ADHD often goes undetected in adults. It explores research into the biology of the disorder, how it affects individuals' lives and how adults cope with the symptoms.
As McNamara explains to The Globe and Mail, many adults may be struggling with the disorder as he did, without realizing they have it.
How common is ADHD in adults?
It's estimated the percentage of children worldwide who have the disorder is about 7 per cent. Not all of those kids actually get diagnosed or treated. In about half of those kids, it will carry on into adulthood. There's varying levels and severity of symptoms, so it's kind of hard to put a figure on, but somewhere around 2 per cent or 3 per cent of adults have it.
What symptoms did the adult subjects of your film have in common?
The primary one is inattentiveness, an inability to concentrate. Hyperactivity, adults don't tend to have the same way children do, which is one of the reasons they fall under the radar. They have problems organizing their time and their schedules, procrastination, having an inability to get a task started and following through, and also problems with short-term memory.
All of these are part of a host of skills we have in our brains called executive functions. The experts figure executive functions are affected by the neurotransmitter dopamine. With ADHD, it's believed there's a problem with dopamine reaching certain parts of your brain – the supply is low, and that may be the root of the symptoms.
At what point did you find out you have ADHD?
I was initially kind of skeptical. I thought, "Okay, I'm projecting myself onto this." It was about four or five months before I actually did the tests, went to a specialist and went through the battery of things you go through when you're diagnosed. And they're like, 'Oh yeah. For sure. You have it with flying colours.'
What was your reaction?
It was kind of a relief in a lot of ways. There were some symptoms that had always given me problems, such as procrastination and having an inability to focus. I still have problems with some of those things. But now that I have a diagnosis, I'm better able to figure out why they're happening and not kick myself for not trying hard enough. It makes a very big difference when you can actually put a name to why certain things are so easy for some people and you have such a hard time doing them.
Why is ADHD in adults often missed or misdiagnosed?
From my own discussions with medical professionals and others, general practitioners don't tend to know a lot about it. It's one of those things that gets covered in medical schools very quickly. There are still a few medical professionals who don't quite believe in it.
And ADHD kind of looks like normal behaviour, but exaggerated. Everyone may have a hard time getting started with things they don't want to do, or lose track of time. But this is chronic, it's a whole host of these things all at once, and it happens in all areas of your life – at home, at work, in relationships. So because it looks like normal behaviour, when you go to your doctor and your doctor asks, 'How are you feeling?' you're probably feeling fine. But the doctor might not ask, 'How are you doing?' And well, you might be having all sorts of problems in your life.
With hyperactivity in particular, people expect to see someone who fidgets and can't keep still in a meeting. There are adults who have those problems, but they tend to find socially acceptable ways of dealing with it. For instance, at a meeting, they might excuse themselves and go to the washroom.
You mention in your documentary that there are certain occupations that seem particularly suited for people with ADHD and that may even mask symptoms. Can you explain?
Because a low supply of dopamine is thought to be the culprit, adrenalin will increase the supply of dopamine to the brain. In the same way, stimulant medications will increase the dopamine supply. So some people will be lucky enough to find jobs that keep them excited, engaged and stimulated. They're more likely to take jobs as firefighters or emergency workers than they are to take jobs as accountants. Or at least if they take those kinds of jobs, they'll be more likely to be successful in other areas of their lives because they've found ways to kind of self-medicate.
I've been lucky enough to be in a job that's fairly creative and constantly stimulating me. I'm doing a different film every four or five months, so I rarely get bored.
Once diagnosed, what have you found helps?
I have to write all these scripts, and that means sitting down at a blank screen. It used to take me forever to do it. I did it, and I did it well enough but it was probably three times harder than it would have been if I'd been diagnosed earlier. In any event, once diagnosed, I was put on a course of medications and within a matter of weeks, things changed. I was more focused, I was better able to keep track of time, I was better able to start tasks, follow through and finish. It really made a big difference in a lot of areas of my life.
A number of people I talked to said they kind of go through what's almost like seven stages of grief. They wonder how different their lives could have been if the disorder had been identified a lot earlier. I'm lucky, but some people have problems with relationships, they get divorced, they have gambling habits or find other ways to keep that dopamine up that are less than healthy.
You make a point in the film that the aim isn't actually to get rid of the disorder. Can you elaborate?
Well, there's no cure. At the moment, the way to treat the symptoms is medications and some forms of therapy. It's a treatment in the way insulin is a treatment for diabetes, or glasses are a treatment for near-sightedness.
As one subject we interviewed said, it'd be a shame to do away with it. There's something fundamentally interesting about the disorder. There's a lot of creative, high-achieving people throughout history, who have ADHD or are suspected to have had it, such as Thomas Edison. Richard Branson [founder of the Virgin Group] famously has it, actor Howie Mandel is self-identified with ADHD. So it's kind of an interesting club to be a part of.
I wouldn't wish it on anybody, but on the other hand, if you identify it and treat it, there are certain benefits. People with ADHD do tend to have a fast-moving, creative mind.
This interview has been edited and condensed.