Why an influx of Canadian adults are seeking ADHD diagnosis and treatment, according to experts

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Looking back, Pippa Boyd can see the telltale signs – like frequently getting in trouble in grade school for moving around too much, and needing an organizational system that relied heavily on cue cards to make it through nursing school – but only recently has she started to think she has ADHD.

“In highly adrenalized situations my focus is spot on, but in daily life it’s a struggle,” says the 54-year-old from Toronto.

That struggle has only gotten worse in the past two years, And it’s one many others are also experiencing.

Clinicians and ADHD advocacy organizations say they are seeing a large influx of adults seeking an ADHD (attention deficit hyperactivity disorder) diagnosis and treatment.

Dr. Gurdeep Parhar says the number of adults coming to his Burnaby, B.C., clinic seeking an ADHD diagnosis is up 25 per cent since the pandemic began. Not all of them will meet the diagnostic criteria, dealing instead with a normal amount of difficulty paying attention, an understandable situation considering all the ways life has changed in the past two years. But with the pandemic’s collapse of routines and schedules – whether it’s no longer going into the office, making it to the gym or attending social functions – many people’s previously undiagnosed ADHD has been brought to the fore, Dr. Parhar says.

“COVID has brought it more to light,” he says. “People who did well in a structured environment, whether it was a classroom or an office, are all of a sudden given all of this unstructured time.”

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There is also a wider awareness of ADHD and its nuances than in earlier generations. This is leading some adults to consider it as a reason for why they are struggling, rather than dismissing it as a diagnosis only found in children, says Heidi Bernhardt, director of education and advocacy at the Centre for ADHD Awareness Canada, a non-profit organization based in Toronto.

Wayne O’Brien runs a support group in Toronto for adults with ADHD. Prior to the pandemic, the group had approximately 100 active members, who would meet twice a month at the Centre for Addiction and Mental Health. The meetings have gone virtual and the number of active members has tripled, Mr. O’Brien says. Many newcomers have yet to be diagnosed, but are sure they suffer from the disorder, he says.

When it was first identified in the 1960s, ADHD was known as “hyperkinetic reaction of childhood.” Thanks to a better understanding of the condition, including identifying inattentiveness as a symptom, it was finally named ADHD in 1987, when the American Psychiatric Association released the third edition of the Diagnostic and Statistical Manual of Mental Disorders.

ADHD is the most common mental-health disorder identified in children, affecting nearly 5 per cent of people of all ages, but an estimated 90 per cent of adults who have ADHD are undiagnosed, Ms. Bernhardt says.

Typically, it is hyperactive boys disrupting classrooms who are singled out for assessment, she says. “Those are the kids who would be picked up because they’re highly annoying to adults.”

People who struggle more with attention than hyperactivity are more likely to slip through the cracks. This is true especially of girls – boys are more than twice as likely to be diagnosed with ADHD than girls, according to the U.S. Centers for Disease Control and Prevention.

“I’ve been finding a lot of women are coming during the pandemic,” says Dr. Doron Almagor, a Toronto-based psychiatrist and former chair of the Canadian ADHD Resource Alliance, a non-profit organization dedicated to improving the understanding of ADHD among health care professionals.

ADHD is a neurodevelopmental disorder and therefore something people are born with, Dr. Almagor says. The pandemic hasn’t caused any adult to develop ADHD. It’s instead brought their ADHD more starkly into focus. “The pandemic may have tipped the balance in their functioning,” he says.

The move to working from home has likely been the biggest such balance-shift for many, Ms. Bernhardt says.

“If you’re in a good job that works to your strengths, if you have a spouse who does all the organizing, if you have good scheduling you thrive,” she says. But when “all that scaffolding disappears,” a person’s ADHD symptoms can quickly become exacerbated. “That’s what’s happened in the pandemic.”

André Brisson, who was diagnosed with ADHD shortly before the pandemic, has struggled with the transition to working from home.

Before COVID-19, he’d often be driving to Toronto from his home in Ingersoll, Ont., to meet with clients. “Constant movement is important for me,” says the 47-year-old, who runs a structural engineering company. “I get bored easily, and when I get bored my impulsivity takes over.”

Working from home has not only meant having to fight boredom, but also structuring and organizing his professional life away from an office, something that is still a challenge.

“I just created my little ADHD office in the last few months. It’s completely separated from everyone else, I’ve got nothing on the walls, it’s got no distractions,” he says.

The pandemic may have also caused some people to wrongly suspect they have the disorder, Dr. Almagor says.

“People are stressed out and might be expecting too much of themselves. There are limits to productivity and focus,” he says.

There is a strict diagnostic criteria for ADHD Dr. Parhar says. While it is based on a psychological assessment, importantly, it must cause dysfunction. If you’re not struggling with work, family or personal relationships, then you probably don’t have ADHD, he says.

As for Ms. Boyd, she will be meeting with a specialist later this summer after her family physician initially dismissed ADHD. She made it through nursing school and therefore couldn’t have the disorder, he told her.

But she has found things harder than ever during the pandemic.

“Keeping on top of e-mails, my phone, it’s hard. I’m really struggling with my organizational stuff right now,” she says.

She is meditating daily, making lists of everything she needs to do and relying on alarms on her Google calendar to try and stay focused. All the research she has done on her own has convinced her she has ADHD and it puts all her earlier challenges in a new light.

“It’s just a real eye opener,” she says.

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