Bringing ADHD Into Focus: Adult ADHD: Tim’s Trials and Tribulations

“Tim”, a thirty eight year old Caucasian married man and father of two, was accompanied by his wife Julia when he came to see me for the first time. Tim nervously explained that his marriage was on the rocks and that his wife Julia had threatened to divorce if he did not get help. He seemed rather bewildered by Julia’s unhappiness.

He was a lawyer at a prestigious firm at Cleveland. He considered himself to be a successful lawyer and was proud of his ability to provide for his family. In fact, he and his wife had recently bought a beautiful home on a large lot in an affluent suburb. “Just the way Julia wanted it.” he smiles. Then he opened his wallet and showed me the pictures of his two beautiful children. “Julia has no reason to be unhappy.” he stated.

However, when I turned to talk to Julia, a totally different world unfolded. She was disturbed by and increasingly concerned with Tim’s inattentiveness. She agreed that he was doing fine at his job but their home life was a disaster. At home, Tim was not much help to Julia with household chores or the children. “He’ll forget to pick up a carton of milk on the way home from work.” Julia said with exasperation, “but what really concerns me that he sometimes forgets to pick up the kids from the daycare.” A few times Julia had asked him to watch their children in the yard but he had become distracted by a task inside the home and left the toddlers unattended! He was forever leaving cupboard doors open- Julia had hit her head on several occasions. She had to constantly remove coffee cups and water glasses left by Tim on their good furniture Julia would make a ‘to do list’ in Tim’s organizer and Tim would also set alarms on his cellphone but his problems were only getting worse.

Tim clearly seemed to be a loving husband and father. He felt he was trying his hardest but Julia believed he was lazy and irresponsible. When I told them Tim suffered from ADHD, they seemed both surprised and relieved.

Do you know somebody who may have adult ADHD?

As was the case with Tim, a majority of adults with ADHD are never diagnosed with the condition as a child. Tim had been an intelligent young boy who excelled academically. Although he had been somewhat diagnosed as a child, his ADHD wasn’t readily apparent. Many kids with ADHD are able to compensate for defects in their youth depending on their overall intelligence, family structure, social situation and school environment. However, as adulthood approaches and life’s demands become more challenging, those affected with ADHD begin to experience increasing difficulties.

Adults with ADHD could experience any of the symptoms that youth with ADHD could experience, however, the following may be the red flags in ADHD in adults:

• Chronic lateness

• Procrastination

• Chronic forgetfulness about appointments, etc.

• Chronic difficulties with meeting deadlines.

• Trouble keeping jobs.

• Chronic, poor motivation.

• Difficulties processing information.

• Overreaction to stress.

• Chronic, overwhelming feelings about daily routine.

• Difficulty prioritizing.

• Poor awareness of time.

• Episodes of “hyperfocus” total absorption in certain activities of interest to an extent that person becomes oblivious to the environment.

• Difficulties regulating one’s mood e.g. easy irritability, etc.

How common is adult ADHD?

As many as six to eight out of every ten young people with ADHD continue to have ADHD symptoms as adults. About 4%-5% of adults suffer from ADHD symptoms; however, the majority of them remain undiagnosed.

Barriers to diagnosis of ADHD in adults:

I believe the following reactions account for under-diagnosis of adult ADHD:

• Many adults with ADHD are told by family and friends that they lack will power and/or sense of responsibility.

• There is a general public belief that everybody has attention problems and therefore we need to ‘deal with it.’

• There is a common misconception that if somebody suffers from depression, bipolar disorder or anxiety disorder then he/she cannot have ADHD along with one of these conditions.

• ADHD in adults is more likely to be masked by drug/alcohol use.

• There is skepticism among mental health professionals about adult patients who present symptoms of ADHD. The professionals often believe these adults are motivated by the need to take stimulant medications which could often be abused.

When to seek professional help?

You should seek an evaluation from a mental health professional if and when your attentional difficulties begin to adversely affect your social, family or occupational functioning.

Treatment of ADHD:

Outcome is most optional when treatment is multifaceted.

• Education: this is critical and empowering since there are several myths prevalent about adult ADHD. You should only use sources recommended by your treating professional.

• Counselling: this should include individual, marriage and family whichever is relevant. This treatment focuses on better coping skills, improving self-esteem, etc.

• Cognitive Behavioral Therapy: this utilizes structured changes in behavior which could result in less procrastination, improved motivation, better time management, etc.

• Organizational tools and/or professional organizers: regular use of calendars, daily task list and reminders could be all beneficial. In difficult cases, the help of professional organizers may be needed.

 *Names have been changed to protect privacy.

*The purpose of this article is for educational purposes only. It is not intended to diagnose or treat any medical or psychiatric issue. Dr. Rakesh Ranjan is a practicing psychiatrist and a researcher. He is a recipient of several research awards and has authored several peer-reviewed journal articles and book chapter on psychiatric illnesses and their treatments. He is a national speaker for several organizations and serves on the medical advisory board for NAMI for Greater Cleveland. If you or a loved one is experiencing any symptoms that would lead you to believe that there could be a mental imbalance, please email your questions to Dr. Ranjan at ask thedoctor@charakresearch.com Each Wednesday, Dr. Ranjan will address some of these questions in this column. All contact info will be kept confidential.