One out of every 5-10 adult psychotherapy clients probably has attention deficit/hyperactivity disorder (ADHD). Key studies and writings emerged in 1995 supporting the idea of adult ADHD, but it took many years of reading and research to confidently recognize and appropriately treat adult ADHD. It continues to be underrecognized by mental health clinicians, even when clients with ADHD are already in treatment for other mental illnesses, and considerable misinformation is circulated. In the edited excerpt below, Jan Willer, author of Could it be Adult ADHD?, explores the myths about Adult ADHD and the facts that disprove them.
Myth: Adult ADHD is a controversial and trendy diagnosis. It does not really exist.
Facts: False. The existence of adult ADHD is strongly supported through multiple converging lines of evidence, including genetics, symptomatology, impairment, neuropsychological testing results, and differences in brain structure and functioning. ADHD is highly heritable and about as heritable as bipolar disorder and schizophrenia, which were previously considered to be the two most heritable mental illnesses.
Myth: Everyone is distractible sometimes. Those people are just making excuses for being lazy and unmotivated.
Facts: Like most other mental disorders, symptoms of ADHD are on a continuum, and the people whom we diagnose with ADHD are in the extreme tail of that distribution. The continuum of ADHD may partially explain the difficulty that doubters have with understanding that ADHD is a true disorder. Of course, everyone is occasionally distractible and disorganized. So it’s easy for some to say, “she’s not sick; she just needs to try harder” or that ADHD is “an excuse.” This attitude is both uninformed and emotionally damaging to individuals with ADHD.
Myth: ADHD is a result of our modern technological lifestyle.
Facts: False. Technology may certainly contribute to distractibility in all adults, including those with ADHD. However, individuals of all ages, including those who grew up with technology and those who did not, have problems with ADHD. Instead, in the past, ADHD was conceptualized differently as a character flaw: “lazy” or “unmotivated.
Myth: ADHD is caused by bad parenting, too much TV, and so on.
“ADHD is highly heritable and about as heritable as bipolar disorder and schizophrenia”
Facts: False. ADHD is primarily a genetically inherited neurological difference. However, childhood stress can increase the likelihood that ADHD develops in a person who is genetically at risk.
Myth: A good diet can cure ADHD.
Facts: In general, no. However, there are a few caveats to this: (a) in a recent meta-analysis, about 30% of children with ADHD were found to improve on a diet free of food additives; (b) there is preliminary evidence that environmental toxins, such as lead and pesticides, may increase ADHD symptoms in children; and (c) the addition of omega-3 fatty acids does help cognition in children with ADHD, although not nearly as much as stimulant medication, so it is not recommended as a primary treatment. Not much is known about diet and adults with ADHD.
Myth: ADHD is a socially constructed disorder.
Facts: Every disorder is a socially constructed way of cutting reality into categories. ADHD is no different from anxiety, depression, or any other mental illness in this regard.
Myth: ADHD is a culture-bound syndrome in the United States.
Facts: False. Multiple international studies of ADHD have documented the presence of this disorder in countries across the globe, including but not limited to Canada, France, Germany, Italy, the Netherlands, the United Kingdom, Japan, and Korea.
Myth: Most children outgrow ADHD by adulthood, so there is a low prevalence of adults with ADHD relative to children with ADHD.
Facts: False. Over two-thirds of adults who had ADHD as children still have significant functional impairment as adults.
Myth: Most adults with ADHD are diagnosed as children.
Facts: False. Many individuals with ADHD—especially those who are women, did not have childhood behavior problems, had inattentive type ADHD, are in disadvantaged groups, or are now age 40 and above—were never recognized to have ADHD as children.
Myth: Adults with ADHD are rare.
Facts: False. At least 4% to 5% of the US adult population has ADHD, and this is probably an underestimate.
Myth: Only a trained neuropsychologist can diagnose ADHD in adults.
Facts: Not necessarily. A well-trained mental health practitioner can, in most cases, diagnose ADHD from a careful clinical interview. In other cases, a well-educated psychologist can clarify the clinical picture by administering appropriate ADHD rating scales, conducting a careful developmental interview, and obtaining observer ratings, if necessary. Nonetheless, neuropsychologists are the one group of mental health practitioners who are well trained to recognize ADHD in adults. Be aware that about 60% of adults with ADHD have normal neuropsychological test results of executive functioning, probably because life is more complicated than neuropsychological tests. So neuropsychologists often diagnose ADHD from history, symptoms and behavior during testing rather than test results. Also, neuropsychological testing can be helpful in very complex cases with multiple comorbidities, especially those with learning disabilities.
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