You've Got ADHD — Now What?
Just diagnosed with ADHD? The next step is to figure out your treatment options — which can be confusing and, at times, overwhelming. Here's how to embrace your diagnosis and move forward with the help you need.
Studies show that adult attention deficit disorder (ADHD) is treated successfully with a combination of medication and behavior therapy. But not all adults diagnosed with attention deficit embrace ADHD help and seek treatment. Many see their ADHD-related traits of creativity, ability to multi-task, and entrepreneurial energy as germane to who they are and their successes in life.
"People worry that ADHD treatment will change how they work and how others view them — and they're afraid of what the changes in themselves will bring," says David Fassler, M.D., a clinical associate professor of psychology at the University of Vermont College of Medicine in Burlington.
As Jet Blue Airways founder and out-of-the-box thinker David Neeleman told us in our last issue, "If someone told me you could be normal or you could continue to have your adult ADHD, I would take ADHD."
As it was for the thousands of Americans who lived this scenario last year, an ADHD diagnosis in adulthood rarely comes as a complete surprise, and often carries with it a mixed bag of emotions. Mixed, because many know that ADHD isn't all about problems. Called "a wonderful condition," by expert Ned Hallowell, M.D., who has ADHD himself, it has led to highly energetic, creative, original thinkers, some of whom are the great entrepreneurs of our day.
At the same time, most adults with ADHD know that they have more difficulties than others with organization, focus, and productivity. "As far back as I can remember, I've always felt out of step with the rest of society," says Debra Brooks, a 48-year-old, Portland-based business consultant and mother of three, who was diagnosed a few years ago. "I just didn't know there was a name for it."
Those diagnosed often feel relief at knowing why they are the way they are, but this can be tinged with regret for past struggles, and for what might have been had they been diagnosed earlier in their lives. "I love my parents," says Thomas Snodgrass, age 33, of Forest Hill, Maryland, who was diagnosed with ADHD in 2004. "But I was angry at first that they did not see my ADHD traits as a child."
Today, he remembers school years filled with angst because of his inability to focus. "I was in the smartest classes, but I always got the lowest grades," he says. He was told again and again by his teachers that he wasn't working up to his potential.
In fact, it's a child's diagnosis that often leads a parent to be tested for and diagnosed with ADHD. A parent may see her beloved son or daughter struggle at school in ways that remind her of her own school days. If her child is diagnosed with ADHD, the parent will probably learn that the condition is hereditary, with a 40 percent chance that one or both parents has ADHD as well. Her ongoing struggles with attention, organization, or forgetfulness might lead to a willingness to be tested, as well.
Other newly diagnosed adults may be carrying heavier baggage. "Research shows that adults with ADHD are more likely than non-ADHD adults to have been left back a grade, make less money, smoke, and depend on alcohol and drugs," says Lenard Adler, M.D., an associate professor of psychiatry and neurology and the director of the adult ADHD program at New York University. In fact, a diagnosis of adult ADHD sometimes occurs when a person is undergoing psychological evaluation to determine the causes of ongoing depression, a failing marriage, or problems at work.
Even if there are no major problem areas in their life, a diagnosis of ADHD can throw adults off balance, because the condition in adulthood is still little known. Experts estimate that about 80 percent of adults with the disorder — roughly 5 million — haven't been officially diagnosed, primarily because ADHD was not seen as a condition that persists into adulthood until about 20 years ago. "Doctors used to be taught that ADHD affected only children," explains Dr. Adler. "But now we know that, although hyperactivity may wane, symptoms such as inattention and impulsivity continue into adulthood."
Says Debra Brooks: "Even though my diagnosis made sense, I just couldn't or didn't want to believe it. I asked everyone — my husband, my kids, friends — whether they thought I had ADHD. They all said they did. I was shocked that everyone had suspected something but me."
To Treat or Not to Treat?
Debra Brooks was another holdout — at first. Depressed about her diagnosis, she says, "for about six weeks, I flailed. I resisted starting medication. But then I remembered what the neurologist who diagnosed me had said: 'Why did you pay me $1,400 if you didn't want my advice?'"
For those who take the plunge and start treatment, it can take time to find the right professional help and therapy — usually medication and behavior modification. Whether going for a diagnosis or treatment, it's best to have some knowledge of the condition and what a clinician should do for you. Even under the care of an experienced physician, it may take weeks or even months to find the medication and dosage that work best for you. As a result, says Harold Meyer, director of the New York City chapter of Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD), "It can take six months to a year to see major improvements."
Despite this caveat, many people report positive results from medication almost immediately. After much deliberation, Brooks started a stimulant medication. "The first day was like, who pulled up the shades?" she remembers. "They've been covering my eyes my whole life. Already, I'm much more organized and on top of things. I can remember what time I told my teenagers to be home. And I notice things I never did before. I got mad at my husband for walking on the white carpet with muddy boots. Before medication, I wouldn't have noticed - or cared."
Michael Adams, age 43, a stay-at-home dad in New York, says he easily accepted his recent diagnosis. He says he's fit the typical ADHD profile for as long as he can remember, struggling in high school, starting but not finishing college, being disorganized at home and at various jobs. When his wife came across a book about ADHD, the signs became clear. Since his diagnosis and treatment, Adams is finally accomplishing what he set out to do 20 years ago. "I'm completing the requirements for my English degree and also getting certified to teach high school English," he says. "I sometimes think about what I missed in school because I didn't know I had ADHD. But I try not to be angry about the past—especially when I have so much to look forward to."
Getting the Right Support
Once a newly diagnosed person has started on a medication regimen, he or she should also begin working with an experienced psychologist, psychiatrist, or life coach, says CHADD director Meyer. These professionals can help people with ADHD learn behavioral, time management, and organizational strategies to enhance their quality of life. Meyer offers these tips for the newly diagnosed among us:
- Know your legal rights. Having ADHD means you're protected under two federal laws that apply to individuals with disabilities.
- Seek support by attending meetings of your local chapter of CHADD, a nonprofit advocacy and education organization (click "Find local chapters" on CHADD's home page).
- Don't feel compelled to tell your boss. "There's more understanding about ADHD now, but that doesn't mean that supervisors are happy to learn that one of their employees has the condition," says Meyer. If, however, you think accommodations—closing your office door, taking more breaks — will help you improve your job performance, you may want to discuss these with your employer.
Adults diagnosed with ADHD may also want to reevaluate and diversify their support systems, so that they rely less heavily on spouses, coworkers, friends, and relatives. "Plenty of people with ADHD are happily married, with kids, and successful in their work," says David Goodman, M.D., an assistant professor of psychiatry at Johns Hopkins School of Medicine and the director of the Adult ADD Center in Baltimore. "Usually they've set up effective support at work, such as a really good secretary, and at home as well."
Thomas Snodgrass was one of those people who'd always looked like he had it all together — and for the most part, he did. A few years ago, he and his wife were about to have their first child. At the same time, he'd just taken on a new full-time job and was also attending graduate school. That's when his coping techniques — such as pulling all-nighters to write papers he'd ignored until the last minute, and working twelve-hour shifts on four hours of sleep — started to backfire.
"I had way too much on my plate," recalls Snodgrass, who works on a transplant team at Johns Hopkins Hospital. "I wasn't sleeping at all — I'd just lie there and go over everything I had to do. I'd forget to take off work on the days I was supposed to watch the baby. I was always losing my keys and my cell phone."
Tired of feeling disorganized and overwhelmed, Snodgrass looked through his insurance company's list of participating doctors, picked a psychologist's name, and called for an appointment. "I basically said to the doctor, 'You can tell me I have ADHD.'" A series of conversations, followed by a clinical evaluation, confirmed his suspicions.
"I kind of liked having ADHD. I could do 1,000 things and get nothing done!" he says, half-jokingly. But he's noticed lots of good come from treatment. "One of my biggest problems has always been saying the wrong thing at the wrong time. I'd be sitting in management meetings, and all of a sudden I'd blurt out something totally off the topic. Now, I have much more control."
Some names have been changed to protect privacy.