- The Past, Present, and Future of ADHD
- ADHD numbers are rising, and scientists are trying to understand why
- The Rise of ADHD
- Is ADHD an American Fad?
- Doctor: ADHD Does Not Exist
- Related Stories
- Thank you!
- Historical Development of ADHD
- The History of ADHD and Its Treatments
- The History of ADHD: A Timeline
- Our History
- ADHD Throughout the Years
- ADHD in Adults
- ADHD is not just a childhood problem. Learn what the signs and symptoms of adult ADHD look like—and what you can do about it.
- Signs and symptoms of ADHD in adults
- Effects of adult ADHD
- Self-help for adult ADHD
- When to seek outside help for adult ADHD
The Past, Present, and Future of ADHD
Attention deficit hyperactivity disorder (ADHD) was recognized and described long before it became known as ADD and eventually as ADHD.
In 1902, an English pediatrician, Sir George Still, described a group of children who were disobedient, emotional, and uninhibited. He blamed these behaviors on biology, having discovered that some of the children had other family members with psychiatric disorders.
Early theories were that these children were the victims of poor parenting, and more discipline was the best treatment. As our knowledge of ADHD has evolved, so have the name of this commonly diagnosed disorder and recommended treatments for it.
By the latter part of the 20th century, ADHD was recognized as a true mental disorder, but was thought to be due to brain damage.
“In the 1960s and 70s, we probably only recognized the most serious cases of ADHD,” says Scott J. Hunter, PhD, director of pediatric neuropsychology at the University of Chicago. “The condition was described as ‘minimal brain dysfunction’ or ‘hyperkinetic reaction of childhood.'”
Hunter says that it was the American Psychiatric Association that first named the disorder in 1980, based on the symptoms of inattention, and called it attention deficit disorder, or ADD. Later, it was renamed attention deficit hyperactivity disorder, or ADHD. “Finally it was realized that there were different types of ADHD and it was broken down into inattentive, hyperactive, and mixed types,” he says.
A glimpse at the ADHD timeline:
- Before 1900. Symptoms of ADHD are considered a moral problem of children or their parents and discipline or punishment is seen as the best treatment.
- 1902. Sir George Still describes ADHD as a behavioral disorder that may be inherited.
- 1919. After some survivors of the influenza pandemic develop encephalitis and show symptoms of ADHD, the condition is blamed on brain damage. ·
- 1937. Scientists first report that stimulants can control ADHD symptoms. ·
- 1940. Symptoms of ADHD continue to be blamed on “minimal brain damage.” ·
- 1955. Ritalin (methylphenidate), a stimulant, is approved by the FDA. ·
- 1968. A disorder similar to ADHD called “hyperkinetic reaction of childhood” appears in the Diagnostic and Statistical Manual of Mental Disorders for the first time. ·
- 1979. An article in the influential journal Science refers to “the hyperactive child syndrome.” ·
- 1980. The third edition of the manual uses the name “attention deficit disorder” (ADD). ·
- 1994. The manual’s fourth edition recognizes the disorder as “attention deficit hyperactivity disorder,” with three subgroups. ·
- 1996. The second drug to treat ADHD symptoms, Adderall (dextroamphetamine and amphetamine) is approved by the FDA. Many other drugs soon come on the market. ·
- 2003. FDA approves Strattera, the first non-stimulant drug for ADHD, and the first to be approved for use in adults. ·
- 2003. The CDC reports that approximately 4.4 million children – about 8 percent of all U.S. children aged 4 to 17 — have been diagnosed with ADHD, and 2.5 million of them are taking medication for the disorder.
“Today we know that younger children are more likely to show hyperactivity ADHD symptoms and older children or adults are more likely to have symptoms of inattention. For most people with ADHD, symptoms are mixed and they change over time,” explains Hunter.
The three subtypes of ADHD recognized today are:
- Predominantly hyperactive-impulsive
- Predominantly inattentive
- Combined hyperactive and inattentive (mixed type)
To be diagnosed as one of these ADHD types, children must have six or more symptoms that fall into that category type. Examples of hyperactive-impulsive symptoms include inability to sit still, constant talking, and constant interruptions.
Symptoms of inattentive ADHD may include being easily distracted or bored, difficulty focusing, daydreaming, or being unable to follow directions.
As the symptoms of ADHD have been categorized, doctors and mental health professionals have created a checklist of symptoms that define ADHD and the subtypes of hyperactive-impulsive and inattentive ADHD.
ADHD is now one of the most common childhood disorders diagnosed and it is increasingly recognized as continuing into adulthood. The fifth edition of the DSM manual is due out in 2013.
What we continue to learn about ADHD may change how we define and treat ADHD even further.
The No Child Left Behind Act, signed into law by President George W. Bush, was the first federal effort to link school financing to standardized-test performance. But various states had been slowly rolling out similar policies for the last three decades. North Carolina was one of the first to adopt such a program; California was one of the last. The correlations between the implementation of these laws and the rates of A.D.H.D. diagnosis matched on a regional scale as well. When Hinshaw compared the rollout of these school policies with incidences of A.D.H.D., he found that when a state passed laws punishing or rewarding schools for their standardized-test scores, A.D.H.D. diagnoses in that state would increase not long afterward. Nationwide, the rates of A.D.H.D. diagnosis increased by 22 percent in the first four years after No Child Left Behind was implemented.
To be clear: Those are correlations, not causal links. But A.D.H.D., education policies, disability protections and advertising freedoms all appear to wink suggestively at one another. From parents’ and teachers’ perspectives, the diagnosis is considered a success if the medication improves kids’ ability to perform on tests and calms them down enough so that they’re not a distraction to others. (In some school districts, an A.D.H.D. diagnosis also results in that child’s test score being removed from the school’s official average.) Writ large, Hinshaw says, these incentives conspire to boost the diagnosis of the disorder, regardless of its biological prevalence.
Rates of A.D.H.D. diagnosis also vary widely from country to country. In 2003, when nearly 8 percent of American kids had been given a diagnosis of A.D.H.D., only about 2 percent of children in Britain had. According to the British National Health Service, the estimate of kids affected by A.D.H.D. there is now as high as 5 percent. Why would Britain have such a comparatively low incidence of the disorder? But also, why is that incidence on the rise?
Conrad says both questions are linked to the different ways our societies define disorders. In the United States, we base those definitions on the Diagnostic and Statistical Manual of Mental Disorders (D.S.M.), while Europeans have historically used the International Classification of Diseases (I.C.D.). “The I.C.D. has much stricter guidelines for diagnosis,” Conrad says. “But, for a variety of reasons, the D.S.M. has become more widely used in more places.” Conrad, who’s currently researching the spread of A.D.H.D. diagnosis rates, believes that America is essentially exporting the D.S.M. definition and the medicalized response to it. A result, he says, is that “now we see higher and higher prevalence rates outside the United States.”
According to Joel Nigg, professor of psychiatry at Oregon Health and Science University, this is part of a broader trend in America: the medicalization of traits that previous generations might have dealt with in other ways. Schools used to punish kids who wouldn’t sit still. Today we tend to see those kids as needing therapy and medicine. When people don’t fit in, we react by giving their behavior a label, either medicalizing it, criminalizing it or moralizing it, Nigg says.
For some kids, getting medicine might be a better outcome than being labeled a troublemaker. But of course there are also downsides, especially when there are so many incentives encouraging overdiagnosis. Medicalization can hurt people just as much as moralizing can. Not so long ago, homosexuality was officially considered a mental illness. And in a remarkable bit of societal blindness, the diagnosis of drapetomania was used to explain why black slaves would want to escape to freedom.
Today many sociologists and neuroscientists believe that regardless of A.D.H.D.’s biological basis, the explosion in rates of diagnosis is caused by sociological factors — especially ones related to education and the changing expectations we have for kids. During the same 30 years when A.D.H.D. diagnoses increased, American childhood drastically changed. Even at the grade-school level, kids now have more homework, less recess and a lot less unstructured free time to relax and play. It’s easy to look at that situation and speculate how “A.D.H.D.” might have become a convenient societal catchall for what happens when kids are expected to be miniature adults. High-stakes standardized testing, increased competition for slots in top colleges, a less-and-less accommodating economy for those who don’t get into colleges but can no longer depend on the existence of blue-collar jobs — all of these are expressed through policy changes and cultural expectations, but they may also manifest themselves in more troubling ways — in the rising number of kids whose behavior has become pathologized.
ADHD numbers are rising, and scientists are trying to understand why
By Rachel Bluth September 10, 2018
The number of children diagnosed with attention-deficit/hyperactivity disorder (ADHD) has reached more than 10 percent, a significant increase during the past 20 years, according to a new study.
The rise was most pronounced in minority groups, suggesting that better access to health insurance and mental-health treatment through the Affordable Care Act (ACA) may have played some role in the increase. The rate of diagnosis doubled in girls, although it was still much lower than in boys.
But the researchers say they found no evidence confirming frequent complaints that the condition is overdiagnosed or misdiagnosed.
The United States has significantly more instances of ADHD than other developed countries, which researchers said has led some to think Americans are overdiagnosing children. Wei Bao, the lead author of the study, said in an interview that a review of studies around the world doesn’t support that.
“I don’t think overdiagnosis is the main issue,” he said.
Nonetheless, those doubts persist. Stephen Hinshaw, who co-authored a 2014 book called “The ADHD Explosion: Myths, Medication, Money, and Today’s Push for Performance,” compared ADHD to depression. He said in an interview that neither condition has unequivocal biological markers, which makes it hard to determine whether a person has the condition. Symptoms of ADHD can include inattention, fidgety behavior and impulsivity.
“It’s probably not a true epidemic of ADHD,” said Hinshaw, a professor of psychology at the University of California at Berkeley and a professor of psychiatry at the University of California at San Francisco. “It might be an epidemic of diagnosing it.”
In interpreting their results, the study’s authors tied the higher numbers to better understanding of the condition by doctors and the public, new standards for diagnosis and an increase in access to health insurance through the ACA.
Because of the ACA, “some low-income families have improved access to services and referrals,” said Bao, an assistant professor of epidemiology at the University of Iowa College of Public Health.
The study, published in JAMA Network, used data from the National Health Interview Survey, an annual federal survey of about 35,000 households. It found a steady increase in diagnoses, from about 6 percent of children between 1997 and 1998 to more than 10 percent between 2015 and 2016.
Advances in medical technology also may have contributed to the increase, according to the research. Twenty years ago, preterm and low-birth-weight babies had a harder time surviving. Those factors increase the risk of being diagnosed with ADHD.
The study also suggests that fewer stigmas about mental-health care in minority communities may lead to more people receiving an ADHD diagnosis.
In the late 1990s, 7.2 percent of non-Hispanic white children, 4.7 percent of non-Hispanic black children and 3.6 of Hispanic children were diagnosed with ADHD, according to the study.
By 2016, it was 12 percent of white kids, 12.8 percent of blacks and 6.1 percent of Hispanics.
Over the past several decades, Hinshaw said, there has been an expanded view of who can develop ADHD. It’s no longer viewed as a disease that affects only white middle-class boys, just as eating disorders are no longer seen as afflicting only white middle-class girls.
Still, he cautioned against overdiagnosing ADHD in communities where behavioral issues could be the result of social or environmental factors such as overcrowded classrooms.
The study found that rates of ADHD among girls rose from 3 percent to more than 6 percent over the study period. It said that was partly a result of a change in how the condition is classified. For years, ADHD pertained to children who were hyperactive. But in recent years, the American Psychiatric Association added to its guide of mental-health conditions that the diagnosis should also include some children who are inattentive, Bao said. That raised the number of girls, he explained, because it seems they are more likely than boys to be in that second subtype.
“If we compare these two, you can easily imagine people will easily recognize hyperactivity,” he said.
That rang true for Ruth Hay, a 25-year-old student and cook from New York who now lives in Jerusalem. She was diagnosed with what was then called ADD in the summer between second and third grade.
Hay said her hyperactive tendencies aren’t as “loud” as some people’s. She’s less likely to bounce around a room than she is to bounce in her chair, she said.
Yet despite her early diagnosis, Hay said, no one ever told her about other symptoms. For example, she said, she suffers from executive dysfunction, which leaves her feeling unable to accomplish tasks, no matter how much she wanted to or tried.
“I grew up being called lazy in periods of time when I wasn’t,” Hay said. “If you look at a list of all the various ADHD symptoms, I have all of them to one degree or another, but the only ones ever discussed with me was you might be less focused and more fidgety.”
“I don’t know how my brain would be if I didn’t have it,” she added. “I don’t know if I’d still be me, but all it has been for me is a disability.”
Bluth is a reporter for Kaiser Health News, an editorially independent program of the Kaiser Family Foundation that is not affiliated with Kaiser Permanente.
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The Rise of ADHD
You probably know at least one child who has been diagnosed with ADHD — attention deficit hyperactivity disorder. You might even know a few adults who believe they have the condition. ADHD seems to be everywhere: among our children, among our peers, and in the headlines constantly.
About 9.5 percent of American children have been diagnosed with ADHD, according to the Centers for Disease Control and Prevention. ADHD is now one of the most commonly diagnosed mental ailments among children and adolescents, and researchers estimate that 4 percent of adults have it too.
Given the rise in ADHD diagnoses, it’s not surprising that sales of the medications used to treat ADHD have nearly doubled over the past five years, from $3 billion in 2005 to $5.9 billion in 2009, according to IMS Health, a health care information and consulting company.
Is ADHD just a fad, the disease du jour of a society accustomed to medicating itself for every conceivable symptom? Or is it a serious condition that, like depression, is just beginning to be well understood?
To make sense of the numbers, it helps to understand the disorder itself. ADHD, when properly diagnosed, is not just an inability to focus and sit still, though those are two of the most common symptoms. “ADHD is a complex mental disorder that affects a person’s ability to regulate cognition and emotions,” says Stephen V. Faraone, PhD, a professor of psychiatry at SUNY Upstate Medical University who has been studying ADHD for two decades.
Those who have the disorder have difficulty coping with complex environments and following tasks through to completion. Because of these symptoms, “people with ADHD are at increased risk of academic failure, substance abuse, depression, divorce, driving accidents, and other negative outcomes,” notes Guilherme V. Polanczyk, PhD, an assistant professor of child and adolescent psychiatry at the University of São Paulo Medical School and an expert on ADHD. “People don’t understand how debilitating ADHD can be,” adds Dr. Faraone.
ADHD was first recognized as a mental disorder in the early 1980s, but researchers say the syndrome had been seen and noted much earlier. “It didn’t just appear magically,” says Ronald C. Kessler, PhD, a professor of health care policy at Harvard Medical School.
Then what brought the disorder to national attention? “Maybe it wasn’t a big deal decades ago,” Dr. Kessler theorizes. “As society becomes more complicated, the deficits that come with ADHD become more obvious. We place a premium on being able to get things done.”
Scientists also know a lot more about mental illnesses. “Child psychiatry as a discipline is a recent phenomenon, dating from the last half of the 20th century,” says Dr. Polanczyk. “Mental disorders in general — such as bipolar, including in children— have been increasingly identified because we know more about these conditions.”
Skeptics, though, worry that the label of ADHD provided a way for parents and others to shirk responsibility. “ADHD became a popular diagnosis in the 1980s as more parents went to work and the role of schools and teachers changed,” wrote Stephen R. Herr, EdD, in an online opinion piece in the Christian Science Monitor in August 2010. Dr. Herr, an assistant professor at Murray State University, went on to say: “The creation of ADHD as a psychological disorder was in part an attempt to deal with some of the difficulties of raising children. Unfortunately, that attempt has fallen short.”
Is ADHD an American Fad?
Once ADHD was defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM), the guide to psychological disorders published by the American Psychiatric Association, diagnoses began to rise steadily. Stimulants such as Ritalin and Adderall turned out to be effective at ameliorating the symptoms of ADHD, particularly problems involving focus and hyperactivity, at least in the short term, and drug companies began to vigorously market these medications.
But it wasn’t just U.S. doctors and clinicians who were beginning to recognize ADHD. At the same time ADHD was classified in the United States, it was defined in the World Health Organization’s counterpart to the DSM — the International Statistical Classification of Diseases and Related Health Problems (ICD). WHO’s definition was a bit more restrictive, though, so the rates of ADHD in the rest of the world seemed lower at first than the rates in the United States, says Faraone, adding that “the two definitions are becoming much more similar now.”
ADHD: Not a Simple Diagnosis
One of the problems in assessing the prevalence of ADHD is that there is no simple test to diagnose the disorder. The DSM instructs physicians to look for symptoms of hyperactivity and inattention that have persisted for at least six months and that interfere with a child’s ability to function in at least two areas of life, such as school and home. But the symptoms, such as “often talks excessively” and “often fidgets with hands or feet or squirms in seat when sitting still is expected,” sound an awful lot like the normal behavior of a child. It requires a skilled diagnostician to determine whether a child’s symptoms are causing real impairment.
Though teachers cannot make a diagnosis of ADHD, they can and do make recommendations about whether a child should be evaluated by a professional. A recent study from Michigan State University found that children born in the month prior to the cutoff date for kindergarten eligibility (i.e. typically the youngest and therefore most immature children within a grade) were far more likely to be diagnosed with ADHD compared to children born in the month immediately afterward. Therefore, some ADHD diagnoses may be “driven by teachers’ perceptions of poor behavior among the youngest children in a classroom” rather than true ADHD symptoms. Similar studies have fueled a suspicion among the public that ADHD is too frequently diagnosed and is diagnosed in a highly subjective manner. However, says Polanczyk, “The media approach misdiagnosis as if it is evidence that ADHD is not a valid disorder, which is absurd.”
And while most researchers believe that the disorder has a genetic component, they acknowledge that the context in which a child lives and goes to school may also contribute to ADHD symptoms. A 2005 WHO report on mental health, for instance, noted that the “diagnosis can be symptomatic of family dysfunction, rather than individual psychopathology, and may re?ect inadequacies in the educational system.”
ADHD: Not Just an American Problem
In recent years, researchers have tried to understand the prevalence of ADHD across the globe. A number of papers have examined studies in different countries and found that when the same diagnostic criteria and research methods are used, the prevalence of the disorder is fairly consistent across cultures. Polanczyk and his colleagues, for example, considered more than 100 studies from around the world and found that prevalence of ADHD was influenced more by the methods of the individual studies than by geographic location. “Wherever people have looked for the disorder, they have found it,” says Faraone.
There is some variation, though, in overall estimates of ADHD. Polanczyk’s study, published in the June 2007 issue of the American Journal of Psychiatry, estimated that the worldwide prevalence of ADHD is 5.3 percent among children and adolescents. Faraone, who coauthored a study published in World Psychiatry in 2003 that examined the worldwide prevalence of ADHD, believes that the incidence may range between 8 percent and 12 percent.
Diagnosis and treatment of ADHD also differs in some countries, as indicated in a new study in the journal Psychiatric Services that surveyed nine nations. Researchers found that some countries, like the United Kingdom, use pychosocial treatment as a first-line approach while others, including Canada, are more likely to use medication.
ADHD: Not Just a Childhood Problem
ADHD — once believed to be a childhood disorder — seems to persist into adulthood in about two-thirds of cases. Kessler of Harvard Medical School conducted a study using national household survey data in the United States and found that 4.4 percent of adults met the criteria for ADHD — though diagnosis is tricky as results are based on self-reporting. “It’s a real thing with adults,” he says. The study, which was published in the American Journal of Psychiatry, found that adults who reported having had ADHD symptoms since childhood had other emotional problems too. Many of these adults were not receiving any treatment.
In another study published in The Clinical Neuropsycholgist, the researchers found that nearly 1 and 4 adults seeking ADHD treatment may be exaggerating or faking symptoms, most likely to obtain stimulant drugs.
Is ADHD Overdiagnosed?
While some cases may be misdiagnosed, many believe that ADHD is underdiagnosed as well, particularly among adults.
Clearly, a more rigorous system for diagnosing the disorder is needed. And parents, teachers, and physicians should be educated about what exactly ADHD is, and when a child or adult requires treatment.
But consider the days when depression was just starting to be treated with medications like Prozac — the public was horrified. There was a sense that depressed people were weak, popping pills to dampen normal human emotions like sadness and despair. And there was a concern that these medications could destroy or impair a person’s innate humanity. “It’s hard for people to believe,” says Faraone, “that normal human reactions could be at the root of a real disorder.”
Return to ADHD In Depth.
Doctor: ADHD Does Not Exist
This Wednesday, an article in the New York Times reported that from 2008 to 2012 the number of adults taking medications for ADHD increased by 53% and that among young American adults, it nearly doubled. While this is a staggering statistic and points to younger generations becoming frequently reliant on stimulants, frankly, I’m not too surprised. Over my 50-year career in behavioral neurology and treating patients with ADHD, it has been in the past decade that I have seen these diagnoses truly skyrocket. Every day my colleagues and I see more and more people coming in claiming they have trouble paying attention at school or work and diagnosing themselves with ADHD.
And why shouldn’t they?
If someone finds it difficult to pay attention or feels somewhat hyperactive, attention-deficit/hyperactivity disorder has those symptoms right there in its name. It’s an easy catchall phrase that saves time for doctors to boot. But can we really lump all these people together? What if there are other things causing people to feel distracted? I don’t deny that we, as a population, are more distracted today than we ever were before. And I don’t deny that some of these patients who are distracted and impulsive need help. What I do deny is the generally accepted definition of ADHD, which is long overdue for an update. In short, I’ve come to believe based on decades of treating patients that ADHD — as currently defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM) and as understood in the public imagination — does not exist.
Allow me to explain what I mean.
Ever since 1937, when Dr. Charles Bradley discovered that children who displayed symptoms of attention deficit and hyperactivity responded well to Benzedrine, a stimulant, we have been thinking about this “disorder” in almost the same way. Soon after Bradley’s discovery, the medical community began labeling children with these symptoms as having minimal brain dysfunction, or MBD, and treating them with the stimulants Ritalin and Cylert. In the intervening years, the DSM changed the label numerous times, from hyperkinetic reaction of childhood (it wasn’t until 1980 that the DSM-III introduced a classification for adults with the condition) to the current label, ADHD. But regardless of the label, we have been giving patients different variants of stimulant medication to cover up the symptoms. You’d think that after decades of advancements in neuroscience, we would shift our thinking.
Today, the fifth edition of the DSM only requires one to exhibit five of 18 possible symptoms to qualify for an ADHD diagnosis. If you haven’t seen the list, look it up. It will probably bother you. How many of us can claim that we have difficulty with organization or a tendency to lose things; that we are frequently forgetful or distracted or fail to pay close attention to details? Under these subjective criteria, the entire U.S. population could potentially qualify. We’ve all had these moments, and in moderate amounts they’re a normal part of the human condition.
However, there are some instances in which attention symptoms are severe enough that patients truly need help. Over the course of my career, I have found more than 20 conditions that can lead to symptoms of ADHD, each of which requires its own approach to treatment. Among these are sleep disorders, undiagnosed vision and hearing problems, substance abuse (marijuana and alcohol in particular), iron deficiency, allergies (especially airborne and gluten intolerance), bipolar and major depressive disorder, obsessive-compulsive disorder and even learning disabilities like dyslexia, to name a few. Anyone with these issues will fit the ADHD criteria outlined by the DSM, but stimulants are not the way to treat them.
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What’s so bad about stimulants? you might wonder. They seem to help a lot of people, don’t they? The article in the Times mentions that the “drugs can temper hallmark symptoms like severe inattention and hyperactivity but also carry risks like sleep deprivation, appetite suppression and, more rarely, addiction and hallucinations.” But this is only part of the picture.
First, addiction to stimulant medication is not rare; it is common. The drugs’ addictive qualities are obvious. We only need to observe the many patients who are forced to periodically increase their dosage if they want to concentrate. This is because the body stops producing the appropriate levels of neurotransmitters that ADHD meds replace — a trademark of addictive substances. I worry that a generation of Americans won’t be able to concentrate without this medication; Big Pharma is understandably not as concerned.
Second, there are many side effects to ADHD medication that most people are not aware of: increased anxiety, irritable or depressed mood, severe weight loss due to appetite suppression, and even potential for suicide. But there are also consequences that are even less well known. For example, many patients on stimulants report having erectile dysfunction when they are on the medication.
Third, stimulants work for many people in the short term, but for those with an underlying condition causing them to feel distracted, the drugs serve as Band-Aids at best, masking and sometimes exacerbating the source of the problem.
In my view, there are two types of people who are diagnosed with ADHD: those who exhibit a normal level of distraction and impulsiveness, and those who have another condition or disorder that requires individual treatment.
For my patients who are in the first category, I recommend that they eat right, exercise more often, get eight hours of quality sleep a night, minimize caffeine intake in the afternoon, monitor their cell-phone use while they’re working and, most important, do something they’re passionate about. Like many children who act out because they are not challenged enough in the classroom, adults whose jobs or class work are not personally fulfilling or who don’t engage in a meaningful hobby will understandably become bored, depressed and distracted. In addition, today’s rising standards are pressuring children and adults to perform better and longer at school and at work. I too often see patients who hope to excel on four hours of sleep a night with help from stimulants, but this is a dangerous, unhealthy and unsustainable way of living over the long term.
For my second group of patients with severe attention issues, I require a full evaluation to find the source of the problem. Usually, once the original condition is found and treated, the ADHD symptoms go away.
It’s time to rethink our understanding of this condition, offer more thorough diagnostic work and help people get the right treatment for attention deficit and hyperactivity.
Dr. Richard Saul is a behavioral neurologist practicing in the Chicago area. His book, ADHD Does Not Exist, is published by HarperCollins.
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Historical Development of ADHD
The symptoms of Attention-Deficit/Hyperactivity Disorder were first described in a children’s book, “The Story of Fidgety Philip,” written in 1845 by Dr. Heinrich Hoffman. The story described behaviors, thought be caused by faulty parenting, that are consistent with what we know as ADHD today. Later, in 1902, a series of lectures published by Sir George F. Still described problematic impulsive behaviors among a group of children. The lecture series, presented to the Royal College of Physicians in England, cited genetic dysfunction as the cause of such symptoms.
Twenty years later, an American physician Dr. Bradley, observed that children treated with stimulant medication showed fewer with hyperactive and impulsive behaviors. During an outbreak of encephalitis in the 1940’s, physicians observed that affected children displayed symptoms similar to those of hyperactive children. As a result, the professional community theorized that hyperactive children were brain damaged.
In response to this line of thinking, the first stimulant medication, methylphenidate (Ritalin), became commercially available in 1957. It was prescribed for impulsive, hyperactive children. Today, it is still one of the most widely prescribed medications for the treatment of the symptoms of ADHD.
The concept of hyperactivity as a disorder caused by something other than brain damage was re-introduced by Stella Chess in 1960. She described the “Hyperactive Child Syndrome” as an environmentally-based problem caused by faulty parenting. Her theories led to a re-evaluation of the origins of ADHD throughout the field. As a result of her work, the official medical name of the disorder was changed to Minimal Brain Dysfunction (MBD). Also, in 1965, the American Psychiatric Association changed the name again to “Hyperkinetic Reaction of Childhood,” supporting the theory that hyperactivity was not a biological disorder, but rather, an environmental problem. According to this theory, parents (particularly mothers) were to blame for the disorder. Thus, professional theories had cycled around to a pre-1902 way of thinking.
In 1980, the term “Attention Deficit Disorder”, or ADD, “With and Without Hyperactivity” was included in the Diagnostic and Statistical Manual of Mental Disorders, Third Edition (DSM-III; the official manual that provides descriptions and definitions of currently accepted psychiatric diagnoses) for the first time. Seven years later, the revised edition, (the DSM-IIIR) contained a variation in the title of the diagnosis, re-labeling it either as “Undifferentiated Attention Deficit Disorder” (for those cases without hyperactivity) or “Attention-Deficit Hyperactivity Disorder” (for cases that included hyperactivity as a symptom). The American definition used today was introduced in 1994, in the DSM-IV. This current definition classifies the characteristics of the disorder into three separate categories: Mainly Inattentive, Mainly Hyperactive-Impulsive; and a combined form of the two.
The History of ADHD and Its Treatments
ADHD wasn’t formally recognized as a distinct medical condition by the American Psychiatric Association (APA) until the late 1960s. But its core symptoms – hyperactivity, impulsivity, and inattention – have been recognized together in a cluster for much longer.
Many authors say the history of ADHD dates back to the beginning of the 20th century with Sir George Frederick Still’s articles and lectures. Others believe its symptoms were first recorded by Sir Alexander Crichton as early as 1798, and described in the children’s stories of Fidgety Phil written by Heinrich Hoffmann in 18441.
ADHD’s exact origin is slightly unclear because the condition wasn’t always called attention deficit. Through the years, the symptoms we now recognize as ADHD were referred to as:
- Incapacity of attending with a necessary degree of constancy to any one object
- Defect of moral control
- Postencephalitic behavior disorder
- Brain damage
- Brain dysfunction
- Hyperkinetic disease of infancy
- Hyperkinetic reaction of childhood
- Hyperkinetic impulse disorder
- Attention deficit disorder: with and without hyperactivity (ADD)
- Attention deficit hyperactivity disorder (ADHD)
- ADHD with three subtypes
ADHD was first considered a defect of moral control, then a result of brain damage. Further research revealed its basis in the brain, and a genetic link between family members. Today, we still don’t know the exact causes of ADHD, but studies suggest three main factor: genetics, environmental factors, or a disruption of development – like a brain injury.
Colloquially, there’s still widespread confusion about whether the condition is called ADD or ADHD.
The History of ADHD: A Timeline
1902: The core symptoms of ADHD are first described by Sir George Frederick Still, a British pediatrician, in a lecture series at the Royal College of Physicians. He observed that a group of twenty “behaviorally disturbed” children were easily distractible, inattentive, and unable to focus for long. He noted that the symptoms were more common in boys, and seemed unrelated to intelligence or home environment2.
1922: Alfred F. Tredgold, Britain’s leading expert on mental impairment, suggests behavior patterns are from physiology – likely a difference in the brain, or brain damage – rather than character flaws or lack of discipline. This is a step toward “medicalizing” symptoms of ADHD as a result of brain activity instead of considering them simply bad behavior1.
1923: Researcher Franklin Ebaugh provides evidence that ADHD can arise from a brain injury by studying children who survived encephalitis lethargica2,3.
1936: Benezedrine (amphetamine) is approved by U.S. Food and Drug Administration (FDA).
1937: Dr. Charles Bradley, a psychiatrist at a home for children with emotional problems, gives Benzedrine to his patients to treat severe headaches. He discovers an unexpected side effect. The stimulant medication improves interest in school, helps academic performance, and decreases disruptive behavior for certain children2.
1952: The first edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) is published4. The DSM and the symptoms it includes are widely considered the authoritative reference for clinicians; it guides which conditions are diagnosed, and how. There is no mention of a condition like attention deficit disorder or its symptoms, only a condition called “minimal brain dysfunction,” which suggests that a child showing hyperactive behavior had brain damage, even if no physical signs of it appeared1,3.
1955: New drugs become available to treat adults with mental illness, and a new phase of experimentation with tranquilizers and stimulants for mental health begins. This renews interest in treating hyperactive and emotionally disturbed children with pharmaceuticals. Chlorpramazine is suggested as a potential treatment for hyperactive children, but it does not become a serious competitor to Benzedrine and Dexedrine2.
1956: The National Institute of Mental Health (NIMH) creates the Psychopharmacological Research Branch (PRB) to develop new psychiatric drugs.
1957: The condition we know today as ADHD is named hyperkinetic impulse disorder by three medical researchers: Maurice Laufer, Eric Denhoff, and Gerald Solomons. Ritalin is first mentioned as a potential treatment for the condition by Laufer and Denhoff2.
1958: The PRB hosts the first-ever conference on the use of psychoactive drugs to treat children5.
1961: Ritalin is FDA-approved for use in children with behavioral problems2.
1967: The NIMH awards the first grant to study the therapeutic effect of stimulants in children with behavioral problems2, 3.
1968: The second edition of the DSM goes into print. It includes “hyperkinetic impulse disorder,” the first time symptoms now known as ADHD are recognized by the American Psychiatric Association (APA).
1970: There’s a growing public concern over abuse of drugs – particularly stimulants. Congress passes the Comprehensive Drug Abuse Prevention and Control Act, classifying amphetamines and methylphenidate as Schedule III substances – limiting the number of refills a patient can receive, and the length an individual prescription can run2.
1971: Amid widespread stimulant abuse across the United States, amphetamines and methylphenidates are reclassified as Schedule II drugs2,6. Dr. Paul Wender publishes a book that mentions how ADHD runs in families, setting the stage for genetic studies of ADHD. Dr. Leon Eisenberg and Keith Conners, Ph.D. receive a grant from the NIMH to study methylphenidate5.
1975: A widespread media blitz claims that stimulants are dangerous and shouldn’t be used to treat a “dubious diagnosis2.” Benjamin Feingold advances claims that hyperactivity is caused by diet, not a brain based condition2. There is public backlash against treating ADHD with stimulant medication, especially Ritalin.
1978: For decades, a positive response to stimulant medication was considered evidence that a child had a mental disorder. Judith Rappaport, a researcher for the NIMH discovered that stimulants have similar effects on children with or without hyperactivity or behavior problems – adding to the controversy around stimulant medication2.
1980: The third edition of the DSM is released. The APA changes the name of hyperkinetic impulse disorder to attention deficit disorder (ADD) — with hyperactivity and ADD without hyperactivity. It’s the first time this group of symptoms is called by its most commonly known modern name1,7.
1987: A revised version of the DSM-III, the DSM-III-R, is released. The subtypes are removed, and the condition is renamed attention deficit hyperactivity disorder (ADHD). What was previously called ADD without hyperactivity is now referred to as undifferentiated ADD3.
1991: In the 1990s, diagnoses of ADHD begin to increase. It’s not possible to know if this is a change in the number of children who have the condition, or a change in awareness that leads to increased diagnosis3. By 1991, methylphenidate prescriptions reach 4 million, and amphetamine prescriptions reach 1.3 million5.
1994: The DSM-III-R divides ADHD into three subtypes: predominantly inattentive type, predominantly hyperactive type, and a combined type3 attention deficit hyperactivity disorder.
2000: The American Academy of Pediatrics (AAP) publishes clinical guidelines for the diagnosis of ADHD in children8.
2001: The AAP publishes treatment guidelines for children with ADHD, and recommends stimulant medication alongside behavior therapy as the best course to alleviate symptoms8.
2002: The first non-stimulant medication, Strattera (atomoxetine), is approved by the FDA to treat ADHD9.
2011: The AAP releases updated diagnosis and treatment guidelines, expanding age range for diagnosis, scope of behavioral interventions, and new guidelines for clinical processes8.
2013: The DSM-V is published, and includes language changes for each of the diagnostic criteria for ADHD. The subtypes of ADHD are now referred to as “presentations,” and the condition can be described as mild, moderate, or severe. The descriptions are more applicable to adolescents and adults than previous versions, but new symptom sets were not created for these groups7.
The History of ADHD Medications
The list of available ADHD medications can seem overwhelming, but there are only two types of stimulants used to treat ADHD: methylphenidate and amphetamine.
All stimulant medications are different formulations of methylphenidate or amphetamine, which have been used for ADHD treatment since before it was even called ADHD. They can be short-acting or long-acting or delayed release. They can come as a tablet, liquid, patch, or orally disintegrating tablet.
There are three FDA-approved non-stimulant medications.
Below is a list of all stimulant and non-stimulant ADHD medications through history. The date noted with each indicates the year that each variation attained FDA approval 3, 10, 11.
- 1937: Benzedrine (racemic amphetamine)
- 1943: Desoxyn (methamphetamine)
- 1955: Ritalin (methylphenidate)
- 1955: Biphetamine (mixed amphetamine/dextroamphetamine resin)
- 1975: Cylert (pemoline)
- 1976: Dextrostat (dextroamphetamine)
- 1976: Dexedrine (dextroamphetamine)
- 1982: Ritalin SR (methylphenidate)
- 1996: Adderall (mixed amphetamine salts)
- 1999: Metadate ER (methylphenidate)
- 2000: Concerta (methylphenidate)
- 2000: Methylin ER (methylphenidate)
- 2001: Metadate CD (methylphenidate)
- 2001: Focalin (dexmethylphenidate)
- 2001: Adderall XR (mixed amphetamine salts)
- 2002: Ritalin LA (methylphenidate)
- 2002: Methylin (methylphenidate oral solution and chewable tablet)
- 2002: Strattera (atomoxetine)
- 2005: Focalin XR (dexmethylphenidate)
- 2006: Daytrana (methylphenidate patch)
- 2007: Vyvanse (lisdexamfetamine dimesylate)
- 2008: Procentra (liquid dextroamphetamine)
- 2009: Intuniv (guanfacine)
- 2010: Kapvay (clonidine)
- 2011: Zenzedi (dextroamphetamine sulfate)
- 2012: Quillivant XR (liquid methylphenidate)
- 2014: Evekeo (amphetamine)
- 2015: Aptensio XR (methylphenidate)
- 2015: Dyanavel XR (liquid amphetamine)
- 2015: Quillichew ER (chewable methylphenidate)
- 2016: Adzenys XR-ODT (amphetamine orally disintegrating tablet)
- 2017: Cotempla XR-ODT (methylphenidate orally disintegrating tablet)
- 2017: Mydayis (mixed amphetamine salts)
- 2018: Jornay PM (methylphenidate)
- 2019: Adhansia XR (methylphenidate)
- 2019: Evekeo ODT (amphetamine orally disintegrating tablet)
1 Lange, Klaus, et al. “The history of attention deficit hyperactivity disorder.” ADHD Attention Deficit and Hyperactivity Disorders, 2:4, pp. 241-255. December 2010. doi: 10.1007/s12402-010-0045-8
2 Mayes, Rick, et al. “Suffer the restless children: the evolution of ADHD and paediatric stimulant use, 1900—80.” History of Psychiatry, 18:4, pp. 435-457. December 2007. doi: 10.1177/0957154X06075782
3 CDC. “ADHD Throughout the Years.” Centers for Disease Control and Prevention. Updated September 28, 2018. https://www.cdc.gov/ncbddd/adhd/timeline.html
4 APA. “DSM History.” American Psychiatric Association. Web. 26 June 2019. https://www.psychiatry.org/psychiatrists/practice/dsm/history-of-the-dsm
5 Charach A, Dashti B, Carson P, et al. “Attention Deficit Hyperactivity Disorder: Effectiveness of Treatment in At-Risk Preschoolers; Long-Term Effectiveness in All Ages; and Variability in Prevalence, Diagnosis, and Treatment .” Rockville (MD): Agency for Healthcare Research and Quality (US); 2011 Oct. (Comparative Effectiveness Reviews, No. 44.) Table 14, Timeline of identification of ADHD and development of treatment—derived from Eisenberg and Mayes. Available from: https://www.ncbi.nlm.nih.gov/books/NBK82373/table/results.t13/
6 Rasmussen, Nicholas, et al. “America’s First Amphetamine Epidemic 1929–1971. A Quantitative and Qualitative Retrospective With Implications for the Present.” American Journal of Public Health, 98:6, pp. 974-985. June 2008. doi: 10.2105/AJPH.2007.110593
7 Epstein, Jeffery, et al. “Changes in the Definition of ADHD in DSM-5: Subtle but Important.” Neuropsychiatry, 3:5, pp. 455-458. October 2013. doi: 10.2217/npy.13.59
8 “ADHD: Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents.” Subcommittee on Attention-Deficit/Hyperactivity Disorder, Steering Committee on Quality Improvement and Management. Pediatrics Nov 2011, 128 (5) 1007-1022; DOI: 10.1542/peds.2011-2654
9 Rosack, Jim. “FDA Approves First Nonstimulant Medication for ADHD Treatment.” American Psychiatric Association. Web. 26 June 2019. doi: 10.1176/pn.37.24.0021b
10 Bourgeois, Florence T et al. “Premarket safety and efficacy studies for ADHD medications in children.” PloS one. 9:7. 9 Jul. 2014, doi: 10.1371/journal.pone.0102249
11 FDA. “Orange Book: Approved Drug Products with Therapeutic Equivalence Evaluations.” U.S. Food and Drug Administration. Current through May 2019. https://www.accessdata.fda.gov/scripts/cder/ob/index.cfm
Updated on December 26, 2019
ADHD was only really recognised as a valid condition in the UK in 2000 when the first National Institute of Clinical Excellence report on the condition was brought out (www.nice.org.uk). Prior to that time throughout in 1990s there was an enormous amount of skepticism about the existence of the condition and virtually no recognition of its importance in children education and mental health services, let alone that the condition could progress into adulthood. For example in 1990, as one marker of awareness of the condition, there were only 40 children in the whole of the UK on medical treatment for ADHD. This fact alone suggests that there are still a great many adults in the UK who were not treated or managed correctly for the condition when they were at school and at least a third of these are likely to have significant ongoing problems as adults, although largely often masked by other psychiatric or personality difficulties and by their underachievement in life. In the early 1990s dyslexia had been recognised in UK schools for about 20 years and this was the predominant diagnosis. Any attempt to bring recognition of the importance of ADHD into the public arena was generally met by an outcry in the press, accusations of turning children into “garden gnomes” or zombies. This was in contrast to the situation in the UK and in the antipodean countries such as South Africa and Australia where even at that time ADHD was recognised as a valid childhood condition. The lack of awareness in the UK however at that time was fairly similar throughout the whole of Europe.
The other compounding factor was that whilst ADHD was not recognised, hyperkinesis was. There was an overemphasis on the importance of severe hyperactivity as the main cause of children’s neurodevelopmental problems with very little recognition that often the hyperactivity was the least of the child’s problems, and that it often lessened with time, but that the impulsiveness and the poor concentration were much more important detrimental factors.
In 1994, the Diagnostic and Statistical Manual recognised ADHD. This is the manual of the American Psychiatric Association. In Europe the International Classification of Diseases continued to recognise hyperkinesis and not ADHD.
The LANC started operation in 1993 and very shortly clearly marked a line in the sand to recognise the importance of ADHD as distinct from hyperkinesis as a very important condition. As a result of this it was the brunt of a great deal of criticism and was accused inappropriately of not only over diagnosing ADHD but also of inappropriate use of medication despite the fact that at that stage only a very small percentage indeed of children with even the severe form of the condition were being treated.
During the 1990s LANC staff had a lot of dealings with the educational system as the staff have always put great emphasis on school liaison and working with schools. The schools generally were fairly negative about ADHD despite the fact that treating such children often made not only the child’s life more bearable but also the teachers’. The clinic had a lot to do with the association of the children with emotional and behavioural difficulties because of this group of children studies have shown that about 70% of them have underlying ADHD and related conditions. Nevertheless the prevailing view was that these children’s problems were largely due to their parents or their environment or their alleged previous abuse in some way or other. This was usually not the case.
Over the next few years a number of articles continued to emphasise the importance of severe hyperkinesis rather than a broader concept of ADHD. However in 1998 there was a joint article between a number of professionals that attempted to equate hyperkinesis with ADHD. Also in 1998 Dr Kewley published the attached article in the British Medical Journal bemoaning the fact that there was such poor recognition of ADHD in the UK.
In 2000 as a result of an extremely negative Panorama programme Dr Kewley took Panorama to the Broadcasting Complaints Commission and secured an apology.
Since 1998 and particularly since 2000 there has been a rapid increase in the recognition of ADHD and related conditions in the UK as important childhood and more recently adult conditions. There has been an explosion of services throughout the UK and the second last report in 2008 very much emphasised the importance of service provision and put the onus on local health areas to have an obligation to provide them. This has been particularly slow to happen with adult services but is now becoming more the case.
Also in this time there has been a gradual increased awareness of the condition throughout education, social services and the youth justice system.
LANC started many of the Youth Justice Board conferences in the early 2000 and found that even within this group of professionals there was an enormous amount of resistance to the concepts being important despite the fact that it has been shown that the offending rates can be drastically reduced with effective ADHD management.
In 2001 the LANC held conferences both in London and in Ireland about the importance of ADHD in relationship to youth justice. In London 70 people attended however in Ireland there were more than 400 attendees with people being turned away at the door. Even then the anti-medication groups protested outside.
The above history particularly emphasises how recognition of ADHD has challenged pre-existing series and ideas and of service delivery. An innate biological lack of self-control and innate concentration difficulty makes all the difference to how professionals think about problems. For example, in education in a child innately has difficulty in concentrating on things that are not interesting because of the way that his or her brain works, then this is a very different proposition for the child who is being lazy and could try harder to concentrate. A person who because of innate lack of self control recurrently has difficulty with the police and youth justice system is unlikely to be helped by being further punished. That is more likely to be helped if the impulsiveness and lack of self‑control can be medically helped. The progression of ADHD as shown in the enclosed diagram is also important and this is not always recognised by professionals. The vulnerability created by having lack of self control and the increased risk of substance misuse, driving accidents, addictive behaviours, school exclusion, relationship breakdown and parenting issues is only recently being fully recognised.
Because the Centre has been so involved in the development of ADHD awareness over the years, it considers that it is in a prime place to assess and manage children with those conditions in a mature and experienced way, to tease out children who do not have ADHD from those that do and to recognise the subtle and complex ways in which people with ADHD can present particularly if they are gifted.
The LANC has therefore been through some very difficult times as the awareness of ADHD and related conditions has germinated in the last 20 years. Being Australian, Dr Kewley had a more North American approach to the management of his children, which gradually has become the norm in the UK. The LANC has kept going because its ethos is to strongly believe that it is impossible to have effective children’s mental health and paediatric services and educational services without there being a full understanding of ADHD as part of this equation. To have services based on dyslexia only or autistic only principles is quite erroneous. There is now recognition that ADHD is very much part of the neurodevelopmental framework and that the majority of children with these difficulties have a number of interlocking problems.
Nevertheless the LANC has been through some very difficult times and has had to endure significant inappropriate criticisms over the years when in fact it was well ahead of its time. This means that the LANC staffs have a very mature pedigree in the management and understanding of people with ADHD and related conditions and this is therefore very useful in the ongoing management of that of the children and families that are seen in the clinic.
ADHD Throughout the Years
The percent of children estimated to have ADHD has changed over time and its measurement can vary. The first national survey that asked parents about ADHD was completed in 1997. Since that time, there has been an upward trend in national estimates of parent-reported ADHD diagnoses across different surveys, using different age ranges. It is not possible to tell whether this increase represents a change in the number of children who have ADHD, or a change in the number of children who were diagnosed. However, the most recent estimate from 2016 is consistent with previous estimates. Future data will show whether the upward trend across the two decades is leveling out.
ADHD diagnosis throughout the years: Estimates from published nationally representative survey data
(Percent of children with a parent-reported ADHD diagnosis)
Closedownload iconDownload Imageimage iconData table
NHIS: National Health Interview Survey, personal interview data
- NHIS annual report: estimates include children 3-17 years of age
- NHIS publications: estimates aggregate 3 years of data and include children 5-17 years of age.
NSCH: National Survey of Children’s Health; telephone survey data; estimates include children 4-17 years of age
*Redesigned NSCH: Now an online and mail surveyexternal icon; estimate includes children 2-17 years of age. Because the 2016 NSCH survey used different methods, the estimate is not directly comparable with estimates based on previous NSCH data
Note: Age ranges for published data vary. In previous decades, the focus of information collected on ADHD generally was on school age children; this has been expanded to include preschool ages as young as 2 years of age. Because the number of children with ADHD increases with age, estimates that include younger children are likely to be somewhat lower than those that focus on older children.
Estimates for the percent of children in the population who have ADHD vary widely across time and across survey methods. A historical view can provide necessary context to understand changes in the epidemiology of ADHD. The way that ADHD is diagnosed has changed over time, so the difference in these numbers is likely to be influenced by variations in how the diagnostic criteria were applied. In addition, there were differences in the demographic characteristics of the samples used to calculate the estimates. It is also possible that the samples were exposed to factors that affect ADHD, but until more is known about these factors, it is not possible to know whether changes in these factors explain some of the variation. Perhaps relatedly, the number of FDA-approved ADHD medications increased noticeably since the 1990s, after the introduction of long-acting formulations.
The historical timeline below shows
- Estimates from studies across the years (until 2013) for the percent of U.S. children with ADHD.
- How the criteria used to diagnose the condition have changed over time.
- The approval of medication treatments by the Food and Drug Administration (FDA) beginning with Benzedrine in 1936.
Timeline of ADHD diagnostic criteria, prevalence, and treatment
ADHD in Adults
ADHD is not just a childhood problem. Learn what the signs and symptoms of adult ADHD look like—and what you can do about it.
Life can be a balancing act for any adult, but if you find yourself constantly late, disorganized, forgetful, and overwhelmed by your responsibilities, you may have attention deficit hyperactivity disorder (ADHD), previously known as ADD. ADHD affects many adults, and its wide variety of frustrating symptoms can hinder everything from your relationships to your career.
While scientists aren’t sure exactly what causes ADHD, they think it’s likely caused by a combination of genes, environment, and slight differences in how the brain is hardwired. If you were diagnosed with childhood ADHD or ADD, chances are you’ve carried at least some of the symptoms into adulthood. But even if you were never diagnosed as a child, that doesn’t mean ADHD can’t affect you as an adult.
ADHD often goes unrecognized throughout childhood. This was especially common in the past, when very few people were aware of it. Instead of recognizing your symptoms and identifying the real issue, your family, teachers, or others may have labeled you as a dreamer, goof-off, slacker, troublemaker, or just a bad student. Alternately, you may have been able to compensate for the symptoms of ADHD when you were young, only to run into problems as your responsibilities increased as an adult. The more balls you’re now trying to keep in the air—pursuing a career, raising a family, running a household—the greater the demand on your abilities to organize, focus, and remain calm. This can be challenging for anyone, but if you have ADHD, it can feel downright impossible.
The good news is that no matter how overwhelming it feels, the challenges of attention deficit disorder are beatable. With education, support, and a little creativity, you can learn to manage the symptoms of adult ADHD—even turning some of your weaknesses into strengths. It’s never too late to turn the difficulties of adult ADHD around and start succeeding on your own terms.
Myths & Facts about Attention Deficit Disorder in Adults
Myth: ADHD is just a lack of willpower. People with ADHD focus well on things that interest them; they could focus on any other tasks if they really wanted to.
Fact: ADHD looks very much like a willpower problem, but it isn’t. It’s essentially a chemical problem in the management systems of the brain.
Myth: People with ADHD can never pay attention.
Fact: People with ADHD are often able to concentrate on activities they enjoy. But no matter how hard they try, they have trouble maintaining focus when the task at hand is boring or repetitive.
Myth: Everybody has the symptoms of ADHD, and anyone with adequate intelligence can overcome these difficulties.
Fact: ADHD affects people of all levels of intelligence. And although everyone sometimes has symptoms of ADHD, only those with chronic impairments from these symptoms warrant an ADHD diagnosis.
Myth: Someone can’t have ADHD and also have depression, anxiety, or other psychiatric problems.
Fact: A person with ADHD is six times more likely to have another psychiatric or learning disorder than most other people. ADHD usually overlaps with other disorders.
Myth: Unless you have been diagnosed with ADHD or ADD as a child, you can’t have it as an adult.
Fact: Many adults struggle all their lives with unrecognized ADHD symptoms. They haven’t received help because they assumed that their chronic difficulties, like depression or anxiety, were caused by other impairments that did not respond to usual treatment.
Source: Dr. Thomas E. Brown, Attention Deficit Disorder: The Unfocused Mind in Children and Adults
Signs and symptoms of ADHD in adults
In adults, attention deficit disorder often looks quite different than it does in children—and its symptoms are unique for each individual. The following categories highlight common symptoms of adult ADHD. Do your best to identify the areas where you experience difficulty. Once you pinpoint your most problematic symptoms, you can start implementing strategies for dealing with them.
Trouble concentrating and staying focused
“Attention deficit” can be a misleading label. Adults with ADHD are able to focus on tasks they find stimulating or engaging, but have difficulty staying focused on and attending to mundane tasks. You may become easily distracted by irrelevant sights and sounds, bounce from one activity to another, or become bored quickly. Symptoms in this category are sometimes overlooked because they are less outwardly disruptive than the ADHD symptoms of hyperactivity and impulsivity—but they can be every bit as troublesome:
- Becoming easily distracted by low-priority activities or external events that others tend to ignore.
- Having so many simultaneous thoughts that it’s difficult to follow just one.
- Difficulty paying attention or focusing, such as when reading or listening to others.
- Frequently daydreaming or “zoning out” without realizing it, even in the middle of a conversation.
- Struggling to complete tasks, even ones that seem simple.
- A tendency to overlook details, leading to errors or incomplete work.
- Poor listening skills; for example, having a hard time remembering conversations and following directions.
- Getting quickly bored and seeking out new stimulating experiences.
Hyperfocus: the other side of the coin
While you’re probably aware that people with ADHD have trouble focusing on tasks that aren’t interesting to them, you may not know that there’s another side: a tendency to become absorbed in tasks that are stimulating and rewarding. This paradoxical symptom is called hyperfocus.
Hyperfocus is actually a coping mechanism for distraction—a way of tuning out the chaos. It can be so strong that you become oblivious to everything that’s happening around you. For example, you may be so engrossed in a book, a TV show, or your computer that you completely lose track of time and neglect your responsibilities. Hyperfocus can be an asset when channeled into productive activities, but it can also lead to work and relationship problems if left unchecked.
Disorganization and forgetfulness
When you have adult ADHD, life often seems chaotic and out of control. Staying organized and on top of things can be extremely challenging—as is sorting out what information is relevant for the task at hand, prioritizing your to-do list, keeping track of tasks and responsibilities, and managing your time. Common symptoms of disorganization and forgetfulness include:
- Poor organizational skills (home, office, desk, or car is extremely messy and cluttered)
- Tendency to procrastinate
- Trouble starting and finishing projects
- Chronic lateness
- Frequently forgetting appointments, commitments, deadlines
- Constantly losing or misplacing things (keys, wallet, phone, documents, bills).
- Underestimating the time it will take to complete tasks.
If you suffer from symptoms in this category, you may have trouble inhibiting your behaviors, comments, and responses. You might act before thinking, or react without considering consequences. You may find yourself interrupting others, blurting out comments, and rushing through tasks without reading instructions. If you have impulse problems, staying patient is extremely difficult. For better or for worse, you may dive headlong into situations and find yourself in potentially risky circumstances. Symptoms include:
- Frequently interrupting others or talking over them
- Poor self-control, addictive tendencies
- Blurting out thoughts that are rude or inappropriate without thinking
- Acting recklessly or spontaneously without regard for consequences
- Trouble behaving in socially appropriate ways (such as sitting still during a long meeting)
Many adults with ADHD have a hard time managing their feelings, especially when it comes to emotions like anger or frustration. Common emotional symptoms of adult ADHD include:
- Being easily flustered and stressed out
- Irritability or short, often explosive, temper
- Low self-esteem and sense of insecurity or underachievement
- Trouble staying motivated
- Hypersensitivity to criticism
Hyperactivity or restlessness
Hyperactivity in adults with ADHD may appear the same as it does in kids. You may be highly energetic and perpetually “on the go” as if driven by a motor. For many people with ADHD, however, the symptoms of hyperactivity become more subtle and internal as they grow older. Common symptoms of hyperactivity in adults include:
- Feelings of inner restlessness, agitation, racing thoughts
- Getting bored easily, craving excitement, tendency to take risks
- Talking excessively, doing a million things at once
- Trouble sitting still, constant fidgeting
You don’t have to be hyperactive to have ADHD
Adults with ADHD are much less likely to show hyperactivity than their younger counterparts. Only a small slice of adults with ADHD, in fact, suffer from prominent symptoms of hyperactivity. Remember that names can be deceiving and you may very well have ADHD if you have one or more of the symptoms above—even if you lack hyperactivity.
Effects of adult ADHD
If you are just discovering you have adult ADHD, chances are you’ve suffered over the years due to the unrecognized problem. You may feel like you’ve been struggling to keep your head above water, overwhelmed by the constant stress caused by procrastination, disorganization, and handling demands at the last minute. People may have labeled you “lazy,” “irresponsible,” or “stupid” because of your forgetfulness or difficulty completing certain tasks, and you may have begun to think of yourself in these negative terms as well.
ADHD that is undiagnosed and untreated can have wide-reaching effects and cause problems in virtually every area of your life.
Physical and mental health problems. The symptoms of ADHD can contribute to a variety of health problems, including compulsive eating, substance abuse, anxiety, chronic stress and tension, and low self-esteem. You may also run into trouble due to neglecting important check-ups, skipping doctor appointments, ignoring medical instructions, and forgetting to take vital medications.
Work and financial difficulties. Adults with ADHD often experience career difficulties and feel a strong sense of underachievement. You may have trouble keeping a job, following corporate rules, meeting deadlines, and sticking to a 9-to-5 routine. Managing finances may also pose a problem: you may struggle with unpaid bills, lost paperwork, late fees, or debt due to impulsive spending.
Relationship problems. The symptoms of ADHD can put a strain on your work, love, and family relationships. You may be fed up with constant nagging from loved ones to tidy up, listen more closely, or get organized. Those close to you, on the other hand, may feel hurt and resentful over your perceived “irresponsibility” or “insensitivity.”
The wide-reaching effects of ADHD can lead to embarrassment, frustration, hopelessness, disappointment, and loss of confidence. You may feel like you’ll never be able to get your life under control or fulfill your potential. That’s why a diagnosis of adult ADHD can be an enormous source of relief and hope. It helps you understand what you’re up against for the first time and realize that you’re not to blame. The difficulties you’ve experienced stem from attention deficit disorder—they are not a result of personal weakness or a character flaw.
Adult ADHD doesn’t have to hold you back
When you have ADHD, it’s easy to end up thinking that there’s something wrong with you. But it’s okay to be different. ADHD isn’t an indicator of intelligence or capability. You may experience more difficulty in certain areas, but that doesn’t mean you can’t find your niche and achieve success. The key is to discover your strengths and capitalize on them.
It can be helpful to think about attention deficit disorder as a collection of traits that are both positive and negative—just like any other set of qualities you might possess. Along with the impulsivity and disorganization of ADHD, for example, often come incredible creativity, passion, energy, out-of-the-box thinking, and a constant flow of original ideas. Figure out your strengths and set up your environment in a way that supports them.
Self-help for adult ADHD
Armed with an understanding of ADHD’s challenges and the help of structured strategies, you can make real changes in your life. Many adults with attention deficit disorder have found meaningful ways to manage their symptoms, take advantage of their gifts, and lead productive and satisfying lives. You don’t necessarily need outside intervention—at least not right away. There is a lot you can do to help yourself and get your symptoms under control.
Exercise and eat healthfully. Exercise vigorously and regularly—it helps work off excess energy and aggression in a positive way while soothing and calming the body. Eat a wide variety of healthy foods and limit sugary foods in order to even out mood swings.
Get plenty of sleep. When you’re tired, it’s even more difficult to focus, manage stress, stay productive, and keep on top of your responsibilities. Support yourself by turning off screens at least one hour before bed and getting between 7-9 hours of sleep every night.
Practice better time management. Set deadlines for everything, even for seemingly small tasks. Use timers and alarms to stay on track. Take breaks at regular intervals. Avoid piles of paperwork or procrastination by dealing with each item as it comes in. Prioritize time-sensitive tasks and write down every assignment, message, or important thought.
Work on your relationships. Schedule activities with friends and keep your engagements. Stay vigilant in conversation and online communication: listen when others are speaking and try not to speak (or text or email) too quickly yourself. Cultivate relationships with people who are sympathetic and understanding of your struggles with ADHD.
Create a supportive work environment. Make frequent use of lists, color-coding, reminders, notes-to-self, rituals, and files. If possible, choose work that motivates and interests you. Notice how and when you work best and apply these conditions to your working environment as best you can. It can help to team up with less creative, more organized people—a partnership that can be mutually beneficial.
Practice mindfulness. While difficult for some people with ADHD to even contemplate, regular mindfulness meditation can help you calm your busy mind and gain more control over your emotions. Try meditating for a short period and increase the time as you become more comfortable with the process.
Blame the ADHD, not yourself. Adults diagnosed with ADHD often blame themselves for their problems or view themselves in a negative light. This can lead to self-esteem issues, anxiety, or depression. But it’s not your fault that you have ADHD and while you can’t control how you’re wired, you can take steps to compensate for your weaknesses and learn to flourish in all areas of your life.
When to seek outside help for adult ADHD
If the symptoms of ADHD are still getting in the way of your life, despite self-help efforts to manage them, it may be time to seek outside support. Adults with ADHD can benefit from a number of treatments, including behavioral coaching, individual therapy, self-help groups, vocational counseling, educational assistance, and medication.
Treatment for adults with attention deficit disorder, like treatment for kids, should involve a team of professionals, along with the person’s family members and spouse.
Professionals trained in ADHD can help you control impulsive behaviors, manage your time and money, get and stay organized, boost productivity at home and work, manage stress and anger, and communicate more clearly.