You Don’t Have ADHD . . . Unless You Do

By: Jennifer Yen Clark, MD
As a board certified psychiatrist who sees patients from preschool to adulthood, one of the most common complaints I hear from people is that they, or their children, are having difficulty focusing and paying attention. Young children are brought to me by their parents because teachers are worried about the fact that they’re not reading yet or that they aren’t keeping up with the other kids in their class. High school and college students arrive at my office because they’re swamped with work and struggling to get organized. Adults report they’re overwhelmed with the responsibilities of life, they can no longer multitask, and their memories are terrible. All these individuals tell me one thing: “Doctor, I really think I have (or my child has) ADHD.”
My answer to them? “Maybe . . . or maybe not.”

What Is ADHD?
Attention Deficit Hyperactivity Disorder, or ADHD, is defined as a persistent pattern of behavioral changes that include inattention and hyperactivity/impulsivity, which disrupts development or the ability to function at home, school, or work. The definition also states that some of the symptoms must be present in an individual before the age of twelve, persist for at least six months, cause issues in more than one setting, clearly decrease functionality or quality of life, and cannot be better explained by another mental disorder. Although there are recent studies with preliminary results suggesting a form of ADHD that presents in adulthood, the current understanding is clear that the disorder must present in childhood. That said, diagnosis may occur at a later time if good social support, individual motivation, and minimal severity of symptoms exist to allow for someone to compensate for the disorder.
How Common Is ADHD?

During the years 2012 to 2014, 10.2 percent of children (around 6 million) between the ages of five and seventeen were diagnosed with ADHD, according to a survey made by the Center for Disease Control and Prevention (CDC). Boys were almost twice as likely as girls to be diagnosed. The survey goes on to state that the average age at the time of diagnosis is seven, although some of the more severe cases are often diagnosed earlier, and that, from state to state, prevalence of ADHD diagnosis in children varies from 5.6 to 18.7 percent. It’s interesting to note that only one in three children with ADHD receives both medication and behavioral therapy, according to the CDC survey. The National Comorbidity Survey of 2005 documented that 4.1 percent of adults in the United States had a lifetime prevalence of ADHD. This reflects the prevailing belief that only a percentage of children with ADHD continue to suffer from significant symptoms when they reach adulthood. However, it has been suggested this number actually underestimates the number of adults who suffer from ADHD.

Why Not ADHD?
Despite the fact that so many people suffer from ADHD in the United States, it is only one of many other mental disorders that present in childhood. For example, 25 percent of teenagers aged 13 to18 develop an anxiety disorder, 11.1 percent have major depressive disorder, 2.7 percent suffer from an eating disorder, and between 15 and 35 percent abuse alcohol and illegal substances. In adults, the numbers are 18 percent for anxiety, 6.7 percent for depression, 0.3 to 1.2 percent for eating disorders, 8.2 percent for substance abuse disorders, and 2.6 percent for bipolar disorder. All of these problems affect cognition, which in turn appears as a change in attention, focus, and memory. Similarly, many physical disorders, including thyroid disorders, autoimmune issues, and chronic sleep problems, can also affect mental clarity. There are even some medications that mimic ADHD symptoms when taken regularly. As the diagnosis of ADHD can, in most cases, only be made after excluding other possible mental disorders, a person complaining of issues should be fully evaluated by a healthcare professional, preferably one experienced in mental health.

How Is ADHD Diagnosed?
When getting evaluated for ADHD, a thorough assessment of the history of onset, types of symptoms, and severity of impairment should be performed along with a clinical face-to-face interview with the person affected. In the case of children, at least one parent or guardian (ideally all caretakers) should also be interviewed. Collateral information from teachers is also important. Consideration of other mental or physical disorders should occur and either be ruled out, or, if needed, psychological or objective testing be recommended. All medications and any illicit substances the person is taking should be reviewed, as they can be factors. It’s possible that the evaluation will take longer than one session, because information needs to be gathered from multiple sources. Rating scales and self-reports are only screening tools and are not reliable for diagnosis.

What Can Be Done If I Have ADHD (Or Not)?
In the instance that an individual is diagnosed with something other than ADHD, treating the disorder in question is the most appropriate first step. If the attention and focus issues don’t improve, a provider can then re-evaluate the residual symptoms. When ADHD is the diagnosis, treatment depends on the individual’s age. For children in preschool or very early on in elementary school, behavioral therapy and school accommodations may be all that’s needed to address the symptoms causing the issues. In severe cases, where the child is disruptive, aggressive, or self-injurious, medication may be recommended. For older children and adolescents, medication is the most common treatment for ADHD symptoms. Classroom accommodations, organizational and behavioral therapy, transferal to a smaller school, or one-on-one teaching can supplement the use of medication to improve functioning. In the case of adults, medication is the most common recommendation if there is significant impairment and dysfunction. Your provider will discuss potential treatment options and help monitor your progress if needed.

What Are Some Important Things to Remember?
Inattention, focus issues, and restlessness are common symptoms and can be indicative of various problems. Increased stress, chronic sleep issues, physical illness, and mood or substance disorders can all result in changes in the way your brain works. Also, keep in mind that some amount of attention and focus loss is normal and doesn’t necessarily require intervention. If you’re concerned, it’s important to seek an evaluation with a qualified mental health professional or experienced medical professional to determine if your symptoms are truly related to ADHD. The treatments available are effective for most people and can provide you with the tools you need to be successful personally and professionally. In the end, whether you have ADHD or not, addressing the core issue will improve your quality of life and allow you to pursue your dreams.

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Jennifer Yen Clark, MD graduated from the University of Texas Medical School in Houston and went on to complete residency training in general psychiatry at UT Medical School. She then completed fellowship training in child and adolescent psychiatry from Baylor College of Medicine. She is currently splitting her time between her private practice, Serenity Behavioral Health, and academics as Clinical Assistant Professor of Psychiatry and Behavioral Sciences at Baylor College of Medicine.

Dr. Yen Clark is also the author of a young adult novel series entitled The Avalon Relics, under her pen name of J.L. Clark. The series follows a teenage girl named Sophia as she discovers a realm of magic, intrigue, and romance. She hopes to send a message of empowerment and acceptance through her writing, while entertaining her audience with a journey through a hidden world of wonder and fantasy.

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