Taking Charge of Adult ADHD
By Russell A. Barkley, Christine M. Benton
The Guilford Press Copyright © 2010 The Guilford Press
All rights reserved.
Is It Possible That You Have ADHD?
Do the experiences you just read about sound familiar? These are the voices of adults with ADHD. The first comment strikes at the very heart of what ADHD is. It's a succinct description of the serious time management problems that ADHD creates for adults in their daily lives.
Do you feel like you're often out of sync with the clock, with schedules and agendas? Always late or scattered or unsure what to do with the limited hours in your day? If so, you know it's no fun feeling like you're constantly letting yourself and others down by missing deadlines and appearing to stand people up for dates and appointments. You know it's hard to maintain a sense of adult accomplishment and competence when those around you think they can't count on you to get things done. Maybe it's time to change all that.
HOW WOULD YOU DESCRIBE YOUR PROBLEMS?
Of course time management troubles aren't caused only by ADHD. But if you share some of the other problems described by the people above, ADHD might be the culprit. And if it is, there's a lot you can do to change your life for the better.
Quickly run through this list and check off each question you'd answer with a "yes."
 Do you have trouble concentrating?
 Are you easily distracted?
 Do you consider yourself highly impulsive?
 Do you have trouble getting or staying organized?
 Do you find yourself unable to think clearly?
 Do you feel like you always have to be busy doing lots of things—but then you don't finish most of them?
 Do people say you talk too much?
 Is it hard for you to listen closely to others?
 Do you jump in and interrupt others when they're talking or doing something—and then wish you had thought first?
 Does your voice seem to carry over everyone else's?
 Do you struggle to get to the point of what you're trying to say?
 Do you often feel restless inside?
 Do you find yourself forgetting things that need to get done but are not urgent?
Only a professional evaluation can tell you for sure whether you have ADHD. But the more questions you answered "yes," the more likely it is that you have this disorder. What I can tell you right now is that reams of scientific data show an association between complaints like these—and hundreds of similar ones—and ADHD in adults.
The data also tell us how severe the fallout can be. ADHD can make people spend their paycheck on something fun right now—and never save enough money for their monthly or annual bill payments or for that vacation or car or house they'll want even more tomorrow than the purchase that seemed irresistible today. It can make them bet it all on an investment that a little patience and research would have revealed as a bad risk. It can make you say and do all kinds of things you later regret. Sound familiar?
But, you might be thinking, I can't possibly have ADHD. I'm not hyperactive! My brother (or sister, nephew, childhood pal, classmate) had ADHD when we were kids, and he was constantly fidgety, restless, and "hyper," always acting out in some embarrassing way. I'm not like that.
One of the things we're beginning to understand well about adult ADHD is that hyperactivity is seen more in kids with the disorder—but then it usually declines substantially by adolescence and adulthood. Often the only thing that's left of hyperactivity in adults with ADHD is that feeling of restlessness and the need to keep busy that you may know well.
If you think you might have ADHD, there are good reasons to seek an evaluation:
[check] We're coming up with lots of answers that could help you. Adult ADHD is becoming well understood by science even though the disorder hasn't been recognized in adults for that long.
[check] This disorder can hurt you more than a lot of other psychological problems—and it can hurt you every day, everywhere you go. ADHD is more limiting in more areas of adult life than most other disorders seen in outpatient mental health clinics.
[check] And there's a lot more help, in the form of effective treatment options and coping strategies, than for a lot of other disorders that affect adults. ADHD is one of the most treatable psychological disorders.
HOW LONG HAVE YOU HAD THESE PROBLEMS?
If you think about how long you've been struggling to manage your time, to concentrate, and to control your impulses, would you say it's been just weeks or months or more like years? Picture yourself as a child: Were you dealing with any of the same problems then? Do you remember also having trouble sitting still in school? Finishing a hobby project? Following the rules on a playing field?
The adults with ADHD that I've studied, diagnosed, and treated have varying memories of the types of problems you checked off earlier. Many were not diagnosed as kids. Sometimes their pediatrician didn't believe ADHD was real. Or their parents didn't think "being hyper or not being able to focus was a reason to take a child to the doctor," as one man diagnosed in his mid-twenties reported. These people may have bought the myth that there was nothing wrong with them that sheer willpower wouldn't cure. Sometimes people end up undiagnosed because they fall into a gray area between ADHD and non-ADHD symptoms or because they had other problems that muddied the picture.
Going undiagnosed as a child doesn't mean you don't have ADHD.
Having less severe problems managing time, concentrating, and controlling impulses than you did as a child doesn't mean you don't have ADHD.
Being hyperactive as a child but not as an adult doesn't mean you don't have ADHD.
But not having any ADHD symptoms as a child probably does mean you don't have ADHD. ADHD-like symptoms that arose only in adulthood or that haven't been going on for very long are probably being caused by something else—a brain injury or other physical illness, for example.
If you don't clearly remember having the same problems you just noted when you were a child, is there someone who knew you well then that you can ask? A parent? Brother or sister? Ironically, the same problems that make it hard for people with ADHD to get things done on time, make wise choices, and even get along with others can make it tough for them to trace their own history accurately—at least until they've reached approximately their mid-to late 20s. I'll explain why in Step Two.
? I didn't have any problems as a child, and I haven't had any brain injuries. Isn't it possible that ADHD hasn't caused me any problems till now because of my intelligence? I scored high on IQ tests in elementary school.
Except in school and possibly at work, intelligence is unlikely to protect you from experiencing impairments. Intelligence is not the only factor involved in domains like family and social functioning, driving, crime and drug use, dating and marital relationships, and, in fact, most others. High intelligence wouldn't necessarily have protected you in these areas if you had ADHD symptoms. Sudden appearance of problems in adulthood is highly likely to be caused by something other than ADHD.
? I think I may have ADHD now even though I didn't have any concentration or other problems when I was younger. Maybe I was just compensating for my ADHD in other ways?
In our research, the average number of major life activities in which adults with ADHD said they were often impaired was 6 or 7 out of 10. ADHD causes serious impairment across all the domains of adult life, from education to work to family. It would be nearly impossible to make it through childhood, adolescence, and even early adulthood by "compensating" somehow. Most professionals would have a hard time accepting the idea that ADHD had not interfered with a person's functioning until adulthood without strong evidence that parents and schools had made extraordinary efforts to help. ADHD is defined by lack of compensation during the childhood years—not by successful compensation during those years!
WHAT ARE YOUR SYMPTOMS?
Only a qualified professional can help you fully answer that question. Still, checking off any of the following questions that you'd answer "yes" will help you figure out whether to pursue a diagnostic evaluation. In our research-aimed specifically at understanding adult ADHD, we've found the following nine criteria most accurate in identifying the disorder.
Do you often ...
 Easily get distracted by extraneous stimuli or irrelevant thoughts?
 Make decisions impulsively?
 Have difficulty stopping activities or behavior when you should do so?
 Start a project or task without reading or listening to directions carefully?
 Fail to follow through on promises or commitments you make to others?
 Have trouble doing things in their proper order or sequence?
 Drive much faster than others—or, if you don't drive, have difficulty engaging in leisure activities or doing fun things quietly?
 Have difficulty sustaining attention in tasks or recreational activities?
 Have difficulty organizing tasks and activities?
Did you check off four of the first seven symptoms on this list, or six of all nine symptoms? If so, you are highly likely to have ADHD. In that case you should seek an evaluation from an experienced mental health professional if you have not done so already.
HOW DO THESE SYMPTOMS AFFECT YOUR LIFE?
ADHD is not a category that you either fall into or don't. It is not like pregnancy. It's more like human height or intelligence. Think of it as a dimension, with different people falling at different points along it.
So where on that dimension is the division between "disorder" and "no disorder"? It's where impairment in a major life activity occurs. Symptoms are the ways a disorder expresses itself in thoughts and actions. Impairments are the adverse consequences that result from showing those symptoms. The table below lists typical impairments caused by ADHD in childhood and beyond.
Now you should have a fairly good idea of whether you might have ADHD and should consider a professional evaluation:
 Do you have at least four to six of the nine symptoms now?
 Do they occur often in your current life?
 Have you been having these troubles for at least 6 months?
 Did they develop in childhood or adolescence (before 16 years of age)?
 Have your current symptoms resulted in adverse consequences (impairment) in one or more major domains (education, work, social relationships, dating or marital relationships, managing your money, driving, etc.)?
 Did you experience adverse consequences from these symptoms in childhood?
If you can answer "yes" to all of these questions, there is a high probability that you have ADHD. Read on to find out what you can do about it.
Can You Handle the Problem on Your Own?
Believing you might have ADHD can feel like a huge relief: At last you have some idea of why your life has been so tough. Problem solved, right? All you have to do now is read a couple books like this one so you know how to deal with the deficits ADHD imposes.
Not so fast. There are some very powerful reasons to get professional help, both for diagnosis and for treatment. This chapter will explain in more depth what one man in his 30s put so plainly:
"I've tried extremely hard over the past few decades to deal with my ADHD on my own and feel I've done OK. But now I think I need some help. I'm tired of being a 'skipping stone' as far as careers go and would really like to settle and excel as I KNOW I can."
In brief, these are the reasons to get professional help:
[check] To make sure your symptoms aren't being caused by a condition other than ADHD that requires attention
[check] To discover whether your problems are being caused by a combination of ADHD and another condition
[check] To get the prescription medication that's proven to give a huge boost to coping efforts if you do receive a diagnosis of ADHD
[check] To find out where your strengths and weaknesses are so you can aim your coping efforts exactly where they're needed
All great reasons to form a relationship with a doctor who can prescribe the right treatment for you.
Convinced? If so, feel free to turn directly to Chapter 3. But if you need to know more about why you should not try to handle this problem alone, read the rest of this chapter.
ARE YOUR SYMPTOMS BEING CAUSED BY SOMETHING ELSE, LIKE A MEDICAL PROBLEM?
Let's go back to the idea that knowing you might have ADHD can be a relief. We've found that finding a name and a neurobiological reason for many of your struggles is, in itself, therapeutic. When you know what's wrong, you can stop beating yourself up for not being able to just shake off your problems. But you can't truly know you have ADHD without that evaluation. Only a seasoned mental health professional has the training and judgment to apply the diagnostic criteria you learned about in Chapter 1. Without that kind of background, you won't be able to factor in the nuances that define the line between signs of ADHD and symptoms that can be found to lesser degrees in the general population of adults. Nor will you be familiar with the other psychological and psychiatric disorders that cause problems with attention, concentration, and working memory so that you can distinguish between those and ADHD.
Just as important, a qualified professional can direct you to any medical tests or procedures you need to ensure that your symptoms are not a result of brain injury or illness, as noted in Chapter 1.
DOES ADHD EXPLAIN EVERYTHING YOU'RE GOING THROUGH?
Even if Chapter 1 gave you a strong feeling that you have ADHD, you need a professional evaluation to make sure ADHD tells the whole story. It would be incredibly demoralizing to address ADHD and still struggle because some other problem has gone undiscovered and untreated. If an evaluation turns up coexisting disorders (called comorbidity), you'll be given not only a diagnosis and some information about your disorder(s) but also a list of treatment recommendations—the first step on your way to leaving behind your life as a "skipping stone."
THE MOST EFFECTIVE TREATMENT—MEDICATION—REQUIRES A DOCTOR'S PRESCRIPTION
You can read all about the medications used to treat ADHD in Step Three. What's important to know right now is that where ADHD symptoms are concerned, medication works. It improves the symptoms. It is effective in a large percentage of adults—fewer than 10% will have no positive response to any of the drugs approved for use with ADHD. Medication even seems to temporarily correct or compensate for the underlying neurological problems that are likely contributing to the ADHD in the first place.
A lot of other treatments and coping methods have little effect unless the person with ADHD is also taking medication. In our experience, adults with ADHD who choose not to try medication following their diagnosis typically return within 3–6 months asking to go on it once they realize that all the other options are not addressing their problems very well.
EXACTLY WHAT ARE YOUR STRENGTHS AND WEAKNESSES?
A professional evaluation involves several steps. These steps are designed to look at your difficulties from a number of angles to make sure important facts aren't overlooked or signs misinterpreted. But if the process seems repetitive or drawn out to you, keep in mind that the evaluator is trying to rule out things that are not causing you problems as well as identify what is causing you trouble. There's another reason to be patient with this process too: in differentiating among all the possible causes of your symptoms, the practitioner will also be unearthing valuable information about your personal strengths. Knowing where you shine in life skills and natural abilities will help you and your therapist choose coping strategies that are tailored to help you most. Artistic talents and engaging personalities, for instance, don't come from having ADHD, but you can learn to use these gifts to compensate for ADHD symptoms. Or you can identify a career path that draws on these strengths. (Continues...)
Excerpted from Taking Charge of Adult ADHD by Russell A. Barkley, Christine M. Benton. Copyright © 2010 The Guilford Press. Excerpted by permission of The Guilford Press.
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