Robert Volpe, a professor of applied psychology, says help is available for adults with ADHD, but self-diagnosis is dangerous
Attention problems and overactivity have long been associated with childhood.
It was first included in the Diagnostic and Statistical Manual of the American Psychiatric Association in 1968 — at that time, it was called hyperkinetic reaction of childhood, says Robert Volpe, a professor of applied psychology at Northeastern and an expert on Attention Deficit Hyperactivity Disorder.
It was understood to refer to the type of ants-in-your-pants behavior that distinguished children with severe motor activity, restlessness, distractibility and short attention spans.
These days, many adults are wondering whether their distractibility and difficulty with managing the tasks of everyday life stem from undiagnosed ADHD. Online discussion boards buzz with their concerns, and diagnostic internet quizzes are available with the click of a keyboard.
“Self-diagnosis is a risky thing to do,” says Volpe, who adds that only licensed psychologists and medical doctors, such as psychiatrists, are qualified to diagnose the condition and recommend treatment.
There’s a danger people may misdiagnose themselves with ADHD when they need to be treated for anxiety or depression, he says.
But adult ADHD is a real phenomenon, Volpe says. And understanding what ADHD is — and isn’t — can be the first step in getting help.
ADHD is a neurodevelopmental disorder
Volpe says ADHD is a neurodevelopmental disorder that is associated with a complex set of interactions between genes and the environment, but for which there is no biological test.
“There are certainly some genetics involved, but it’s not one gene. It’s a combination of genes,” he says. The environment also must be factored in, as is the case with most psychiatric disorders.
There are different types of ADHD
In the 1980s, the disorder was referred to as simply attention deficit disorder.
There are three subtypes now of ADHD now, Volpe says.
“Hyperactivity only is very rare and only found in young children. Hyperactivity is also very rare in adults. The two common subtypes for children and adolescents are ADHD Predominantly Inattentive Type and ADHD Combined Type.”
Two sets of nine symptoms
There are two sets of symptom criteria, one for inattentive ADHD and one for hyperactive/impulsive ADHD, Volpe says.
People with the disorder must have at least six out of nine symptoms for one or both, he says.
The Cleveland Clinic says symptoms for inattentive ADHD include trouble paying attention to detail, listening to others or staying focused on long-winded tasks such as reading or listening to a presentation.
The symptom list also includes lack of follow-through on tasks and obligations as well as difficulty keeping track of everyday items such as pencils, wallets and keys, or staying in the moment without distractions.
In addition, people with the inattentive type of ADHD can have trouble managing time and meeting deadlines, performing tasks that require brain power (such as filling out forms and writing reports) and remembering to complete routine chores and errands.
Symptoms for hyperactivity and impulsivity include fidgeting, getting up instead of staying seated, having difficulty waiting one’s turn, interrupting others and speaking out of turn or finishing others’ sentences.
Excessive talking, trouble doing tasks quietly, restlessness and appearing to be always on the go or “driven by a motor” complete the symptom list.
When it’s not ADHD
“Having trouble concentrating happens to everybody,” Volpe says. “Everybody’s distractible at one time or another.”
Maybe you’re not getting enough sleep or are starting a big, new difficult task that has you feeling like you are spinning your wheels, he says.
Other mental health conditions include similar symptoms to ADHD. “If you’re highly anxious, you’re going to be highly distractible. If you’re really depressed, it’s going to be really difficult for you to sustain effort on mental tasks.”
In addition, it’s not enough to have symptoms — to meet the symptom criteria for ADHD people have to be symptomatic for a sustained period of time and cause impairment, Volpe says.
“As with any DSM disorder, these problems have to be in place for six months or longer,” Volpe says.
Age of onset also matters, he says. “It’s a chronic disorder.”
Lost friendships and jobs
People meeting ADHD diagnostic criteria are impaired in more than one setting, such as social and occupational venues, he says
“Have you been fired from a job because you weren’t able to complete your paperwork and keep things organized? Do you have a hard time making friends?” Volpe says.
He says people with ADHD can have trouble maintaining social relationships because they may interrupt frequently, be too distracted to listen attentively to their friends and forget about social engagements.
What treatments work
Stimulant medications such as Adderall and Concerta can help people with ADHD manage symptoms, Volpe says.
THis is true for some, but not all people. Maybe 70% will respond to a first stimulant and maybe another 10 or 20% will respond if others are selected.
“They work really well for keeping you on task. You can get through some really difficult paperwork pretty easily if you’re on stimulants,” Volpe says.
For best results, he likes to see medication paired with therapeutic interventions, coaching and positive reinforcement to improve home and work life.
“It’s not just about paying attention,” Volpe says. People with ADHD “have real skills deficits because it’s a developmental disorder. It doesn’t go away for most people who have it.”
Help for adults with ADHD
“We’re getting better at diagnosing adults and the treatment for adults would be really addressing the skills deficits they have.”
That could include career counseling and steering people with ADHD away from jobs with tedious assignments that can overwhelm them, Volpe says.
“There are coaches out there that will work with them on organizational skills. Maybe they have a really difficult time managing their finances. They might have a difficult time keeping track of their paperwork.”
Some individuals swear by the Pomodoro Technique, which involves 25 minutes of concentrated work followed by a five-minute break, Volpe says.
And everybody — ADHD or not — could benefit from taking time out from scrolling social media and reading a book, playing music or doing a craft, he says.
Social media saturates your brain with bumps of dopamine, Volpe says. “This may make it more difficult to complete tasks that deliver relatively less stimulation.”