What is Attention Deficit/Hyperactivity Disorder?

By Allen Walker, D.O.

WHAT IS ATTENTION DEFICIT/HYPERACTIVITY DISORDER?

Attention Deficit/Hyperactivity Disorder (ADHD) is a term we have heard numerous times. It is used loosely and in many ways has become a part of our everyday lexicon. ADHD is described in the DSM-IV as a persistent pattern of an inattention, hyperactivity and impulsivity, which is present before the age of 7 years old. Many people can be hyperactive, impulsive or inattentive but this does not necessarily mean that they have ADHD.

WHY IS UNDIAGNOSED ADHD IMPORTANT?

Historically psychiatrists have made this diagnosis in boys more often than girls of similar ages. This diagnostic pattern generally appears to be related to the differences between males and females in the expression of their symptoms. For example, it is quite obvious to teachers and parents when a child is restless, impulsive and disruptive.

As psychiatrists we are now learning that boys typically present more of the impulsive and hyperactive symptoms than their female counterparts. Females with ADHD have a tendency to be a less hyperactive and disruptive but equally inattentive. This means that females with ADHD are generally not noticed as much by parents and teachers and therefore may go undiagnosed.

Another example is that people with ADHD (similar to the general population) can have IQ levels ranging from gifted to below average. Typically, undiagnosed individuals with higher IQs will forge their way through school and life mostly unnoticed and undiagnosed. Keep in mind that this usually comes at a relatively high price, as they are unable to realize their biggest dreams and full potential. For those individuals with lower IQs life becomes even more of a struggle. Undiagnosed individuals (no matter what their IQ) may eventually drop out of school, abuse alcohol and/or drugs, become depressed, anxious or even disabled.

The consequences of navigating life with undiagnosed ADHD can be biologically, psychologically and socially devastating as many individuals are alienated by frustrated parents, peers, teachers and coaches as lazy, stupid and troublemakers. These derogatory labels will typically become integrated at an early age into a person's self-esteem, which then can become a self-fulfilling prophecy. This scenario can ultimately lead to depression, anxiety, substance abuse and a sad life of unrealized potential and unfulfilled dreams.

HOW DO SYMPTOMS DIFFER BETWEEN ADOLESCENTS AND ADULTS?

This is a complicated question to answer because the activities and levels of independence greatly differ between adolescents and adults. Adolescents are customarily in the classroom or home being told by educators or parents the when, what, where and how of their daily activities. Compare this to an adult who has the freedom of choice as to when, what, where and how he or she lives and works.

I have found in my clinical experiences that adults with ADHD prefer flexibility and independence where they are able to choose how to live and work. They are usually risk takers who enjoy occupations that offer incentives, adventure, spontaneity, creativity, flexibility and the ability to use their energy and imagination to achieve success. Adolescents (and adults who have not modified their behavior) with ADHD also enjoy these qualities in their activities but have a need for discipline, organization and boundaries as they usually lack the maturity and impulse control to do so themselves. This can lead to adolescents being oppositional and defiant in nature as they do not like to be told the when, what, where and how of things. This is likely why we often find the comorbid diagnosis of Oppositional Defiant Disorder in the child and adolescent population. Adolescents (and some adults) also have a tendency to be more impulsive than their more mature adult counterparts with ADHD, as they have not yet acquired the wisdom to learn the consequences of their impulsivity.

WHY AM I INTERESTED IN ADHD?

As a child and adolescent I was competitive, athletic and artistic, winning numerous awards and even a college scholarship. I played four years of football and proudly graduated from Trinity High School and then went to the University of Illinois , Chicago and graduated with a bachelor of fine arts degree in studio arts. Despite excelling in many different areas of my life I was also painfully aware that I was deficient in others and different from my peers. In hindsight, I now understand why I could not compete in classes requiring sustained mental focus and attention to detail.

This was a very painful, frustrating and angry period in my life because my parents, coaches and teachers would often call me lazy, dumb and stupid. One math teacher even told my mother, "Do not bother sending him to college as he will never make it." I have since forgiven my parents, coaches and teachers, as I am certain they shared my pain and frustration.

At the age of 23 and with my mother's prompting and financial support I was evaluated and diagnosed with ADHD. I began to experience profound emotional relief and then, with self-education, a gradual renewed sense of self-confidence. Words cannot describe the feelings associated with being able to identify the problem that had plagued me for years. It was like having undiagnosed nearsightedness and not having eyeglasses for 23 years to correct the problem. Once the problem was identified it was easier to bring about positive and productive change, and that is exactly what I set my mind on doing. While reading about ADHD I became inspired by two Harvard psychiatrists also diagnosed with ADHD. I decided that would be my new goal, to go back to school and become a physician - a psychiatrist - and specialize in the diagnosis and treatment of people with ADHD.

IF I THINK I HAVE ADHD, WHAT SHOULD I DO?

You could call your primary care physician, pediatrician and or psychiatrist (if you have one) or you could contact the Kentucky Psychiatric Medical Association at:

Mail: Kentucky Psychiatric Medical Association
P.O. Box 198
Frankfort , KY 40602-0198

Phone: 502-695-4843
Toll-free: 1-877-597-7924
Fax: 502-695-4441
E-mail: WaltonKPA@aol.com

The diagnosis of ADHD is most accurately made through an extensive and comprehensive exploration of one's psychiatric, medical, educational and family history. Various psychological testing can also be utilized to assess attention capacities, which help to support a diagnosis.

Dr. Frederick Allen Walker completed his psychiatric residency at the University of Louisville School Of Medicine . He currently practices private psychiatry in Louisville .