What's the difference between a multitasker and someone with ADHD? Start here
Most people have heard of attention-deficit/hyperactivity disorder (ADHD) in children, but what about in adults? How can you tell whether you are a multitasker who can get distracted versus a person with ADHD?
This month’s Healthy Actions expert is Dr. Max Wiznitzer, division chief of pediatric neurology at University Hospitals Rainbow Babies and Children’s Hospital and a professor at Case Western Reserve University Medical School.
He practices around Northeast Ohio, including in Medina, and specializes in children and young adults with developmental disabilities, including those with ADHD and who need management of it. He is also on the board for a national advocacy group, Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD), and is co-chair of the professional advisory board.
In addition, he's helping to develop guidelines for the assessment, diagnosis and management of adult ADHD in the U.S.
This is an edited version of our interview. There also is a video and podcast available of our interview.
What’s the difference between ADD (attention-deficit disorder) and ADHD?
There really is no difference. At one time, they were distinguishing between ADD with hyperactivity and without. But they found out that was cumbersome and not really on target. It is now ADHD.
What are some common signs or symptoms of ADHD?
There are three major categories: inattention, hyperactitivity and impulsivity.
A patient may find it difficult to initiate a task. They’re not tasks you like to do, but you have to do or maintaining or sustaining a task. They will look for excuses to avoid a task they perceive as too difficult for them. They're easily distractible, they're not well organized and they lose or misplace things.
Depending on the age, their time management is not good at and they're planning is maybe all awry because they get distracted by other things. When you look at the hyperactive component that's there, it's anything from being fidgety in your chair to getting out of your seat to basically being excessively moving and these individuals can literally bounce off the walls. Another is being verbally hyperactive. They talk a lot. Normal talking, but it’s a lot.
The third one is impulsivity and the classic criteria, which is mainly focused on children, are such things as difficulty waiting your turn, interrupting a lot or blurting out answers in the classroom. There could also be behavioral impulsivity. Some people continue even as adults to have problems with self-control and self-regulation, which means they blow up easily and they act before they think.
Do ADHD patients tend to have one or several of these symptoms?
These are usually a mixture and you have to meet some core criteria. It’s not like you just have one or two, but for adults there's criteria with nine features of inattention and nine for hyperactivity. For adults, you have to have at least five of them. For children, it is six. Also, for adults, you’ll find they have been symptomatic or showing features, even if it’s not full-blown features, for many years. It doesn’t just appear magically in the adult years.
When you were younger, you had people help you with organization. By the time you get to the later grades, you're supposed to do things more and you’re on your own in high school. If you go to college, you really are more on your own. That's when people may start noticing as the structural routine and consistency that was imposed on them by the environment tends to fade.
How can you differentiate between a multitasker and someone who is easily distracted versus somebody with an ADHD diagnosis?
A multitasker gets things done. The ADHD individual does not. One of the key things I hear about in adults is they start lots of tasks but don't finish. They have finished something after awhile, but usually after they've been urged repeatedly by their spouse to get things done.
A multitasker sometimes may or may put too much on the plate, but they’ll recognize that’s happening, narrow it down and get everything done in a timely fashion. Individuals with ADHD, whether they're kids or adults, are inefficient in their productivity. If it's a report that should take two hours, these individuals dilly dally and get distracted.
Time management is often a problem. Individuals with ADHD are usually late because they get distracted at home by 12,000 other things and don't get out the door.
Are there other issues that can come with an ADHD diagnosis?
People may develop secondary problems as a consequence of ADHD. Their self esteem goes down because they see themselves as not as good. They get negative criticism from the environment and therefore they maybe develop a secondary anxiety or even a secondary depression as a consequence of their poor performance. And if all we do is focus on the depression and the anxiety and not asking what's actually provoking it, you're never going to come to resolution.
Does our world of constant notifications on our phones and computers exacerbate the problem for people with ADHD and for everyone to focus?
Definitely, because you are getting many more external distractors than we used to a generation ago. It's really the temptation of the phone is such that it really some to some degree can make it more difficult to diagnose ADHD. But individuals with ADHD, when they're not on their phones, are still symptomatic. Turning off your notifications can help everyone not be distracted.
Are more adults and children being diagnosed today with ADHD?
The diagnosis in children has stayed about steady. It's up a smidge, but it's still underrecognized. The diagnosis in adults has improved because now we recognize that it’s present. In the past, people would give other excuses for why those behaviors were there.
Is it possible for an adult to have slipped through diagnosis as a child and then be diagnosed an adult?
It is very common because of support services they had or because they were able to compensate to make it through school, but then when they hit the stone wall of life as an adult, all of a sudden they're faced with the reality of these difficulties. It is not unusual, for instance, during a diagnosis on a child that one of the parents says “You know, now that I think about it, it sounds to me like I have the same thing."
Can a child diagnosed with ADHD grow out of it or not need medication as they age?
Yes. About half the individuals with childhood ADHD may no longer need medication treatment as adults. The numbers vary depending on what studies you look at. It does not go away at this magical age of 16 or 18.
Many adults recognize when they do need to be treated and when they don't. My patients in college frequently will say, “I don't need the medicine on weekends. I can manage quite well, but I need it when I'm in my classes” and there are others who say they need it every day.
When should someone seek medical advice if they think they have ADHD?
If we have an individual who is symptomatic showing features of ADHD — the inattentive features, hyperactive impulsive features or both — and it is negatively impacting their daily functioning, then irrespective of the reason why those behaviors are there, they should seek medical care. It could be due to ADHD or a medication side effect or some other condition that's present. About a third of individuals with ADHD also have anxiety disorders. They can also have learning challenges or motor-coordination problems.
For children, go to your pediatrician because they are very comfortable with the diagnosis. For adults, many primary care providers are not as comfortable diagnosing ADHD, but they also know what resources or referrals are available. You can also consult with an adult psychiatrist.
What kind of treatment is there for ADHD?
There are two components to ADHD management. For the core features of ADHD, the inattention, the hyperactivity, the impulsivity, those respond best to medication. Stimulant medicines can be very effective in improving attention, reducing hyperactivity, impulsivity and things like distractibility and motor overactivity. But none of those medicines teach you how to do things right.
You still have to have the skills to work with your ADHD, and in those cases, whether you're a child or adult, working with someone in order to gain those skills whether that’s a psychologist, therapist or coach.
It can be very helpful to take advantage of the improvement that the medication does for you in order to develop those good habits that will help you out even when you're not on the medication.
There are also co-existing conditions that can be present such as anxiety disorders or depression, which are probably the two we hear about most in the adult years. The other things that we have to worry about are substance use for people who've been trying to self treat and self medicate before a diagnosis is made.
Have medications improved or advanced over the years?
There have been several advances that have occurred. One was the introduction of extended-release formulations. Instead of having to take a pill every four hours, now you can take something that should last most of the day and that's very helpful, especially for individuals who have to remember to take their medicine.
There are also more ways the product can be delivered. In the old days, it was only a pill. Now, it could be a pill, liquid formulation, a sprinkle (opening a capsule to sprinkle the pellets) or a patch.
We’ve also done a better job of identifying if stimulants don’t work for you or you don’t tolerate them, there are non-stimulant options on the market.
Why do you use a stimulant with somebody who is hyperactive?
The stimulant lengthens the attention span. If we're able to pay attention to something for a longer period of time, you'll sit still for a longer period of time. In one of the classic models of ADHD, there's a relative deficiency of a neurotransmitter, a little chemical with which the nerves talk to each other called dopamine.
The stimulant medication is a misnomer. The stimulant increases the amounts of dopamine in the brain for people who are dopamine deficient. It gets you to a level that you should be at. It's not really stimulating you above and beyond where you should be.
Is there anything else you’d like to cover before we go?
Individuals with ADHD symptoms are not misbehaving. They’re not deliberately acting the way they do. Some people get a bad reputation. When the ADHD is under good management, they tend to do much better.
It’s a real medical condition. It affects in pediatrics, 8% to 9% of the population and in adults, about 4% to 5% of the population. There are established diagnostic criteria that when followed can be very helpful. There are effective interventions that could basically lead to a good life. If you don't intervene, we have data to show that there's a shortening of the lifespan of individuals with ADHD due to the fact that they develop unhealthy behaviors, there’s an increase risk of diabetes, increased risk of suicide, especially in the untreated populations in the adult years.
We want to change that trajectory to basically let individuals be productive, have good self esteem and be contributing members of society as well as have good relationships with everyone around them.
Healthy Actions is a look at a medical topic of interest with a local expert. To see previous columns, go to www.tinyurl.com/BettyHealthyActions
Beacon Journal staff reporter Betty Lin-Fisher can be reached at 330-996-3724 or blinfisher@thebeaconjournal.com.
This article originally appeared on Akron Beacon Journal: Healthy Actions: Spot the signs of adult ADHD
