Boys are diagnosed three times more often than girls. Girls’ symptoms are quieter and are often underdiagnosed. By adulthood, ADHD rates for women equal that of men. Between 60-90% of children retain ADHD symptoms throughout life, costing society an estimated $122 billion annually, not including the costs of incarceration.
ADHD is hereditary, in fact, seventy five percent of the disorder is accounted for genetically. ADHD is well known to coexist with depression, anxiety, bipolar disorder, substance abuse, personality disorders and autism. A hallmark of ADHD, impaired executive functioning (disorganization, poor time management, poor planning) combined with low tolerance to frustration can result in academic, social and occupational failure. Failure, in both children and adults, crushes self-esteem and can lead to harmful defiance, conduct disorder and substance abuse – direct pathways to prison. In fact, 25-40 percent of juveniles and adults, in prison, males and females alike, have ADHD.
Early diagnosis and treatment are key. So is access to stimulants. Since the covid pandemic began, there has been a relentless shortage of stimulants, the gold standard treatment for child and adult ADHD.
In childhood, ADHD is best diagnosed by multiple converging sources including rating scales by a teacher, a caregiver and clinical evaluation by a professional trained in ADHD. The disorder cannot be diagnosed by rating scales alone, by neuropsychological testing, or brain imaging. For struggling adults, parsing out what diagnoses exist requires a well-trained professional but evidence-based treatment is widely acknowledged to be a combination of “pills and skills” shown to manage symptoms and improve functioning.
In May, at an ADHD conference I attended in Amsterdam, significant evidence supports the use of stimulants in children and adults. Although parents may be understandably hesitant to give their child a stimulant, the combined benefits of improved self-esteem, enhanced peer relationships, and improved academic performance outweigh temporary side effects. Early treatment interrupts the progression to secondary psychiatric problems and very unhappy life outcomes in adulthood.
An often unknown, but core symptom of ADHD is emotional heightened reactivity. This is the chronic and pervasive difficulty in managing intense emotions. Individuals with ADHD have problems with impatience, irritability and having a short fuse. They experience significant internal distress which leads to external disruptions in relationships. Adolescents with ADHD will have significantly more turbulent teenage years. Girls will have more magnified symptoms and are 43% more likely to become pregnant. Enhancing parent monitoring and opening parent-teen communication to address risky sex can prevent future problems.
Treatments for ADHD such as Dialectical and Cognitive Behavioral Therapies have been shown to calm emotions, reframe negative thinking, and improve self-esteem for teens and adults. Families, often adversely affected by their child’s ADHD, can increase family harmony and maintain parental sanity through Parent Behavioral Training (PBT), though it does not reduce ADHD symptoms, per se.
Individuals with ADHD have real challenges, but they also have significant strengths. They are high-energy, passionate and imaginative. When they love something or someone there is no stopping them. They can be relentless perfectionists but they show grit to soldier on despite their limitations. Many highly successful people have ADHD.
A more modern approach to ADHD acknowledges both the challenges and strengths of individuals with the disorder, which in turn, reduces stigma. With early diagnosis and treatment, children and adults with ADHD can build life changing skills, adapt successfully over time and thrive, but access to stimulants is a key part of improved overall functioning.
