April 9, 2009

ADHD: A Berkeley lecture -- Adult ADHD

A couple of years ago, I was giving a lecture at Wheeler Hall, a 600-seat auditorium at the University of California, Berkeley. The Interdepartmental Studies course drew hundreds of undergraduates who were in many different majors, with many pre-meds and public health students.

I opened with a test. Paraphrased from several websites I found on Adult ADHD, all of which promised help or cure with a purchase of nutritional supplements, vitamins, medication from Canada, or a service such as counseling or self-help or spinal manipulation. I asked the students if:

  • They find their mind wandering from tasks that are uninteresting or difficult
  • They have trouble keeping focused on written material that’s not very interesting even if it’s important they know it
  • They sometimes find it hard to stay focused on group conversations
  • They find it difficult to complete long tasks when there are many shorter tasks competing for their attention
  • They think they have the potential to accomplish much more than they do
  • They sometimes notice a lot of time has gone by and they haven’t finished what they thought they would, and don’t know where the time went

I requested a show of hands, which showed an overwhelming majority of the students in the room to have, by these criteria, adult ADHD.

Next I turned to presumed therapy for their presumed ADHD. How many, I wondered, would be willing to take something that improved concentration and alertness, and might make them feel a little less tired. A main side effect of this class of drug was appetite suppression and even weight loss. I didn’t want to embarrass anybody or ask any of the students to reveal their pre-lecture psychological diagnoses. So I didn’t ask how many actually were taking prescription ADHD medication. I did show a slide listing the many substances that have many of the same effects on brain chemistry. These include coffee, tea, and Coca Cola. A majority of the students admitted to self-medicating with some form of stimulant.

Do we all have ADHD? Surely many or most of us use mild stimulants to help with alertness and concentration.

The official diagnostic criteria for the diagnosis of ADHD include a long checklist of predictable symptoms covering impulsivity, inattention, distractedness, and so on. But it’s not enough to have the required number of symptoms, even if they are severe.

In my experience, the single most important factor in the diagnosis of ADHD is, “There must be clear evidence of clinically significant impairment in social, academic, or occupational functioning.” (From the American Psychiatric Association.)

A few years ago I saw an interview on TV featuring the CEO of an airline. He said that he had ADHD and thus had a continuing struggle. He also noted his long happy marriage, and successful children. Where, I wondered, was the significant impairment? He didn’t say if he was taking medication, but if he was, why was he taking it? Though there may have been some students in my lecture who had been diagnosed and were in treatment at that time, those who met the criteria I gave them from the internet site on adult ADHD were not significantly impaired. They were almost all extremely successful students in a demanding program at an elite university.

I am often called upon to evaluate a child for ADHD. They usually do have symptoms that have brought them to the attention of their teachers or parents who have sent them on to me. But the smarter kids (and, I believe, the smarter adults), develop compensatory skills which can be very effective. They concentrate on things they’re good at and avoid those that are particularly difficult. Don't we all try to do that? Maybe they go into more creative, less structured fields. Maybe they successfully negotiate for certain types of flexibility from the teacher. Maybe they need to run their own business. Maybe they need to be CEO of an airline.

Next Post: Is ADHD inherited?

The sampler above is in my office. Sorry about the fuzzy photo, but it was taken through glass. The verse reads, "When I was young I little thought/That learning was so dearly bought/But by experience I do find/That it is not gained by an idle mind." Of course, it's easy for her to look back wistfully to when she was young, since she was 8 when she did this.

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