Recognizing ADHD in Adults
Transcriber: Minh-Hung Nguyen
Reviewer: Hani Eldalees
Most of the time,
when you think of somebody with ADHD,
this is what you think of.
But now I’d like for you to meet Sally.
Sally is an incredibly creative person.
She has a master’s in fine arts
from Boston University.
She’s the person that
people at work come to
if they need fresh ideas.
Sally has ADHD.
So Sally is driving down the road
and there’s this constant conversation
going on inside her head.
She’s thinking,
why did I have
to look at that last email?
I thought it was going to take me
two minutes to write a response,
and 20 minutes later, the stupid
thing still isn’t written. And I’m late.
And I would say I’m
going to do better next time.
But I say that every single day
and nothing changes.
So what’s the deal?
And then friends and family,
people who love Sally,
say things like, you forgot.
How could you forget? I told you 10 times.
Are you listening to me?
Do we need to get your ears checked?
Are you just not paying attention?
Or how could you go to the grocery store?
All we needed was bread and milk
and you come back with a hundred
and fifty dollars worth of groceries
and no bread or milk.
How does that happen?
So you can see this would be
a hard place to have confidence
because Sally has her voice
on the inside of her head
telling her she’s not doing well
and she has voices on the outside
of her head confirming it.
So this makes Sally anxious.
As you can imagine, a lot of adults who
have ADHD feel anxious, actually,
75 percent of adults who have anxiety
actually have ADHD as
the cause of their anxiety.
Whether they’re anxious or not,
they know something is not right
and they’ll make monumental efforts to
make it right. But it’s still not right.
And they’re usually waiting for
the other shoe to drop,
for everybody else to figure out they’re
not as competent as they appear.
But here’s the thing. Sally is actually
competent.
So what’s going on?
What’s going on with ADHD?
At its core, ADHD is a deficiency
of neurotransmitters,
mainly dopamine and norepinephrine.
You need dopamine
to be interested in things
like what your husband is telling you
to get at the grocery store;
and need norepinephrine
for executive functions
like concept of time and prioritizing.
Because you need to know how
much time has passed,
so you know whether you need to stop
answering that email so you can get to
your appointment.
And you need to know that it’s more
important to get to the appointment
on time than it is to finish
that email today.
And there are many, many other
examples I can give.
Now I’d like for you to meet Tom.
Tom is a people person.
He is a great friend.
He can connect with just about anybody.
Tom checks his mail about once a week,
usually when the door of the mailbox
won’t close all the way because
there’s so much mail in there.
Tom has to force himself to go
get the mail and he brings it in
and he sets it down on the table
because the mail is not interesting.
Unfortunately, he sets to the mail down
on last week’s mail
and that sitting on top of mail
from the week before that.
So the mail started out
being an interesting
but then it ended up being overwhelming.
And at some point, Tom just swept
all the mail into a box
and stuck the box in a closet.
And it doesn’t matter
that there were bills
that needed to be paid
because they’re not interesting
until the situation becomes overwhelming
and now the water gets turned off
because Tom didn’t pay his water bill.
Now he’s interested.
And this doesn’t just happen at home.
It happens at work, too.
At home, if Tom is overwhelmed,
he can just move right past it.
But he doesn’t have that luxury to work.
So if you see Tom sitting in a meeting,
he is just seething internally
because he has so much that he has to do,
and these people are just wasting his
time in another boring meeting.
And the problem, it’s not just the mail.
It’s the mundane details of human
existence that we all have to deal with,
like going to the doctor,
going to the dentist.
And people with ADHD know
they need to do them,
but they’re either mundane
or they’re overwhelming.
And you can see that neither one of those
situations will get the job done.
Until the situation becomes so big that
they have to address it.
So these are people who are living their
life in crisis all the time.
And just think about the health
implications of that,
the risk of heart attack, the high
blood pressure, the weight gain.
And this doesn’t just affect
the person with ADHD.
It affects everybody around them
because they don’t understand
what’s going on.
But then neither does the
person with ADHD.
Nobody understands what’s going on.
So this is the corporate executive
who has great ideas,
but she’s late getting your
individual reviews done.
This is the stay at home mom
who is frantically
running around all day long.
But when her husband comes home,
the house is a mess and she hasn’t
even started dinner yet.
This is a college professor
who’s a great teacher,
but it takes him forever
to grade his tests.
And this is the husband who
has to stay late at work
because he can’t get any work
done until everybody leaves,
because that’s when he can focus.
Now, here’s where this gets interesting,
because most people with ADHD,
including Tom and Sally,
are perfectionists.
What’s up with that?
It’s all about the shame.
Because they know what they need to do,
they’re clear thinking adults,
but they can’t get it done.
And they have a world of people
who see that they’re
not getting things done.
They don’t understand. They’re not
aspiring to be that person.
They’re trying really hard
not to be that person.
And it’s not working.
In their minds,
the only way to counter the shame
of not getting something done
and then hearing about it
is to do it perfectly.
So what’s the solution?
That’s the best part of this conversation,
because there is a solution.
Medication helps tremendously
because this is a chemical deficiency.
Sally gets her ADHD treated
and now she can have creative thoughts
without having that big swirl of ideas
running around in her head.
And she can look at an email and see
if she has time to answer it
or she needs to save it for later.
Now, Sally can be on time
for her appointment,
and that frees up the perfectionist
who was trying so hard
to be on time before
and was failing every time.
Tom gets his ADHD treated.
Now he can open up the bills
and pay them
and he can sit down and read a book
and remember what he read.
At work, Tom can sit quietly,
as any adult would in a meeting,
even though it’s a really boring meeting
because he doesn’t have to stimulate
himself to be interested in it.
Now the corporate executive
gets her reviews done
and she has more time
for great ideas.
The stay-at-home mom
can spend time with her kids
really being present with her kids
because she’s not frantically
running around all the time.
The college professor can help the
students who are struggling
because he knows what their grades are.
And the husband can come home on time
and spend time with his family
because he got his work done
during work hours.
So does everybody have this? I mean,
don’t we all feel stressed at times?
Yes, of course we all feel stressed,
but for some people
this is life altering.
They can’t move forward and they
live a life of hidden shame.
In the 28 years I’ve been seeing patients,
in my professional opinion,
I think we’re looking at two
to three out of ten people,
and that’s a lot of people who could
be feeling a whole lot better.
Thank you for your time.