ADHD Is Real But Not At All What You Think It Is
Over-diagnosed and overmedicated, or under-identified and under-supported?
Unethical journalism practices further perpetuate misinformation
That is a more accurate headline for a recent article published by investigative journalist Rory Carson, as part of a BBC program called Panorama.
A recent episode focused on private ADHD clinics in the U.K., but very similar concerns have been raised here in Canada as well. Similar to the UK’s National Health Service (NHS), Canada’s healthcare system is terribly backlogged, leading to unacceptably long wait times for services.
Both the NHS and Canada’s healthcare system leave many people with nowhere to turn. We are frequently shuttled from one service to the next, with no one really knowing where to send us to access proper supports.
This is particularly true for adults with ADHD.
Apparently ADHD is only a childhood problem and adults with ADHD don’t exist.
Enter private ADHD clinics.
If you build it, they will?come
Or, more accurately: See a need and fill it, then reap the profits.
Currently in Manitoba, wait times for ADHD assessments for children and youth are anywhere between 6 months and 3 years. I would say this is similar for adults, but it really depends.
For one thing, it depends on whether our doctors will even give us a referral for assessment in the first place.
I am actually one of the lucky people who has a family doctor, and a pretty good one at that, but he’s certainly not perfect.
Nearly four years ago I sat in my GP’s office and told him my son had recently been diagnosed with ADHD. As I learned more about ADHD, I started recognizing a significant number of traits or symptoms in myself as well.
I asked him if I could be assessed for ADHD.
Initially, he didn’t want to make the referral. His first response was to tell me that whether an assessment is useful is really about our “daily functioning”: whether our house is a mess, we’re constantly late for or missing appointments, we’re chronically disorganized, and so on.
I’m not sure how he could have any opinion on whether or not my house was messy or my workspace disorganized, it’s not as though he’d ever been to my home or seen my office, but okay.
Luckily, I had done my homework.
ADHD, actually: Beyond stereotypes
I explained to my doctor that ADHD isn’t just about being messy and disorganized (which I was anyway, I was late for every single class throughout my entire 3-year College program, but I digress…).
I emphasized that quality of life is impacted by executive dysfunction, emotional dysregulation, and relationship difficulties — all of which can be challenges we face due to ADHD.
Looking back, it is unbelievable to me we didn’t recognize my ADHD sooner. I believe the two main reasons for this are: 1. I was a girl, and 2. I did well academically.
I even have all the “classic” ADHD signs which are commonly identified in boys: distractibility, forgetfulness, hyperactivity, emotional intensity, impulsivity — even aggression!
When I specify that I did well academically, that’s because I didn’t do well in school in a more general sense. I did well on tests, assignments, and report cards. I knew how to give the answers the teachers were looking for, and the work was incredibly easy for me.
Outside of that, however, school was an absolute disaster. I was relentlessly bullied, I had very few friends, and I was constantly in trouble.
Barriers to assessment and diagnosis
Given all this, I still had to convince my doctor to “let” me get an assessment for ADHD.
If I hadn’t had the time and resources to do my own research prior to that appointment, I might never have been diagnosed. Having my ADHD identified and treated has had a significant positive impact on my life, and I feel very fortunate for this.
Many others are not so lucky, and this may be why they turn to private clinics for help — if our public healthcare system won’t do anything for them, what choice do they have?
I am not a fan of these private clinics, although it would be unfair to paint them all with the same brush.
Generally speaking, what I see on their websites and in their advertising are claims of “fixing” ADHD symptoms, as though they can make ADHD go away with expensive supplements and (even more expensive) brain training.
That would be false advertising.
The focus of these private clinics is selling their products and services for profit. That’s why they exist — that, and the fact that there’s such a demand for them because people can’t get help otherwise.
Behavioural diagnoses
ADHD and Autism are diagnosed through questionnaires and behavioural observations.
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For adults, this often involves answering questions directly, as well as asking loved ones to fill out questionnaires, and providing a detailed developmental history.
Ruling out other potential causes for distractibility, hyperactivity, difficulty focusing, emotional dysregulation, and so on — symptoms which can be caused by anxiety, depression, trauma, and other underlying mental health conditions.
It’s important for the clinician to understand whether the symptoms are fairly new, or whether they’ve been present for most of your life. New symptoms would be indicative of significant life events or circumstances which may be causing the symptoms, rather than a neurodevelopmental disorder.
That said, if symptoms were present throughout childhood, but seemed milder and now seem to be increasingly impacting one’s life, this can be potentially due to ADHD (not exclusively, mind you, and I’m speaking in generalities here).
Sometimes life changes, hormonal fluctuations, and increased demands on us (i.e. going to University, becoming a parent, or getting a new job) can highlight ADHD traits that have always been present, but were previously less of an issue.
Clinician bias
There is extensive evidence of the biases which influence a clinician’s evaluation and assessment of a patient, including whether or not they diagnose ADHD.
Because we don’t perform brain scans to confirm the diagnosis, it is left entirely up to clinical judgement — decisions made by imperfect human beings, which therefore produce imperfect results.
Sometimes mistakes are made. Misdiagnoses happen.
This does not mean there is some kind of collusion between “big pharma” and doctors to over-prescribe stimulant medications. It’s a little early for conspiracy theories and tin foil hats yet.
While I’m sure that some adults have pushed for a diagnosis in order to access stimulant drugs, and some companies do over-diagnose conditions for their own financial gain, this is not a fait accompli.
Instead of insinuating that ADHD is over-diagnosed and stimulants are over-prescribed, let’s take a look at the real problem: Our healthcare system is so stretched that people cannot access timely supports.
There are so few resources out there for adults, especially those of us with ADHD, private clinics are able to sweep in and take advantage of our desperation.
We need to focus our energy (and money) on addressing those issues, rather than pointing the finger at these private clinics which shouldn’t have the opportunity to exist in the first place.
? Jillian Enright, Neurodiversity MB
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References
Busch, A. J., Balsis, S., Morey, L. C., & Oltmanns, T. F. (2016). Gender Differences in Borderline Personality Disorder Features in an Epidemiological Sample of Adults Age 55–64: Self Versus Informant Report. Journal of personality disorders, 30(3), 419–432. https://doi.org/10.1521/pedi_2015_29_202
Gehricke, J. G., Kruggel, F., Thampipop, T., Alejo, S. D., Tatos, E., Fallon, J., & Muftuler, L. T. (2017). The brain anatomy of attention-deficit/hyperactivity disorder in young adults — a magnetic resonance imaging study. PloS one, 12(4), e0175433. https://doi.org/10.1371/journal.pone.0175433
Skodol, A.E., Bender, D.S. (2003). Why Are Women Diagnosed Borderline More Than Men?. Psychiatric Quarterly 74, 349–360. https://doi.org/10.1023/A:1026087410516