When Zoë Rose discovered she had attention deficit/hyperactivity disorder, also known as ADHD, four years ago at the age of 38, it was like the moment at the end of the Bruce Willis film The Sixth Sense when (spoiler alert! ) it is revealed that the main character was dead the whole time.
“Same scenario, but you had ADHD the whole time,” says Rose. “You have to review your whole life.”
ADHD gave her a new lens to understand so many things about herself: why she wasn’t able to keep her house tidy, her misunderstanding of nuanced social cues, her “very, very, very big emotions,” her ability to hyper – Focus on very macro or very micro details, but not everything in between, its inability to turn off background noise.
It wasn’t that Rose hadn’t considered the possibility of ADHD before that time; a work colleague had suggested it many years before, and she was coming across a growing amount of information about ADHD that made sense to her. But she was a grown woman with a great job, a stable marriage, and a successful child. He didn’t look like the stereotype of the 10-year-old who can’t sit still in class.
Em Rusciano opens up about being diagnosed with ADHD at age 40: video
But then her partner became ill and Rose had to take care of many more mundane and mundane tasks in life, such as renewing her car registration and paying the bills.
“Looking at the paperwork and all these things he does, I couldn’t understand it one bit,” he recalls. The wheels were well and truly off the bus. “If the criteria to have or not to have [ADHD] it’s just that if it’s ruining your life, well, okay, it looks like I’ve crossed that threshold.
But Rose rejects the idea of ADHD as a deficit. “I had ADHD too when things were going well,” she says. “I’ve always had ADHD.”
ADHD occupies an odd place in the pantheon of psychiatric conditions. It’s one of the most well-researched conditions, says clinical psychologist Ass Prof Emma Sciberras, an ADHD expert at Deakin University’s Center for Social and Early Emotional Development. But it is also one of the most stigmatized and misunderstood.
“There’s a growing recognition that ADHD isn’t just about naughty boys,” says Sciberras. “People understand that ADHD is actually a neurodevelopmental condition; that means it’s something that continues over time.” Although the condition by definition occurs in early childhood – before the age of 12 – it is with someone for life.
This awareness has reached the wider community and has led to several high-profile individuals such as Em Rusicano and Mia Freedman revealing their journey to being diagnosed with ADHD as adults. Some commentators have questioned whether the disease may be overdiagnosed or even “fashionable” thanks to exposure on social media.
But if anything, ADHD in Australia is underdiagnosed, particularly among women, says Sciberras. “We are seeing increases in diagnoses, but … in Australia there is little evidence of a rate of diagnosis beyond what would be expected is the prevalence of ADHD in the community,” he says. The current feeling of increasing diagnoses, particularly in adult women, could simply be a matter of catching up.
Obtaining reliable data on ADHD diagnoses in Australia is challenging. About one in 20 Australians is estimated to have the disorder, and a 2019 report suggested many more men than women were being diagnosed in their lifetime. However, Professor Mark Bellgrove, a cognitive neuroscientist at Monash University’s Turner Institute for Mental and Brain Health, says this could reflect under-diagnosis in women, particularly during childhood and adolescence. rather than a genuine gender difference in presentation. “In childhood, there is a gender disparity that favors more boys being diagnosed than girls, while in adulthood, this does not seem to be the case,” he says. “I think girls are more likely to go undetected in childhood because their presentation is different.”
Recognition of ADHD in both childhood and adulthood is likely to increase further with the publication this week of the first evidence-based guidelines for the screening, diagnosis and management of ADHD across the lifespan.
The clinical guidelines, developed by the Australian Association of ADHD Professionals (AADPA) and endorsed by the National Health and Medical Research Council of Australia, provide evidence-based recommendations about screening people for ADHD , the diagnosis and the best treatment and support, both pharmacological and non-pharmacological. pharmacological According to Bellgrove, who is president of the AADPA, they are an important step toward improving outcomes for people with ADHD.
“It’s really important that for a condition that affects around a million people in Australia that we have a unified bible in terms of diagnosis, treatment and support for people with ADHD,” Bellgrove says. “It is also very symbolic, for people living with ADHD in Australia, that the NHMRC has approved the guidelines; effectively, it acknowledges their lived experience.”
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The challenge with diagnosing ADHD has always been that many people would likely tick at least a few symptom boxes, such as regularly losing or misplacing important things, poor attention span, inability to finish tasks, restlessness that is difficult to control , impulsive behavior, being. too talkative, easily distracted.
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But Bellgrove says that for ADHD to be diagnosed, those symptoms must be responsible for persistent, long-term impairment. “It’s about the adult reporting that they’re not coping with their ADHD symptoms in multiple aspects of their daily life,” such as education, work, partnerships and parenting, she says. It may seem like several degrees of unfinished business, changing jobs regularly, starting but not finishing tasks; things that can cause “really deep damage to their self-esteem and self-esteem,” says Bellgrove.
This does not mean that adults with ADHD cannot cope with anything. Rose says that in her experience, adults with ADHD tend to excel at crisis response, creative problem solving, and tasks that require deep concentration. She knows that her ADHD causes significant impairments. But he also knows his strengths and his weaknesses, and it’s better to take advantage of the former and manage the latter.
This may be typical of adults with ADHD, says Bellgrove, who hold high-pressure jobs: “Often what you’ll find, I think, in these situations, and probably evidenced by media reports, is that for them. to do that, they’re literally running a million miles an hour to keep all those balls in the air,” he says. “The downside of this hyperfocus is really a period of near exhaustion that occurs, because they put so much of their cognitive effort and cognitive resources into completing it that they have nothing left at the end of the day.”
Another essential characteristic for making a diagnosis of ADHD in adulthood is that the symptoms must be present since childhood. “If you look back, you should be able to pick up some telltale signs,” says Bellgrove.
So if ADHD is a lifelong neurodevelopmental condition, why the increase in diagnoses now? Sciberras says one theory is that some of the adults diagnosed today may not have been picked up as children because their presentation was more attention deficit than hyperactivity. “They may not have been picked up by their parents or teachers, but the adults themselves are recognizing the difficulties they have in this area and then moving on to assessment,” he says.
This could also explain why more boys than girls are diagnosed in childhood, while the opposite seems to be true in adulthood. There is growing evidence that girls are more likely to have the symptoms of attention deficit disorder, which can be more daydreaming and inattention, than the disruptive hyperactivity that appears to be more common among boys. As such, it is possible that girls are less likely to be diagnosed during childhood, but instead are diagnosed as adults.
Another possibility is that, as more and more children are diagnosed with the disease, their parents realize that they too meet the diagnostic criteria. This is not surprising, given that ADHD has a strong genetic component and tends to run in families.
One of the issues the new guidelines address is the issue of screening everyone for ADHD in childhood to pick up those who are currently slipping through the cracks.
Although the guidelines advise against it, there is clear evidence that some are more likely to meet criteria for ADHD than others: for example, people with mental health or neurodevelopmental disorders, people with a family history of ADHD, with substance use disorders, in prison. , with acquired brain injury, with sleep disorders. Screening among high-risk groups could pick up those missed diagnoses; A study in Ireland did just that and found that about 20% of more than 630 adults attending an outpatient mental health clinic met criteria for ADHD symptoms, but only one in 10 of them had been previously diagnosed.
The diagnosis not only opens up the possibility of treatment, both pharmacological and psychological, but can be life-changing, Bellgrove says. It can help people understand why they have struggled…