Adult ADHD: then and now
The study of Attention Deficit Hyperactivity Disorder in adults has come a long way in 15 years
In 2013, the newest version of the Diagnostic and Statistical Manual of Mental Disorders, DSM-5, was released, following years of controversy. The DSM-5 has many critics, and will undoubtedly be revised, as was each of the earlier versions. But for the first time, the DSM-5 lists specific criteria for adults with Attention Deficit Hyperactivity Disorder and a more complete description that reflects ADHD across one’s lifespan. ADHD is categorized as a neurodevelopmental disorder, with the age of onset raised to 12. And those with autism spectrum disorders (revised to include Asperger’s Syndrome) are no longer excluded from a co-occurring ADHD diagnosis.
This is how far the study of ADHD has come.
My introduction to adult ADHD came in September 2000, when I began an internship with Health and Counseling Services at Massachusetts College of Art and Design in Boston as a graduate student in clinical mental health counseling.
In my former professional life as an artist, educator and coach I worked with novices and seasoned professionals, career changers, and people with goals and dreams of all kinds. They included artists, designers, inventors, innovators, skilled craftsmen, entrepreneurs, and people facing career and life transitions. I had a great appreciation for quirky, self-directed and non-traditional learners and a lifelong fascination with the question of why given equal talent some people seemed to have an easier road to success.
As my clients shared difficult aspects of their lives, I felt that I needed more training to be able to work at a level that integrated all of who a person is. When I enrolled in graduate school I had the specific goal of combining mental health counseling, career counseling and coaching.
In 2000 there were still many medical professionals who did not believe ADHD existed, and there were many conflicting and overlapping theories about the cause and course of ADHD. The biological basis of ADHD was still in its infancy. The great advances in neuroimaging studies and use of the internet as a research and information sharing platform were just a few years old, as were the first clinical trials geared toward adults.
When I was introduced to the ADHD specialist psychotherapist on staff at MassArt I wondered, Why would a college have an ADHD specialist?
The answer came during a presentation designed to introduce the interns to signs and symptoms of ADHD in adults and older adolescents. At that time, ADHD was listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) under “Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence,” in the section, “Attention-Deficit and Disruptive Behavior Disorders.” Adult ADHD was barely acknowledged. But our instructor had trained directly with the authors of “Driven to Distraction,” Drs. John Ratey and Edward Hallowell. It was the first book written by medical doctors about ADD/ADHD for the general public, and had been published six years earlier.
New information showed ADHD was not just a childhood disorder. Three percent to 7 percent of all children were then being diagnosed with ADHD, and among those children, there were many whose symptoms of ADHD changed over time, but they did not grow out of it as they matured.
In addition to that group of grown kids, there was believed to be a substantial group of undiagnosed adults whose ADHD was never accurately identified. Thus, these folks had no clue their problems with inattention, impulsivity, inconsistent motivation and performance, distraction, procrastination, perfectionism, low tolerance for boredom, organizing and time management challenges, social miscues, and related anxiety, depression, and failure to live up to their own and societal expectations of success were related to a neurologically based difference. And that there was a name for it.
As the MassArt interns’ introduction to adult ADHD continued, we began to understand that in addition to the negatives, there were also great strengths and gifts associated with this way of processing information and being in the world. For example, ADHD adults are often extremely intelligent creative thinkers and problem solvers.
The specialist explained that among the highly diverse students and faculty at this renowned college of art and design it was reasonable to expect a greater than usual percentage of people with ADHD, dyslexia, dyscalculia and other learning differences and disabilities. The counseling center had made a commitment to helping these students achieve their goals by providing specialized services for assessment and treatment.
As I learned about adult ADHD, a giant light bulb turned on above my head just like in the cartoons. The more information I absorbed, the greater my realization was that this description was very familiar to me. Not only did it match the stories and life experiences for many of my former students and clients, and for my friends in the creative community, but it also fit me and members of my extended family. For the first time it all made sense. We were not alone.
Once the spark was lit I tried to learn everything I could about ADHD in general and adult ADHD in particular. I hyper-focused my curiosity and attention on my new area of interest. It was challenging and exhilarating as I began to absorb and understand the research being done in the field, and the still- unanswered questions.
The following year I accepted the position of ADHD specialist psychotherapist at MassArt, and stayed there for the next seven years, as I worked another full-time counseling job, continued coaching, and followed the professional path to licensure.
All the while, I became ever more acutely aware of the impact of undiagnosed ADHD in adults. I designed workshops and presentations on adult ADHD for treatment providers, teachers and probation and parole personnel, in hope that education might influence more positive outcomes. Adult ADHD was still such a new concept, and people needed to know.
We focused on strengths while acknowledging areas of limitation, and collaboratively devised workarounds and creative solutions to empower people to lead fulfilling and rewarding lives.
Sessions with clients were full of laughter and tears, which is very normal when people have worked so hard for so long to compensate for differences of an unknown origin. Along the way I learned to practice what I preached. When I hit an impasse of my own, it occurred to me that things could progress more smoothly with a little additional support. I could do for myself what I had helped many clients to successfully navigate. It was not easy, but I contacted New Hampshire Vocational Rehabilitation, and asked for and received the help I needed to reach my professional goals.
About half of my clients are adults with ADHD, and their significant others. Treatment for adult ADHD is multifaceted and highly individualized. Medication (which is not in my scope of practice) is frequently, but not always, a component of treatment, and there are alternative approaches as well.
Some of my adult ADHD clients want coaching, which is goal-directed, objective, and present- and future-focused. Most of the coaching sessions center on academics, careers and relationships, within a framework of education about the nuances of adult ADHD. Other clients come for the full range of counseling and mental health psychotherapy services, including coaching. I do the holistic wellness based work that I envisioned so long ago. I could never have predicted how that first day at MassArt would change the direction of my life. How it changed everything.
Robin Bellantone, BFA, MA, LCMHC, BCC is a licensed mental health counselor, psychotherapist, and board-certified coach in Portsmouth. She facilitates the monthly Seacoast Adult ADHD Support Group, which is free and open to all ADHD adults. Newcomers can email firstname.lastname@example.org.