Mythbuster: ‘You can’t have ADHD if you’re able to hold down a job’

In our most recent article debunking healthcare misconceptions, general practitioner Dr. Toni Hazell discusses why it is important not to brush off a possible ADHD diagnosis just because someone seems to be doing fine in their everyday routine.

If you have kept up with current events through newspapers, the internet, radio, or TV in the past year, you have likely come across discussions about the growing number of ADHD diagnoses. According to a study analyzing data from 2000 to 2018, there has been a significant increase in ADHD diagnoses, with a 20-fold increase overall. The largest increase in actual numbers was seen in children, but the most significant percentage increase was observed in adults.

This has caused doubt among some people about the accuracy of all diagnoses, particularly in individuals who seem to be leading typical lives, excelling in academics, or maintaining a successful career.

Although there are valid worries about individuals seeking private diagnoses because of the lengthy wait times for NHS assessments, a lot of doubt likely stems from misunderstandings about how ADHD presents itself in various demographics.

What is causing the rise in diagnoses?

ADHD is a condition that affects how the brain develops and can cause problems with paying attention, controlling impulses, and being overly active. There are many possible reasons for the increasing number of ADHD diagnoses, including the fact that girls and women have historically been less likely to be diagnosed. Boys with ADHD are often more hyperactive and tend to be noticed earlier because of their behavior. On the other hand, girls with ADHD are more likely to have difficulty paying attention and may not be as easily recognized because they may be quiet and not causing disruptions. Girls with ADHD are also less likely to be given medication for their condition, even when their symptoms are just as severe as boys. Additionally, girls are often diagnosed with ADHD later in life. The same pattern can be seen with autism as well.

What are other ways that ADHD could be overlooked?

The criteria used to diagnose ADHD state that the symptoms must be present in different environments, such as at home and school. However, it has become more understood in recent years that some children, especially those with high intelligence, can hide their ADHD symptoms. This is often referred to as the 'cola bottle effect' - where a child tries to conceal their symptoms at school, which can be exhausting and limit their ability to learn. As a result, teachers may not suspect ADHD. Eventually, the child may release all their built-up frustration and anger at home. When parents seek help from their doctor, they may be told that a diagnosis can only be made with a referral from the school. However, if the child appears well-behaved at school, the opportunity for a diagnosis may be overlooked. In a school system that is struggling to meet the needs of students with additional challenges, it is not surprising that subtle signs of ADHD or other conditions can be missed.

Similar issues are also seen among adults. Media attention has often focused on the growing trend of self-diagnosis and individuals requesting ADHD referrals from their doctors. It is often suggested that this desire for a diagnosis has been influenced by social media or is simply following a current trend, rather than stemming from a deeper understanding of their own neurodiversity that has gone undiagnosed. There is a common misconception that if an adult has been able to navigate their life successfully, holding down a job and staying out of trouble, then they couldn't possibly have ADHD severe enough to require treatment. In reality, adults with undiagnosed ADHD often expend a significant amount of energy trying to mask their symptoms, just as they did in their childhood. However, this may not be as apparent as it was in childhood, as they no longer have a parent to lean on for support and societal norms prevent them from having the same type of outbursts they may have had as a child. As a result, those with undiagnosed ADHD may become increasingly exhausted and overwhelmed from constantly trying to hide their symptoms, eventually leading to a decline in their work performance or the need to take time off due to burnout. This phenomenon has been observed in various professions such as doctors, lawyers, civil servants, and academics - all careers that require a high level of functionality and success.

Tips for not overlooking a possible ADHD diagnosis

So, what is the main point to remember from this? Essentially, we need to expand our perceptions of what a person with ADHD appears like. They may not just be a young boy in school running around, but could also be his older sister who is calm and obedient, although a bit distracted, graduating with decent exam results despite having the potential for higher grades.

Likewise, it is known that ADHD is frequently not identified in men who exhibit impulsive behaviors that lead them to be involved in the criminal justice system. However, we must also consider the possibility that professionals may be experiencing burnout without any clear cause. Could the strain of hiding their ADHD symptoms be becoming overwhelming for them?

Many people may have doubts when asked to be evaluated for ADHD, especially with the current strain on the NHS and lengthy wait times for referrals. However, it's crucial for individuals with a history and symptoms related to ADHD to undergo a thorough assessment. ADHD can be effectively treated, and medication can greatly improve one's quality of life, job performance, or academic success.

Remember to consider those who are being treated for different mental health problems. If someone is not getting better with antidepressants, it could be because their ADHD is not being acknowledged and addressed. It's important to be proactive in considering the possibility of ADHD, just like we do for any other medical condition, instead of waiting for the patient to bring it up. Keep an eye out for your coworkers as well. You may be working with someone who has either been diagnosed with ADHD or is struggling with it without a diagnosis. They might be hesitant to share this information for fear of judgment.

There are new ways of providing care for ADHD being tested across the country, with the goal of reducing wait times. It is possible that in the future, ADHD treatment will be more accessible, allowing patients to receive help quickly and benefiting from effective treatment so they can continue with their lives.

Dr. Toni Hazell works as a general practitioner in the northern part of London. She is a member of the committee for the British Association for Neurodiversity, a group of GPs who focus on ADHD.