Not all Attention Problems are ADHD
February 28, 2020
Why is the question of attention deficit hyperactivity disorder being asked earlier in childhood AND later in adulthood? As I started my career in neuropsychology, most families would not ask the question as to whether or not their child had ADHD until potentially 6 to 7 years of age. This is when they would have longer school days, may start to stand out in comparison to their peers, and when behavioral problems usually manifest. Now, we are seeing families more routinely asking if their 3 or 4-year-old child may have ADHD. At the other end of the spectrum, as we progress through our lifespans, it used to be anticipated that it may be harder to multitask, we have to be more focused on one thing at a time, and by the time we hit our mid-to-late 50s, it seemed to be more routine for us to expect that we might not be able to do as much as we once could in our 20s and 30s. However, we are also seeing more individuals in their late 50s or sometimes even individuals in their 70s and 80s, asking if they might have ADHD as well. In a world with longer days, more to do, working longer, learning faster, more access to knowledge, communication and media, it seems amazing to pay attention at all. One common factor that is often overlooked and misdiagnosed as ADHD is the normal process of lifespan development.
Just as concerning is how easy it is to diagnose an attention problem. Some specialists will argue that completing a rating scale about themselves or a child and documenting that the attention problem has some type of negative influence on their daily life activity is enough to quickly prescribe a medication to try to enhance their performance. This became so prominent that the United States government nearly had to declare state of emergency because the supplies for psychostimulant medications could not be maintained in order for patients to fill their prescriptions. We forget that many other factors in life will cause attention problems; and most of these are not ADHD. Sleep problems, challenges with nutrition, headaches/migraines, allergies and asthma, stress, learning disorders, anxiety, depression and so many other factors will all either directly cause or be highly correlated with attention deficits.
We are also sitting longer, being expected to learn more material earlier in our educational sequence, and expected to keep up the pace of dynamic changes in our careers at a faster rate than before, as we become a technologically integrated society. These factors can increase physical restlessness, contribute to tension that can give way to impulsive reactions or feelings of agitation, which will then mimic symptom reports of ADHD. Having to complete more tasks, faster, and then more daily activities make it harder to manage the day. And, those who are struggling will be much more likely to be asked by an employer if they had ever considered the possibility that they might have ADHD. Those who are retired may also be working longer in their careers than prior generations, and even if not, they have more opportunity to try to keep up with their children and grandchildren. As a result, I have seen more 70 and 80-year-old individuals thinking that they might have ADHD because it is something they have seen in their grandchildren and they have heard comments from their own family that this could be a problem. We are forgetting that a challenge with attention is just one symptom that will be highly correlated with nearly any medical, mental health, or other unusual demand in our lives. Unfortunately, we live in a world that wants us to perform and always be at our best, so we can jump to quick assumptions that our children, someone we know or maybe even ourselves may have ADHD, rather than recognizing how we may need to make some changes in our lives or that we’re encountering an expected problem associated with other factors in our lives. This increases the risk of over-diagnoses, frank misdiagnoses, the overuse or reliance upon medications such as psychostimulants, which can also have side effects that lead to further complications, resulting in the inappropriate treatment of an individual.
The diagnoses of ADHD should be carefully evaluated, not something that should be taken lightly. Common side effects of medications used for treating ADHD include: changes in sleep patterns, suppressed appetite, irritability/increased agitation, headaches, possible coronary reactions, and can slow physical growth. It is important for those concerned about possibly having ADHD, to be more carefully evaluated. Most who have concerns about ADHD will fill out a form with a rating scale about themselves or a family member, which will easily elevate symptoms of ADHD, but this is not sufficient to support the diagnoses. Some centers only have individuals complete one sustained computerized test and an attention rating scale, which increases the risk of over-diagnoses or misdiagnoses.
It is essential for practitioners to assess prospective ADHD cases more carefully/cautiously. For most, even if it is ADHD, there are higher risks for other challenges in life, necessitating not only the use of a possible medication to address the attention deficits, but they may need other functional interventions to assist with school, work or life as well. It is not uncommon for individuals to habituate to the medication, then either need higher doses or the medications may eventually not work as effectively as they once had. Therefore, learning other compensations will still be needed. Working with a team that has multiple assessment and intervention models will hopefully provide a more accurate diagnosis, as well as offer multiple strategies for intervention.
About the Author: Dr. Michael Wolff, Psy.D., ABPDN is a neuropsychologist and co-owner of BRAINS. Dr. Wolff specializes in autism spectrum disorders, ADHD, forensic evaluations, medically complex cases, and other neurodevelopmental and genetic disorders. He has awards for his contributions to the field of psychology and has a history of committee participation through the National Academy of Neuropsychology, the American Psychological Association as a graduate student, and is a Professional Advisor for the Epilepsy Association of Michigan and on the Board of Directors for the Down Syndrome Association of West Michigan.