For years it was considered a childhood disorder. Some people still hear from doctors that they “invent” and that there is no such thing as ADHD in adults. For people who have been struggling with its symptoms for years, delay in diagnosis means more years of suffering that can be remedied. Karolina Grzywacz, a psychologist and ADHD therapist in adults, explains what this therapy looks like and what challenges people with attention deficit disorder and psychomotor hyperactivity must face on a daily basis.
- ADHD is a disorder that manifests itself, inter alia, in attention deficit disorder as well as impulsiveness and hyperactivity
- People with ADHD often forget, lose things, get distracted, can’t manage time and plan
- – If we assume that an adult can focus on his work for 20-40 minutes without breaks and distracting thoughts, a person with ADHD, dealing with a moderately interesting task, can do it for a maximum of 6-7 minutes – says the psychologist
- Some patients find it difficult to come to terms with the diagnosis. – They mourn their previous life, have to work through the regret that it could have looked different, if someone would become more interested in them, noticed the symptoms, found out about the disorder earlier – explains the therapist
- More information can be found on the Onet homepage
Paulina Wójtowicz, Medonet: A screaming, constantly running child that is difficult to tame – this is the most common image that comes to our mind when we hear about ADHD. Meanwhile, adults also suffer from this disorder.
Karolina Grzywacz: That’s right. ADHD stays with 100 percent. children who were diagnosed with it in childhood. According to statistics, the disorder affects at least 2-3 percent. population, but there are data that say up to 6 percent. ADHD affects adults, both genders, because while in the past, mainly men were diagnosed with ADHD – mostly because they had greater access to doctors and more often show hyperactivity and impulsiveness – now the statistics have evened out. There are as many women with ADHD as diagnosed men.
If we are already dealing with stereotypes, there is one more that needs to be dealt with. The main symptom of the disorder is not always excessive mobility. So what does ADHD manifest in adults?
ADHD is a spectrum. A symptom that occurs in all subtypes is attention deficit disorder. It consists in a short time of focusing on moderately attractive tasks, easy distraction, missing things, postponing tasks for later, making so-called Czech mistakes – I will not see anything here, I will not read there, I will miss some facts. This is good reasoning, but bad execution (executive function disorder). Someone can tell you how to do something, but will almost certainly make a mistake or mistakes in execution. A great example is doing laundry. A person with ADHD will sort dirty laundry, put the laundry in, start a good program, but either not pour the powder into the drawer, or forget to take the laundry out.
How do you distinguish this from the usual distraction that happens to all of us?
Frequency. It can happen to us from scattering, let’s assume, once every three months. The person with the disorder – practically every day or very often. If we assume that an adult can focus on his work for 20-40 minutes without breaks and distracting thoughts, then a person with ADHD can do it for a maximum of 6-7 minutes. Importantly, however, these are moderately attractive tasks. In people with ADHD, we also often deal with the reverse process, the so-called hyperfocus, i.e. excessive focus on activities, not paying attention to even important external stimuli.
How is this trait displayed in such a person in his daily activities?
He makes tea and forgets to brew or drink it, often he just leaves it somewhere. When she does order, she walks around with one thing, wanting to put it back, but she doesn’t get there because she meets her dog or cat on the way, starts to pet it, puts away the thing she was carrying, takes another, and finally doesn’t know what happened with the former and begins to search for it. He often loses things, lives in chaos, wastes a lot of time every day to find something.
Besides, a person with ADHD is easily distracted by external stimuli. These can be sounds, particularly monotonous, such as the ticking of a clock or the dripping water from a tap, or sudden, such as a dog barking outside a window or wall. Some even struggle with misophonia, hypersensitivity to sounds, and therefore suffer from noises, such as those made by other people, in the same room. Usually it is swallowing, biting, chewing. Odors can also be distracting.
And your own thoughts?
Definitely yes, internal stimuli are distracting in the same way. A person with ADHD falls into all sorts of chains of associations. She does one thing, remembers she’s done it with some friend before, tries to remember his name, and when she succeeds, wonders what’s up with him – and it does.
And again: this also happens to all of us, but the person with the disorder is notoriously distracted, several times a day. He also has difficulty selecting information, differentiating important from unimportant. It can be considered that the brain classifies all incoming information as important. When a person with ADHD enters a room, he notices so many different things that his brain cannot choose which one to focus on. They are all equally important, they have the same priority. And that dripping water, and a barking dog, and a browser with 30 open tabs, everything.
In what situations does attention deficit disorder occur most frequently?
The less attractive and the more monotonous the task and the more tired it is, the more likely it is to happen. Often, however, distraction also occurs during a conversation with someone. A person with ADHD symptoms tries to listen carefully to what someone is saying, but he is drifting away in thoughts, distracted by external stimuli, thinking what to say next. As a consequence, he asks a question that the interlocutor has just answered, changes the topic or omits the topic. The more interlocutors, the more difficult it is to focus on the topic of the conversation.
The rest of the article is available under the video.
Sabine Bernau, the author of the book “ADHD in adults”, which you edited substantively, mentioning the subtypes of ADHD, mentions a specific group of patients. Who are messiah?
They represent one of the types of ADHD symptoms. These people are chaotic, not very orderly, they have trouble getting away from objects. They are accompanied by problems with making decisions and postponing the implementation of tasks. They usually work slowly, colloquially speaking, they give the impression that they were walking and looking for yesterday. People with excessive mobility and impulsiveness jump from task to task, move around classes in a reckless and chaotic manner, as if they wanted to do everything at once. Therefore, from the outside, they resemble a fly closed in a jar, which is eagerly trying to get outside.
Apparently, people with ADHD do not part with the calendar. Why?
One of the most characteristic features of people with the disorder is the enormous difficulty in organizing, planning and managing themselves over time. When we add to this notorious forgetfulness, disaster is ready. Before many of my patients knew that they should use a calendar or a notebook, they did it in a way that was totally inappropriate for their way of functioning. Some tried to face this challenge realistically, took some time management course, but it didn’t make sense: the methods proposed in such courses were designed for neurotypical people, without symptoms. For ADHD patients, they just don’t work.
How do people experiencing this type of problem cope with such challenges as remote work, which has been widespread in the last two years?
Contrary to appearances, some of my patients functioned very well at home during the pandemic. They did not feel the tension and anxiety that they had to be somewhere on time, get ready and be on time to work. They got up and worked from bed, or moved their working hours to the afternoon, when most of them were functioning better. But in fact there are also people for whom the lack of this time frame for starting work meant that they were not able to start work at all.
One of the symptoms of ADHD is mood swings. Patients complain that they can go from euphoria to total resignation and apathy in an instant.
This is not a symptom, but a consequence of ADHD. The mood changes with the way that person functions during the day. Some patients with ADHD symptoms have a very good mood in the morning. Then they are full of energy, they have enthusiasm, plan, enthusiasm, they are sure that they will complete all the tasks on the list. As the hours go by, most often in the evening, you may feel depressed, sometimes resembling a very mild episode of depression. The mood swings are also influenced by impulsiveness, the ease of reacting to the situation around me. This dissatisfaction with what had failed did not go their way. There are patients who delve into it intensively: they grind topics, roll, ponder, analyze what they did wrong. Hence the short path to anxiety disorders or depression, which often accompany ADHD.
How is ADHD diagnosed in an adult?
The first thing is the diagnostic criteria – American, included in DSM 5, and European ICD-10 and ICD-11 (criteria have not been defined yet, only classification). We already know that the nomenclature in the new ICD-11 classification has been changed significantly. This is a big and important change because it was previously assumed that a patient would need to have all three components of ADHD (attention deficit, hyperactivity, and impulsivity) in order to be diagnosed. Currently, subtypes have been distinguished (the same as in DSM 5), which increases the diagnostic possibilities even in adults.
Generally, people with full-blown ADHD, i.e. attention deficit disorder, impulsiveness and hyperactivity, come to the office most often. Those with attention deficit alone rarely assume they have ADHD at all.
Diagnostics always start with an interview with the patient. We focus on what his life was like in childhood and what it looks like today. If the patient has been suffering from attention deficit disorder for a long time, it already gives us food for thought. Psychological tests that enable us to observe the patient under task conditions are also helpful. We check how he behaves by taking the test: does he give impulsive answers, is he spinning in a chair, if he mechanically touches his hair or rubs his neck, does he read a question many times, does he need a break, etc.
The diagnosis is made by a psychiatrist or psychologist?
Always a psychiatrist, but a person suspecting ADHD should also see a psychologist. The doctor can only interview her, while psychological tests – as the name suggests – will only be performed by a psychologist. By the way, I would like to add that before going to a psychiatrist, it is worth finding a good specialist, looking for recommendations, preferably from people who have already had a diagnosis or therapy or are in the process of it. Unfortunately, there are still doctors who can tell a patient that he “thinks” that there is no such thing as ADHD in adults, that it is depression for sure, and that they prescribe medication in the end. And all this within a 15-minute visit. Fortunately, these are unique situations.
How do patients react when they hear they have ADHD?
Regarding the type of reaction, patients can be divided into three groups. In the first, there are people diagnosed with children. They heard from a child psychiatrist that ADHD is hereditary. They are skeptical, but for the sake of peace of mind, they come and test. It is difficult to say whether they are surprised or not, because in the end they expected it a bit.
In the second group, we have patients who have been thinking for months and some years that they may have ADHD. They read the criteria, did the tests available on the internet, entered the adult group with ADHD and are pretty sure, they just need confirmation. And they feel tremendously relieved to learn that what they are feeling has a name and that they already know what the source of their problems is.
There is also a third group. These are people who feel that something is wrong, but not so much that they think about it. Ultimately, however, something is overflowing with bitterness. They think: I’ll go, check it out, maybe I’ll find out something. They are really surprised by the diagnosis. Some people find it difficult to come to terms with it. They mourn their previous life, have to work through the regret that it could have been different, had someone become more interested in them, noticed the symptoms, or found out about the disorder earlier.
Do patients with ADHD feel up to coming out? Is he even necessary?
It depends – on the patient’s age, personality, relationships with relatives. If the patient is on good terms with his parents, I sometimes invite them for an interview during the interview. Often, however, patients do not want it and it is not necessary either. Unfortunately, there are still many myths around ADHD and sometimes coming out with a diagnosis can cause more difficulties than benefits. Fortunately, there are more and more people, companies and sources of reliable information who treat ADHD with seriousness and understanding.
Is it possible to recognize ADHD in a loved one?
I guess so. If people looked at the behavior of others, wondering what could be causing it, what happened that someone did, I think it would be easy to recognize the disorder. Unfortunately, we tend to judge and label someone: that someone is lazy, that they don’t feel like it, that they are a mess or that they come to work because they have to. However, when we talk to this person we will hear that it is not a matter of not wanting to get things done, but feeling overwhelmed by the number of things to put in their place, they just don’t know where to start. Then the topic looks completely different. I don’t deny that there are people who don’t like order, but in ADHD people can’t make it and keep it, even though they know it’s good for them.
What could be the consequences of undiagnosed ADHD?
You can definitely live with it, of course, with the introduction of appropriate patterns of action, coping with difficulties. However, without knowing it is ADHD, it can be very difficult. Quarrels and unpleasant situations often occur, in relationships it often ends with separation or divorce. For example, you tell your husband to take out the rubbish when he leaves, buy milk when he comes home from work, and in the evening to take care of the nest that has been buried for weeks. If he has ADHD, he probably won’t do any of these things, even though he will hear, nod and promise. These are minor issues, but if they pile up, they last for months, they can be a source of conflict.
Why are women more difficult to diagnose towards ADHD than men?
It is a matter of parenting style. When a boy is messing up, it’s okay, unless he is messing up too much – that’s when we take him for a diagnosis. Girls are taught from a very early stage that they have to behave in a certain way. When they are diagnosed, they usually have residual ADHD symptoms, for example, they feel very strong internal anxiety, find it difficult to focus, but they know that under no circumstances are they allowed to get up, move, discharge, playing with an object – because it does not fall out.
In women, the symptoms of attention deficit disorder are often more visible, or actually felt. Patients say that they cannot focus, organize their work, get distracted easily, have 500 projects started and cannot finish them. They feel overwhelmed, don’t know where to start. They add that it was very similar in childhood. Interestingly, most of them were very good students. Few people know how enormous work and with how many sacrifices these enviable results were paid.
How is treatment going – or maybe a better word would be therapy – for ADHD?
If we consider that treatment means alleviation and not removal of symptoms – because it is impossible – then we can use that word. The treatment is therefore two-pronged. We have drugs on the one hand, therapy on the other. The latter includes cooperation with a psychologist or psychotherapist, but also various trainings. For example, the patient learns to plan and organize time. The recommended therapeutic trend is cognitive-behavioral therapy. It includes psychoeducation about ADHD, methods and techniques of dealing with attention disorders, hyperactivity, impulsiveness, memory, procrastination.
What are these methods and techniques?
For example, keeping a notebook and treating it as external storage. A person with ADHD writes down the things to do there. At the same time, he learns to prioritize them, assess which are the most important, which are important, and which can be implemented later. Breaking down tasks into smaller chunks results in the satisfaction of completing many of them, instead of not completing one, but a large one. The patient is happy because he did something, he made it, he made it on time – several times a day. It motivates you, drives you to continue. And it releases, because the patient has a feeling that he does not have to remember everything and constantly make choices, jump from one thing to another, constantly distract himself.
How long does this therapy last?
It depends on the severity of your ADHD symptoms. In my experience, patients who come to psychoeducation and skills training using these techniques will feel a marked difference within three to four months. Some people see the first results after two or three meetings. However, if the symptoms of the disorder are severe and / or complicated, the therapy continues until the patient decides that he has achieved everything he wanted, that is enough for him.
Can ADHD be turned into your advantage?
In a way, yes. The most important thing is to be aware of your strengths and weaknesses and to use them skillfully. The patient must answer the question of what he feels comfortable in, find a place that meets his needs. For some, it will be creative classes, moreover, among people with ADHD, there are many graphic designers, illustrators, programmers, game designers, and journalists. For others, it will be monotonous activities. I have patients who say that working on the production line is enough for them, because it is repetitive, familiar, and does not generate surprises that may be a challenge for them. By finding a space in which they feel good, they will have a chance to better control themselves and their emotions, and this will allow them to fully realize themselves.
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