Navigating My Son’s A.D.H.D. Made Me Realize I Had It, Too

The New York Times

By Heidi Borst

Feb. 25,2021

Experts say some symptoms, especially in women, are mistaken for other conditions such as mood disorders or depression.

I heard my 7-year-old son’s cries of frustration loud and clear despite the closed door between us. Seconds earlier, I’d left him stationed at a desk in my bedroom, hoping he’d complete at least a portion of his virtual school assignments without me at his side while I left to wash the dishes.

“This is so BORING,” he groaned. Finishing each of his math problems required enduring an animated character’s long-winded ovations and cheers. The work was easy for him, but the system didn’t allow him to zip through it. Pulling up a chair, I sat with him in solidarity as he finished up.

Remote learning is daunting for most parents; it’s particularly thorny when your child has attention deficit hyperactivity disorder. As I tried to guide my son through his online lessons over the course of the pandemic, I began to see parallels between his struggles and my own. While hyperactivity was never an issue for me, we had many other traits in common: impulsivity, distractibility, lack of organization and low frustration tolerance — all key signs of A.D.H.D.

Primary school was easy for me; from third grade on, I was enrolled in gifted classes and earned straight A’s. Nonetheless, I recall many tear-laden homework sessions where exasperation over a tricky math problem threw me into emotional overload. During study sessions, I often became disinterested and zoned out, rereading sections of text until I could focus enough to absorb the information. I attributed my difficulties to character flaws: I was spacey and forgetful, a master procrastinator lacking drive and ambition.

Though I received an academic scholarship and entered college with a 4.2 grade point average and 15 credits from Advanced Placement classes, my performance at university was subpar. Lacking structure, it was tough for me to stick to any semblance of routine. In large lecture halls where I was an unknown in a sea of students, I floundered. I changed my major five times and eventually lost my scholarship. I never imagined an underlying neurological disorder was at play.

People who have A.D.H.D. but who do relatively well in school often don’t get diagnosed until later in life, said Lidia Zylowska, associate professor of psychiatry at the University of Minnesota Medical School and author of “Mindfulness for Adult A.D.H.D.” She said the expression of A.D.H.D. symptoms can change as life gets more complex, becoming more overwhelming as responsibilities increase in adulthood. For those who have advantages such as intelligence and family support, “school may be a place where you thrive. But when you don’t have that support, whether it’s in college, or you get your first job,” or if you become a parent, Dr. Zylowska said, “that’s when the impairment really starts showing up.”

No one in my family (nor my husband’s) had been given an A.D.H.D. diagnosis, yet research suggests a strong genetic component to the disorder. “We’ve known for many years that A.D.H.D. runs in families; it’s not just a childhood disorder,” said Mark Stein, director of A.D.H.D. and related disorders at Seattle Children’s Hospital. He said 20 percent to 30 percent of children with A.D.H.D. will have another family member who has it. “A big part of it is genetics, but it’s also awareness. Once you’re aware of what A.D.H.D. is, you’re more likely to recognize it in others,” he said.

Dr. Stein said it’s not unusual for parents to realize they have A.D.H.D. after their child is diagnosed, as in my case. “That’s a real common pathway,” he said. “A child has symptoms and problems and is being evaluated, and then the parent for the first time looks at their life and views it from the frame of, ‘Well, maybe I have this, and this is why I had those difficulties.’”

As a 3-year-old, my son was evaluated by a school psychologist because of hyperactive, disruptive behavior in preschool. He was formally given an A.D.H.D. diagnosis at age 5; by then I’d become his tireless advocate, collaborating with our school district to ensure he was set up for success in the classroom. In 2020, I reached out to my doctor about my concerns about my own symptoms and received a preliminary diagnosis of A.D.H.D; I’ll undergo a comprehensive neurological evaluation this spring.

When I was in elementary school in the ’80s, no one ever brought up the possibility that I had A.D.H.D. Experts say that’s not uncommon. Because men tend to exhibit more disruptive symptoms than women, they’re far more likely to be given diagnoses early on, said Russell Barkley, a psychiatry professor at Virginia Commonwealth University Medical School and author of “12 Principles for Raising a Child With A.D.H.D.”

Dr. Stein noted: “For 10 or 15 years now we’ve been talking about how it’s not identified in females, and that it’s often missed, and even though we’ve improved somewhat it’s still much more likely to be missed in females, especially in moms.”

Research shows girls with A.D.H.D. tend to internalize their struggles rather than acting out. “Girls tend to be a little bit more inattentive and less hyperactive,” Dr. Barkley said. “If they’re disruptive, it’s mainly talking too much and socializing, whereas the boys, if they’re disruptive, it tends to be more reactive emotion and aggression, as well as defiance and oppositional behavior.”

Dr. Stein said the increasing stressors and external demands of motherhood can worsen A.D.H.D. symptoms. “I think of A.D.H.D. women as typically suffering in silence,” he said. They may seek care for something like being demoralized or having low self-esteem, or feeling overwhelmed, he said. “It’s often assumed this is a mood disorder or depression.” He added, “We’re treating the effects and the aftereffects” of A.D.H.D., “but not the underlying cause.”

I’ve had anxiety for most of my adult life; experts say the longer A.D.H.D. goes untreated, the more likely people are to experience comorbidities like anxiety, depression, substance abuse, and bulimia/binge eating. About 30 percent of children with A.D.H.D. have an anxiety disorder, a statistic that increases in adulthood. While many women do have depression and anxiety, Dr. Barkley said, “It’s just that it’s being picked up as the primary problem without looking behind the curtain, so to speak, to see what else might be there that could also be contributing to these difficulties.”

Dr. Zylowska said treatment tools for adult A.D.H.D. are very similar to those for children, but newly diagnosed adults often have an additional problem of struggling with feelings of self-doubt and shame. “You sort of have this long-life experience of getting in your own way, of having good intentions, but not being able to deliver, and that can be really demoralizing,” she said. Part of the treatment is to “help develop this less judgmental, less negative view of yourself, understanding A.D.H.D. as a neurobiological difference and developing self-acceptance and self-compassion, which can really be important,” Dr. Zylowska said.

Mindfulness-based therapy is a helpful self-regulation tool for working through feelings of inadequacy and shame, and developing self-compassion, she said.

Medication can play a role in managing A.D.H.D. symptoms for many people, but Dr. Stein said it’s part of an individualized treatment plan that may also include good nutrition and sleep. While A.D.H.D. can be a big problem for kids in school, adults often have more control about choosing to be in an environment that suits the way their brains work. “It’s less of a problem if you have the right fit with your occupation,” he said, because it’s easier to focus if you find a career you’re passionate about.

This diagnosis has been eye-opening for me. My treatment plan will most likely include medication, but my doctor is waiting for data from my scheduled neurological evaluation before she prescribes me anything. There are so many options when it comes to A.D.H.D. medications; testing will ensure that I receive the most effective one based on my individual needs. Experiencing the improvement medication may have on my daily functioning will allow me to make a more informed decision if and when the time comes to medicate my son. Thus far, it hasn’t been recommended for him.

Meanwhile, I’m able to more deeply empathize with my son when he is frustrated; after all, I’ve been there too.