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Misdiagnosis .... ADD or Depression?
By Judie Gade
Over the past year,
I have been fielding calls from women and men from all over the
Australia, after a story was aired about women with Attention Deficit
Hyper-activity Disorder (ADHD) on A Current Affair, a prime time, top
rating current affairs program. ADHD is primarily an inherited
disorder and affects a part of the frontal lobe of the brain. It is a
neurological disorder, not a behavioural one as many believe.
Inappropriate behaviour is a result of the quirky brain we possess.
Most stories seem
to be concerned with little boys who “bounce off walls”,
destructive little people who are out of control! This is the media
perception, and for some parents it is the way it is. It is not,
however how it really is on the whole. The kids I have been dealing
with need understanding and compassion for the confusion that they
feel, and so do the parents who may be unknowingly ADHD themselves.
Education and learning about ADHD is part of the key to living as an
ADDer.
There has been
much in the media from so-called experts, especially about the over
diagnosis of Attention Deficit Hyper-activity Disorder. This has
mainly been concerned with children, nearly always boys and not
adults, of which there has barely been any coverage in the media at
all. Unfortunately the same opinions have been manipulated to involve
adults as well. The issues are very different for an ADHD adult. Many
learn coping mechanisms from years of struggle, but still “it” is
there, making life a real problem at times, just contending with the
little things that most people make appear easy can be stressful.
Things such as remembering a birthday, paying bills, cleaning the
kitchen, even remembering to pick up the kids at school!
Most of the big
studies have been male orientated, to do with children & with no real
thought about the females who are ADHD. So, if this is true, how
can they say if it is over-diagnosed when the opposite appears to be
very much the case regarding adults? In ADDventurous Women, an
Australian based e-mail support group, the main concern for members is
educating the public about ADHD in a positive manner.
The way the general
public sees people with ADHD has been a negative one, which is
extremely unfortunate, as many of these adults are highly intelligent
& very talented in their areas of expertise. The positives about the
disorder are many. I would rather be ADHD than not!
The public
perception is a negative one….. and why? Because the media prefers
to go with the sensationalism instead of the truth; the negative
instead of the positive! Never mind the response from the public,
which they have invoked, & the fact that they are the main source of
education for the general public. No, they would rather see people
fighting it out in the public arena. These are mainly people who will
benefit financially from the uproar through the sale of books, zealots
whose religious sect benefits from the sale of tapes and videos via
web sites, denouncing the very existence of ADHD. Some experts, with
university degrees that flaunt an apparent understanding of ADHD (eg.
Neurologists, psychiatrists & psychiatrists), prefer to put the blame
squarely on parenting skills or an effort to take the easy way out.
The only person
in the media spotlight that has come close to the truth has been Oprah
Winfrey. The interviews were tasteful, full of empathy, humorous &
insightful. She also had experts and adults with the ADHD to
interview, people who were highly successful such as actors, Olympic
gold medallists & even a Harvard university Professor of Psychiatry! I
have been told by various newspapers and media groups that they are
not interested in doing a story, unless someone came forward,
preferably a family or perhaps a noted public figure, before they
would even consider doing a ‘story’. Forget the truth & the many
positive aspects of ADHD, they just prefer to give any negative that
can be twisted to appear like the truth! Better still if these people
are professionals! Many people are too scared to come forward because
of the threat of public ridicule and bad reporting by the media, and
this is such a shame as there are thousands of children who could
benefit form a more positive self image.
Recently there
have been stories on Depression in women being on the rise. If
anything, this is an illness that is being misdiagnosed. Many of
the women who called me were prescribed anti-depressants. Many were
refused a referral by their Family Doctors for ADHD assessment (which
is not covered for adults by Medicare if done by a psychologist), and
when they were referred to a psychiatrist, they encountered someone
who did not believe that ADHD even existed! Some of the women walked
out of these unsympathetic offices worse than when they went in
looking for answers.
This is the first
stumbling block that many people face, especially women… their trusted
practitioners & specialists who are supposedly “in the know”.
Without their approval there can be no assessment by a psychiatrist.
In Australia, an assessment may be made by a psychologist, but they
are unable to prescribe medication. Only a psychiatrist (or
paediatrician in the case of kids) is able to prescribe medication &
do a full diagnosis even if they do rely partly on a report from a
suitably qualified and knowledgeable psychologist.
Although the story
on A Current Affair was about Mothers with ADHD, many people
identified & the penny dropped: “that’s ME! It finally all makes sense
why I am the way I am!” was the comment I heard from the people
contacting me. Some were so excited they could not get the words out
quick enough to explain the way they felt. Many felt plain relief at
being finally able to open up to someone who could understand what
they had been trying to tell doctors for years.
A few concerns
came to light from these phone calls. The main one was the problem
getting a referral to a psychiatrist from the family doctor. Women
who called, who had children diagnosed with ADHD, had never been asked
the question with regards to family history. Considering there is a
very strong genetic link, I cannot understand why this had not come
up. Family doctors, if there is a diagnosis by a specialist of a
child, should be querying the parents, especially if there is a
substance abuse or an addiction problem of some kind evident, or if a
parent has been treated for depression. Better still, the
paediatrician should be looking at the parents and referring them, if
indications are there, to a psychiatrist that is knowledgeable in the
ADHD area (many are not). When I was assessed, after demanding an
assessment, I was asked all these things. My parents came in as well
(they are in their 70's) and it became evident that ADHD was on both
sides of my family.
Another problem
has been the location of a support network or the fact that one of the
family members does not believe in the diagnosis. They prefer to
believe that it is a “cop out”. It is not uncommon for a family member
to lose contact with the ADDult due to personality traits &
misunderstandings. Many women have found themselves on their own when
their partner has left. There is a high incidence of divorce amongst
families where there is undiagnosed ADHD.
Let me explain
what it is like to be a woman with ADHD symptoms….. We are not
stupid, lazy, crazy, space heads, nerds & not worth knowing. We have
difficulty in organising our minds when things appear boring. Our
brain effectively bombards our minds with so many possibilities that
it almost becomes impossible to choose! So where it has been thought
that we are not paying attention, really what can be happening is that
we are trying to process the information just heard. Unfortunately
that means we could well miss pieces of the ensuing conversation,
whilst this is going on, and it may appear we are not listening or
ignoring what we are supposed to be hearing! Also in stress situations
we can space out, or we can hear one word that can trigger a whole
different mode of thought in our minds. Daily tasks become
overwhelming, and if there is an impulse to do something, like a hobby
or shopping for instance, we find it very difficult to not do the
activity “calling to us” without treatment. There is an addictive side
to our personality. This can come out as an obsession with a hobby
that has a creative edge to it such as painting, writing, ceramics,
cross stitch or website design to an addiction such as food, shopping,
alcohol and drugs. It is all addiction of one form or another.
Women have many
different issues to contend with in their life, especially if married
& with children. Keeping the house clean is a major obstacle in
many cases, organising lunches, school excursions, bill paying &
cooking. Remembering birthday and Christmas cards, picking the kids up
at school, after school activities…… well it can all get a bit much
even when treated! Untreated this can become an absolute nightmare! By
our very nature we are perfectionists, we expect to do our best and
when we cannot, stress sets in.
If the children
are gifted, as many ADDlets are in some area, and the same can be said
of ADDults, the concerns become even more complicated. Teachers do
not see the ADHD symptoms for the intelligence. These “Little
Einsteins” are forgetful, untidy (or excessively tidy), argumentative,
do not study as it all comes so easy & find everything is boring. They
go on the computer and don’t come off, glued to the screen and being
totally oblivious to all that is going on around them. A bomb could
drop, and they would not notice it, so intent they are on the
particular activity they are involved in. (how can a child be ADHD
when they can concentrate so intently??) They make friends, but cannot
keep the friendship going if untreated. Some gifted children with ADD
can also have a learning disability such as dyslexia. Sometimes
they are gifted or very advanced in all areas of the curriculum but
still cannot organise themselves to hand their work in on time & they
constantly lose things.
One of the
behaviours exhibited by ADHD people is risk taking behaviour. The
risk element may not necessarily be dangerous. It can be related to a
business, an idea that they have and believe in that they pursue
relentlessly (there is a fine line to be drawn between obsession and
focus!) or travelling away to live in unfamiliar surroundings without
family support (immigrating to another country). However, the risk
taking can also lead to injury or death (extreme sports, drug taking,
alcohol abuse, doing stupid dares to fit in with their peers or
getting into a car hitch hiking when knowing the dangers).
Experts, the world
over, agree that somewhere between 2 and 15% of the world’s population
would be ADD/ ADHD. A conservative estimate is 5%. Taking into account
Australia’s beginnings as a penal colony, our gold rush history and
immigration policies of the years gone by, and our rate of youth
suicide per capita ~ the second highest in the world~ our percentage
could be significantly higher than this. In fact, a recent federal
government document on the mental health of our youth (ages 6 to 17)
in the school system indicates that the figure is an average of 11.2%
Australia wide! Did they publicise these figures? NO! They did
publicise the mental health issues figure of 15% though. It is cheaper
to treat depression than ADHD.
Let’s get down to
facts…… Australia has nearly 20 million people living in it. Take 5%
of that and you have nearly 1 million people that could be ADHD. Let’s
halve that because some of these people are only mildly affected. That
leaves 500,000 people in our country, conservatively, with ADHD,
diagnosed or undiagnosed & needing treatment. It is very expensive to
be assessed in most cases, if you are an adult. The assessment by a
psychologist is not covered by government subsidies although the
psychiatrist’s appointments do have a rebate. Treatment & assessment
would make a huge dent in the wages of most people. To me, this
amounts to discrimination by the government.
The ones that are
disadvantaged most are the low income earners, & those on government
benefits. About 50,000 Australian children are now believed to be
taking stimulant medication to help with their symptoms. How can ADHD
be over-diagnosed when this only attributes to 10% of the total
expected, conservative figures? One would presume that there would be
less adults than children diagnosed, unless the adults had children.
Besides, children are normally easier to pick up on their symptoms
compared to adults, who in may cases have learnt coping mechanisms so
that their symptoms are less obvious. Yet life is still difficult and
they strain to cope with the multitude of stresses that being an
adult can bring. Even moreso if there are children involved and ADHD
ones at that!
What came to light,
after the ACA story last year, was that many had sought treatment from
their Family Doctors (and I had over 160 phone calls & e-mails until I
stopped counting!) . Many had been put on anti-depressants and told
that adults do not get this disorder! You mean that the ADHD fairy
comes along at the age of 18 and says “you are now an adult, you do
not have ADHD anymore …. Be gone! Cope! GROW UP!”? Sorry, but this
does not make an ounce of sense...
Another thing that
TOTALLY amazed me was that only two of the women with diagnosed
children were asked what they were like as children, ending in a
referral to a specialist for themselves. Many had to bring up the
possibility of their ADHD with the doctors. The possibility that it
came from an inherited element is extremely likely; 90 to 95%
probable. How can a mother help her child with their problems, when
the mother cannot handle her own? Compare this to flying in an
aeroplane; the word from the captain is…. It is going to crash land!
You have your toddler with you… what do you do? Put the oxygen mask on
your child first or on yourself? You put it on yourself first,
otherwise who will help the child when you are dead? The same applies
to ADHD mothers (and let’s not forget fathers!). You need to be able
to help yourself before you can help your child, otherwise your stress
levels go out of control, the marriage is affected and you are yelling
incessantly at the child who only rebels even more. You are in a no
win situation.
Anti-depressants
do not address the root cause of the depression, although they can
help immensely in some cases. Unfortunately family doctor’s are,
on the whole, not very astute at treating or even detecting this
condition. I have spoken to grandmothers who finally twig that they
may be ADHD like a couple of their grandkids, especially after their
own child will exclaim to the grandchild “you are just like Grandma!”
Why wasn’t the question of a possible ADHD diagnosis asked and
explored, especially when the mother was obviously stressed to the
point that she needed anti-depressants? Why wasn’t the question asked
when, in extreme cases, the problem between mother and child has come
to a stage where the parents give up their children to community
services, as they cannot control their own moods let alone help their
child?
Mind you, these
“mother’s little helpers” called anti-depressants, only help stop the
mother from stressing so much. It does not help with all the other
things she has to cope with such as being disorganised at home, having
her finances in a mess & no motivation. It just stops them from
worrying about it as much. Take care of the problem (ADHD) and a lot
of the time they do not need the anti-depressants. I have seen women
emerge as a cleaning machine within 20 minutes of their first time on
medication. It is like a fog has lifted, being able to “see” things
that need doing for the first time, and being able to sort through the
steps that you need to take to do the job.
Due to government
constraints and policies, these people cannot get the treatment they
deserve & need to have a productive life. Now this is what is so
confusing to me……… How can a government recognise ADHD as a
disability? In fact, some people are so severely affected by being
ADHD that are on a disability pension. More often than not these are
people who cannot afford the best treatment possible..........
specialist psychologists, counsellors and coaches, people who can help
reframe the way they think, teach new living & social skills, helping
them to gain confidence in themselves and their often innate
abilities.
Yet still, if
Methylphenidate is prescribed, it is not covered by the government
subsidy whether you are on a pension or not. The government has made
it so hard for people to afford treatment by medication, that many
just give up. And trying to get treatment without medication, getting
counselling, psychologists etc., well it is nigh on impossible for the
average person, let alone someone on unemployment or a pension! The
governments offer no solutions, only obstacles to people who just wish
to be comfortable in their own skins.
There are two
main stimulants that are prescribed in Australia. One is
dexamphetamine (Dexadrine), which with a health care card is cheaper,
and methylphenidate (Ritalin, Attenta brand names) which is not
subsidised at all. Many people have no choice but to be prescribed
Ritalin because of side effects with Dexamphetamine, yet they still
have to pay the exorbitant prices charged for methylphenidate.
If you have a family of ADDers, the cost is truly frightening. In the
USA there is a huge range to choose from. (go to the
www.add.org site for info)
Hopefully, one day, the government in its wisdom will approve what is
essentially the same drug in a different delivery system.
(Methylphenidate in the USA comes in once a day form, great for teens
and kids who have to face the stigma attached to having lunchtime
medications)
I would like to add
here, that in many cases medication, I believe, can be used as a
learning tool, not as a crutch. How can a person learn an appropriate
action if they have never experienced the normalcy of a lineal brain?
In other words, if you constantly are thinking outside the square in
all manner of things, how can you think “straight”? Medication allows
people to know how it FEELS to think in an organised fashion. From
this we learn how to react in different ways, recalling the
experience. Like an Olympic athlete, we have to train our brains &
this often takes years of work. Sometimes we just have to forgive
ourselves for our little failures (like housework…….. I still cannot
get my head around it unless I have someone doing it with me!).
However, there are certain individuals whose hyperactivity is so great
they find it hard to function in "regular" society without medication.
Everyone has different needs.
Many ADDers have
severe allergies as well that need medication…. Asthma, eczema,
sinusitis, food allergies such as lactose intolerance etc. Often they
have bowel problems such as diverticulitis, lower back problems,
ulcers & migraines. Treat the ADHD and often some symptoms, especially
stress related ones, cease to exist. Australia, compared to the
United States, is extremely limited with medication treatment and it
will be a long time before we actually see an improvement in the
situation. In the meantime, we will just muddle along, hoping that we
have said the right thing, haven’t forgotten to pick up the kids at
school, remember to take out the night’s dinner from the freezer & to
stock up the toilet paper……… Life goes on!
With a little
understanding from the general public, education of family doctors and
teachers, correct media reports (especially by academics
without a limited viewpoint), increased government involvement and
acceptance for our “quirks” by the people who we come into contact
with, then maybe we can just ‘be’, enjoy our ‘selves’ & have happy,
stimulating & productive lives – something everyone has a right to.
I underwent
assessment in June and July of 2000. I knew that there was a
problem & had actually booked in for assessment 4 years prior to be
assessed, but the cost was so great that I could not afford the
testing. This is required for a correct diagnosis; you have to know
where your problems are, your weak areas, so that you can have a plan
for yourself. Being the true ADDer that I am, I procrastinated until
I could not cope with the way my life was heading any further. Perhaps
if I had taken up my parent’s offer to pay for the assessment, I would
have been better off, maybe not. All I know is that my kids would have
been happier, my husband would have had less to deal with because of
my lack of household organisational skills, and yes, I would have been
happier.
You can't think
like an ADDer anymore than an ADDer could think like you. Their
brains work in a totally different way to the norm. In fact it is
strong ADD traits that have been found in world leaders (Sir Winston
Churchill, the Kennedys) and some of the world’s biggest, scientific
brains (Edison, Einstein, Marie Curie). Musical geniuses (Mozart), war
hero’s, leading entrepreneurs (Richard Branson) and of course some of
the funniest people to grace our planet (Robin Williams, Billy
Connelly, Whoopi Goldberg, Cher) have either been diagnosed, or have
presented, with Attention Deficit Disorder traits! It is amazing how
many of our favourite TV programme’s are based on ADHD type characters
such as The Simpsons, The Osbournes (Ozzy, Kate and Jack are all
diagnosed), Malcolm in the Middle, Friends (Joey and Phoebe…), Just
Shoot Me and the cartoon Pepper Ann, to name a few.
I had the
opportunity to meet with Professor Richard Silberstein from the Brain
Sciences Institute at Swinbourne Institute of Technology, I viewed
scans of an ADHD brain and listened to this passionate man explain his
views on the matter. In essence he said that ADHD is a difference,
a type of brain that has a purpose. This is supported by his good
friend Thom Hartmann, (author of ADD A Different Perception and my
mentor), who has a theory that ADHD people had the traits necessary
in a Hunter’s society…… easily distracted, live in the moment, lateral
thinking, short attention span, risk taker. In fact without these
traits Hunters could easily have been killed! It is a difference,
just like there are different coloured eyes, hair and skin, there are
different ‘coloured’ brains!
No, I don’t find
being ADHD negative, not at all. The only negative thing I can see
are misinformed people and those with no compassion. The sooner
people can see that ADHD is an ADDition and not a CONdition, the
happier, healthier and a more accepting our children will grow to be.
I am in good company and with all the little quirks….. I like me just
the way I am!
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