Confused about ADHD?
You can find a lot of information about ADHD, and it can be confusing.
Is it a fad? Is it real?
Do adults have ADHD or just kids?
How do I know if I have it?
They say you have to have had it in childhood, but what if you weren’t diagnosed with it then?
Why are so many adults, especially women, getting diagnosed later in life?
This brief summary will address these questions and concerns.
You may have heard it is a “fad” diagnosis.
It may be helpful to first look at how diagnoses are determined and a bit about the history of that process. We have been classifying diseases and disorders for 2,000 years. ADHD appears under a different label in texts published in 1777 and 1872 but with the same cluster of symptoms and a description similar to one we use now in texts. [So it’s probably not caused by television, fast food, the internet, or working mothers]. Most people are familiar with the DSM-5, the Diagnostic and Statistical Manual of Mental Disorders, which is a primary reference for diagnostic codes to identify mental disorders. The first DSM was created to fine tune the International Classification of Diseases (ICD). DSM has gone through five revisions since its first publication as DSM in 1952.
ADHD has gone through many changes over these revisions and went through a change in the most recent edition of the manual as well. We used to refer to the disorder by the label ADD or ADHD, and now the official DSM diagnosis labels it with only ADHD. It includes these three subtypes: ADHD, hyperactive type, ADHD, inattentive type, and ADHD, combined type.
For comparison, let’s look at another DSM diagnosis. Depression was recognized in ancient Greece though it was not called depression. It was called “melancholia” in the 18th century. Many psychological labels have been changed throughout time for various reasons. This is true of physical ailments as well: tuberculosis was once called consumption, for example. Most of the changes are based on new information gathered through research and clinical practice, and most professionals agree on the basics of these classifications.
However, the decisions are finalized by committee, and you probably know all the ways that can complicate matters. So, though we may agree on the basics of each classification, there is room for disagreement as well. That is material for another discussion about ADHD: look for “Disagreements about ADHD” on our blog in the future.
You may have heard there is no scientific basis for the diagnosis.
More than 1,000 peer-reviewed scientific research studies have been conducted on this disorder. It is one of the most studied diagnoses in the DSM-5.
You may have heard that it only affects kids and that they outgrow it.
That was an early understanding that research has shown to be false. We now know it is a developmental problem that can be managed but not cured. And that it is carried into adulthood by a large percentage of kids as they become adults.
You may have heard that it only affects boys.
We know that it does not discriminate and anyone can have ADHD.
You may have heard women do not have ADHD.
Adding “inattentive type” captured a new demographic and now women are being identified with and treated for ADHD. Isn’t equality grand?
WHY HAVE I BEEN DIAGNOSED WITH ADHD IN MY
20s, 30s, 40s, 50s, 60s, and, yes, 70s.
So, to apply this information to our world today, and to your question about why you have suddenly been diagnosed with ADHD, we can see that for many of us, the specific edition of the DSM may not have included the criteria that would have helped parents, teachers, and doctors to identify us. The recent history of the diagnosis, showing the changes in our understanding, may help you identify why you have been diagnosed in adulthood and were not diagnosed when you were a child.
Showing the status of the understanding of ADHD by your current age may give you an understanding. The age ranges represent people who would have been in school up to the age of 18, when most people are diagnosed, as it may first be identified in academic settings.
If you are in the age range between 73-90+ [I know people who fit this age range who have been diagnosed] the DSM diagnostic reference manual did not include this diagnosis at all. Even though it has been recognized since even before 1775, there was a long gap in history when it was not being considered.
If you are in the age range between 55-72, ADHD was included in the DSM as “hyperkinetic” disorder and as that label implies, hyperactive boys were the focus of diagnosis during that time.
If you are in the age range between 42-54, the DSM did not include what we now call “inattentive type.” This has particular relevance for females as they are more likely to have this type.
So if you are a female in the age range of 42-90+, and you have ADHD, you were not likely to be diagnosed with it in childhood.
It was 1995 before we recognized ADHD lasted throughout the lifespan. Another reason you may not have been diagnosed at an earlier age is that many health care professionals do not learn about ADHD in their medical training. This includes primary care physicians, nurses, psychiatrists, psychologists, and social workers. Those who specialized in working with kids may have had more training though not necessarily. The skepticism that we have seen in the general population has been apparent in the medical and psychological fields as well.
If you are interested in learning more, read anything by Russell Barkley on this topic. You might be interested in the changes he wanted to see regarding ADHD in DSM-5, including his emphasis on changing the name, as it is not well-named. People with ADHD do not have an attention deficit, by the way, which we will explore in another blog post - coming soon!