Why it’s important to discuss adult AD/HD: Some key points from the adult support group program

It finally happened.

In February 2013, during the  AD/HD Society of the Philippines (AD/HDSP) general assembly, two people who were not parents were elected into the Board of Trustees. See, the AD/HDSP had always been a parent-run organization. But in its 13th year of existence, two adults who are diagnosed with AD/HD became part of the board.

I was one of them.

And it was exciting. Together, this other board member and I were going to start something that supported adults with AD/HD, in contrast to the lobbying-for-children approach that the AD/HDSP had always been known for. Of course, we always need to lobby for parents and their school-aged children to help give them support. But what I felt back then was a certain sense of giddiness of doing something no one else had done.

It was then that the Adult AD/HD Support Group was born. And while it started with a few, it eventually doubled into a small group meeting that discussed different topics and giving one another that needed breather and support once a month. This paralleled the Parent Support Group meetings–upholding the core values of acceptance, confidentiality and empowerment.

Zooming forward to more than  1 year later and after much contemplation, we’ve compiled a thematic summary as to the impairments of this demographic after having gone through more than 20 individuals in the adult support group. Here are the top issues of the AD/HDSP Adult Support Group so far.

GETTING A DIAGNOSIS
How hard is to obtain P3,500 and go to a psychiatrist just to find out once and for all if you have AD/HD? The fact is, the suspicion of AD/HD rarely comes in a person’s life when everything is in order. The time when you think to ask your doctor if you have AD/HD is often the time when you feel under pressure, or in the middle of combating a financial issue. With that in mind, getting a diagnosis is difficult, especially during the early post-college graduation where the person isn’t earning much, or not at all.

For parents who have children diagnosed with AD/HD early, college graduation signifies the end of “helping” their kids out, since there are no more academic tasks to keep track of. But any transition period would be quite the challenge for anyone with AD/HD. All the added pressure and uncertainty certainly does not help. “That’s nothing. There’s nothing wrong with you.” This statement is basically a paraphrase of some parents from our support group to their kids when the topic of getting diagnosed is brought up. Thus, even in many adult cases, denial from the family is still an issue. And this is the challenge to obtaining medical help—even from those families who have the means to provide for this.

FINANCIAL MANAGEMENT
We’ve observed that, at more than one point in time, individuals in our support group struggle with finances. Impulse buying, and not being able to keep track of daily expenses, versus what the person actually earns tends to balloon into financial deficits or even heavy debt. Note that this tends to come from two separate issues of AD/HD, too: impulsivity (shopping sprees with one’s credit card) and working memory deficit (keeping track of things, such as one’s finances). Some members even bought books solely focused on how to get out of debt.

In relation to paying for one’s diagnosis, you’d typically encounter individuals earning P12,000 to P15,000 in the Philippines. Given the cost of psychiatric evaluation, since it does not just check for AD/HD but also takes into account and rules out other medical conditions, that would be around a third of your typical working Pinoy’s salary!

COMORBIDITY OF OTHER CONDITIONS
In the U.S., a study was conducted for adults who were diagnosed with AD/HD as children, and it was found they were more likely to develop anxiety disorders such as depression when they became adults. In addition, it was mentioned that developing these conditions would make the afflicted individual more likely to commit suicide. Take the recent passing of Robin Williams, for instance. It’s no secret that Robin Williams was diagnosed with AD/HD. Some may even attribute his condition to his acting and comedy chops. But the fact is, Williams’ death was due to a myriad of mental health disorders, which also included a history of substance abuse and depression. An author writes that this incident “…is a wakeup call for hypersensitive adults with AD/HD.”

And we find the same profiles among our adults with AD/HD in the support group. There are frequent cases of depression and bipolar disorder in particular. And it’s hard for these individuals to manage the symptoms. In one case, we had a member who expressed a struggle with academic, relationship, and familial pressure by shouting inside his house; his actions were triggered by a seemingly small argument. In a different case, there was one who messaged a suicide note via text messaging. Thankfully, that person was secured by friends and the incident was managed.

OBTAINING AND SUSTAINING TASKS
When you take a look at the symptoms enumerated above, it’s no wonder why many find it a struggle to manage day-to-day tasks. Stephen Covey, author of The 7 Habits of Highly Effective People, once wrote, “The private victory must come before the public victory.” However, many of these individuals are expected to perform even before they learn how to manage themselves. Performing well in such tasks such as a college thesis, a decent job, and one’s own business can be a long-shot for those with AD/HD.

One of the things I focused on in my MA studies are executive skills. Peg Dawson & Richard Guare published a book called Smart but Scattered, which highlighted the importance of the intervention of executive skills, which includes our ability to remember and keep track of our tasks, to reduce procrastination through starting and sustaining the attention needed for tasks, and committing to long-term goals until they are done. A study published in 1997 by Dr. Russell Barkley, a renowned medical practitioner who focused on AD/HD, showed that much of the deficit that describes AD/HD can be seen as a deficit in executive functioning. These functions are attributed to the prefrontal cortex of our brain. This study further established the neurobiological basis of AD/HD. In addition, it also gave us the information that if there is one consistent indicator of AD/HD, it’s an impairment in executive functioning.

How impaired exactly are adults with AD/HD with long-term tasks? What we have observed in many of our cases is that, many of them would have great ideas, good ways to start tasks, and then not follow through. Certain concepts developed and discussed in the support group involved having one’s own graphic design business, a social entrepreneurship business, a college-level thesis, and simply just holding one to their current job or course in college. Many of these ventures, unfortunately, do not come into fruition despite enthusiastic beginnings. Another impairment is simply managing day-to-day tasks. Many of our participants have issues with missing deadlines, flaking out on appointments, and remembering to do important tasks.

IMPULSIVITY IN OTHER AREAS OF LIFE
According to the 5th edition of the Diagnostic & Statistical Manual of Mental Disorders, a criterion for being diagnosed with AD/HD is the impairment not being limited to a single area of one’s life. For example, all the symptoms discussed here should manifest not just in school, but in the family setting.

One issue common among adults in the support group is impulsivity in these multiple settings. To use a layman’s definition of impulsivity: it’s the tendency to act with little or no reflection or thinking; to make actions that the person would regret later on as a bad decision. We’ve already mentioned the case of impulsive buying to supposedly relieve stress—only to cause more stress later on. We’ve also had cases of individuals who have had history of drug and alcohol abuse. Another aspect we’ve encountered is sexual impulsiveness, which could of course lead to obvious consequences.

Within the family setting, we’ve observed many members who have strained relationships with their parents. We have several members who find it hard to avoid hurtful, verbal altercations with their parents while they are emotionally charged. Typically, many individuals have also had histories of “not fitting in” at one point in their lives. Looking closely at this, many cases of social problems tend to stem from being “too quick with the tongue”—not taking the time to think and reflect on what is on one’s mind before they say it.

CONCLUSION
Overall, we can see through the examples of deficits in the adult AD/HD support group members that there is still a need for support for us. For parents, workmates, classmates, and friends who are reading this, I say to you that we try to find ways to prevent someone from being an alcoholic, maxing out his credit card, or attempting suicide by being proactive about the issue of adult AD/HD. This means that we anticipate these things before they even begin. Personally, my most recent psychiatric evaluation noted that I may be prone to suffering from symptoms of bipolar disorder. Thus, I informed my family about this and they help manage my diet, sleep, and stress levels to make sure I’m as well as I could be. The point is, we can start by recognizing that support is needed as early as now so we can do something before any severe, life-debilitating, or even life-threatening event occurs.

TO END
You might feel at the end of this article a sense of wanting to further understand this issue. If that’s the case, then good! There’s growing attention and information on adult AD/HD that continues to give an evolving view on it. If you’re like me, who felt a little bit skeptic when I first encountered the term, I understand. When you look at it anyway, it isn’t just those with AD/HD who encounter these issues, right? Let me be clear: everyone encounters at least one, or some, of these problems at some point in their lives. But when these symptoms have been consistent throughout the lifespan of an individual, despite one’s best efforts to remediate it, then it’s a disorder. It took me some time to really understand this, and it enabled me to go from that guy who didn’t want to tell anyone about my AD/HD to become an advocate and even serve on the board of the AD/HD Society of the Philippines.

Dr. Russell Barkley once said that we can’t advocate AD/HD as some sort of gift. It’s something that has to be dealt with seriously, and I  have to agree. I do believe that any individual with AD/HD, or any human being for that matter, has gifts. In our support group, we have many of them ranging from successful law practice, graphic design, writing, entrepreneurship, oratorical ability, mathematical ability, and, in my case, teaching other kids with AD/HD! But I would argue that AD/HD by itself is not a gift. It’s a body of symptoms that carry with it deficits that still allow us to be good members of society, but are deficits nonetheless. Hence, the person with AD/HD is not the deficit—and has in his or herself the inherent ability to overcome these deficits.

“The point is, we can start by recognizing that support is needed as early as now so we can do something.”

Remember that we are persons with AD/HD, not AD/HD persons—our personhood comes first. And to be successful adults, we have to be able to hone our gifts, and compensate for all these deficits to be happy and productive members of society. And what better time there is than now, especially with the AD/HD Society of the Philippines holding its 2014 national conference that goes beyond most of our conventional literature of looking at the school setting, and focusing on the workplace—the “AD/HDult Journey.”

By the way, that childhood friend of mine in the story? She has since obtained her diagnosis and has taken good measures to improve her life—especially with work and finances. As for me, I’ve decided  to become open with my AD/HD, improve my skills as a one-on-one SPED teacher so that my students can be proactive too by learning the lessons earlier than I did, and to be an advocate for the society—I’m even brushing up my public speaking skills at a local Toastmasters Club!

You might ask, “Do the struggles end?” No. The challenges just continue—I’m still finishing my MA thesis as we speak, and this article is a good excuse to take a break! But, for sure, we’re not backing down on life and we’re going to give it our best shot to be the best “AD/HDults” we could possibly be. FJM 

EDITOR’S NOTE: If you’re aged 18 years old and above, diagnosed with or suspected to have AD/HD, you may join our adult support group which meets every 3rd Friday of Saturday of the month. Contact 0917-5555175 for inquiries.

FIEL JOHN MERIA is an academic coach for upper elementary to college students, typically those diagnosed with Attention Deficit/Hyperactivity Disorder, Autism Spectrum Disorder, and Learning Disabilities. He graduated from the Ateneo de Manila University with a degree in Interdisciplinary Studies in 2009, with tracks in Psychology and Communications. He’s currently finishing his MA in Special Education at the University of the Philippines-Diliman.

REFERENCES

• American Psychiatric Association. (2013). “Diagnostic and statistical manual of mental disorders (5th ed.).” Washington, DC: Author.
• Barkley, R.A. (2007). “Behavioral Inhibition, Sustained Attention, and Executive Functions: Constructing a Unifying Theory of AD/HD.” Psychological Bulletin. 121 (1), 65-94.
• Covey, S.R. (1989). “The Seven Habits of Highly Effective People.” New York: Simon & Schuster.
• Dawson, P. & Guare, R. (2009). “Smart But Scattered.” New York: Guilford.
• Kessler, Z. (September 2014). Robin Williams’ Death Shocking? Yes and No. Retrieved from http://blogs.psychcentral.com/adhd-zoe/2014/08/robin-williams-deathshocking-yes-and-no/
• Seaman, A.M. (March 4, 2013). Children with ADHD Often Develop Other Mental Health Problems Later On. Retrieved from http://www.huffingtonpost.com/2013/03/04/children-with-adhd_n_2807293.html