Myth #2: ADHD Is An Excuse for Irresponsibility

Using ADHD as an excuse

 

“ADHD Is An Excuse for Irresponsibility.”

Psychologist and ADHD expert J. Russell Ramsay has heard that line so many times he’s named it one of his top three myths about ADHD (the other two follow in future myth-munching posts).

As the co-director at the University of Pennsylvania’s Adult ADHD Treatment and Research Program, he’s noticed that clients often expend much-higher-than-average time and effort trying to meet their responsibilities—typically “twice the effort for half the result.” Instead of seeking an easy way out, he argues, “They want to gain a measure of predictable cause-and-effect in their lives.”

Harold Meyer, founder of The A.D.D. Resource Center in New York City and an ADHD coach, agrees. “People with ADHD usually know what needs to be done,” he says. “Their difficulty, and continual frustration for both themselves and others, is in doing what they know or, at times, thinking before they act. Instead of Ready-Aim-Fire, it’s Ready-Fire-Aim.”

Or, as one of Meyer’s clients put it, “By the time I think about what it is I should have done, I’ve already done the first thing I thought about.”

Yes, it’s true that some adults with ADHD use the diagnosis as an excuse. Frankly, though, that mostly seems to happen when they don’t realize that treatment can largely eliminate the need for excuses of any sort. They’ve simply learned that their ADHD symptoms are not, as long thought, character flaws that they could change “if they really wanted to.” And that, no doubt, must come as a relief.

________________

Next time, we’ll examine Myth #3:

“ADHD Symptoms Are Basic Human Behaviors.”

How about you? Have you heard this ADHD-is-an-excuse line?

Or, did you ever—gasp!— find yourself saying it?

Comments welcome! It’s easy; no annoying codes to decipher.

—Gina Pera

23 thoughts on “Myth #2: ADHD Is An Excuse for Irresponsibility”

  1. Dr. B — Don’t we use the rat model because rats are so similar to humans? 😉

    Re: the impaired appetite. Decreased appetite was just one of the common problems with IR Ritalin (and other IR stimulants), which is why the current thinking advises long-acting, gradually released medications like Concerta, Vyvanse, Daytrana, etc.

    Anecdotally speaking, I don’t hear that complaint from parents as much as I used to. And there are workarounds. I’m no expert in this, but I see the same kind of poor medication protocols with kids as I see with adults: often too high a dosage (or not high enough) on IR stimulants, which just cause more problems for most people; no way around it. So, it’s hard to know, from these studies, what’s the result from poor clinical practices or best clinical practices.

    As for the growth suppression, I think the latest word on that is covered by Dr. James Swanson, on Web MD: http://www.webmd.com/add-adhd/news/20070720/adhd-drug-does-stunt-growth

  2. That’s a great story, Monica — and a prime example of how adults with ADHD often have to “self-advocate.” 🙂

  3. Yes indeed. Sacrificing themselves for science, poor little things. I used to do research until I had a dream about a giant rat knocking on my door. 🙂 Anyhoo impaired appetite with ritalin is a big deal for moms trying to get their boys to eat and grow. The whole kids and meds thing is a big guilt trip no matter what you do. From what I remember the growth thing amounts to about an inch over the lifetime and your point that the negative effects of the disorder is a good one.

  4. P.S. As far as long-term effects on brain function — rat or human — I’ll have to get back to you. As far as I’m aware, no research has demonstrated negative effects on brain function, and the impact on height, etc. seems to be miniscule at best. But I’m not remembering the latest research on this.

    But, as ADHD experts such as Yale psychologist Tom Brown like to point out, we do know the risks of untreated ADHD are significant and severe.

    I had to look up the ACNP (American College of NeuroPsychopharmacology). I’m betting many rats gave their lives for those poster sessions, bless their little rat hearts. 🙂

  5. Yes, stimulants have been shown to help with these other manifestations, but with adults that’s mostly from clinical observation and from the adults themselves (and their loved ones, bosses, friends, etc.). It would be difficult to measure improvements in financial management, cooperation, etc. But we do have studies showing the increased rates of bankruptcy, divorce, physical altercations, encounters with the criminal justice system, more lost time on the job, more on-the-job accidents, etc. with adults who have untreated ADHD.

    There is a significant body of research on adult ADHD driving skills and medication, though. Driving safety is markedly improved with the use of stimulant medication.

    But for late-diagnosis adults, who have a 75% chance of having a comorbidity, treatment is more complicated; it’s seldom a simple matter of taking a stimulant.

    Sometimes they carry a lifetime of accumulated sleep debt (ADHD can adversely impact sleep, too), so that needs to be addressed. Sometimes they are depressed and anxious, from the lifetime’s pileup of frustrations and negative feedback.

    And, with women, they often aren’t diagnosed until they hit peri-menopause or menopause, when fluctuating hormones wreak havoc with neurotransmitters, pushing them into worse cognitive function. So, sometimes thyroid and other metabolic issues are involved. So are chronic deficiencies in certain vitamins and minerals (particularly Bs, magnesium, calcium, potassium, etc.).

    Finding a physician who can carefully address all these issues is tough! It’s tough even to find a physician who knows that, for some people, the AMP medications will push them into irritability and anger. I really like Dr. Charles Parker’s blog because it covers all the bases: http://www.corepsychblog.com

  6. Yes, that is informative. So do stimulants help with these other manifestations of ADHD? And what is your read of the literature on long term effects on brain function and growth from rats and (if there is any data) in humans? I remember seeing a rat poster once when I was wandering around the poster session at the ACNPee pee. meeting (little joke, har har)

  7. Hi Dr. Bremner,

    If you mean how many children with ADHD outgrow symptoms as they reach adulthood, the research is mixed, but it’s safe to say about 30% experience symptom mitigation as they mature. That’s why it’s recommended for parents of growing children who take medication to do an annual assessment to see if they indeed should continue the medication.

    Key research in this area includes Dr. Barkley’s Milwaukee study, detailed in the book ADHD in Adults: What the Science Says. Here’s how Dr. Stephen Hinshaw, ADHD investigator and Psychology Department chair at UC-Berkeley, summarized it in an interview for my book:

    “Psychologist and ADHD researcher Russell Barkley has followed up on the children with ADHD from a study he conducted in the late 1980s. These subjects are now in their early twenties. How many of them still have ADHD? It depends on whom you ask. If you ask those young adults, it’s 5 percent. If you ask their parents, it’s 50 percent. Moreover, if you loosen the diagnostic criteria to measure the adult manifestations of ADHD, as opposed to those of children, it is nearly 70 percent.”

    This emphasizes the point that “self-reports” are often problematic when it comes to ADHD.

    Another issue: Some people have gotten confused by one of the results from the MTA study follow up, showing that the medication doesn’t provide a long-term benefit for children with ADHD. It’s a complex subject, but basically what the study found is that when you stop medication, you stop getting the benefits. That’s nothing new, though! We know that stimulant medication can be compared to wearing eyeglasses: That is, you see better when you’re wearing the eyeglasses, not because you wore eyeglasses three years ago.

    In general, what the public largely doesn’t understand is that ADHD isn’t all about kids paying attention in school. In fact, adults with ADHD can face much bigger problems than they did as children — in managing money, keeping a job (or working at their level of training/education), maintaining relationships, driving safely, avoiding addictions, and living a healthy lifestyle.

    I hope that answered your question! 🙂

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