A new focus on ADHD in women

Are the demands of modern life driving some women to distraction? Or is it something else?

The Washington PostMay 10, 2011 

Michelle Suppers of Manassas, Va., has struggled her whole life with being organized. When her older son, Anthony, was diagnosed with ADHD, she suspected that she might also have attention-deficit problems.

CAITLIN TEAL PRICE | WASHINGTON POST

  • Screening for ADHD

    The questions below are used to help screen for attention-deficit hyperactivity disorder, or ADHD, developed by the World Health Organization. On the test, meant for adults ages 18 and older, the possible answers are "never," "rarely," "often" and "very often." Repeated responses in the often/very often range suggest symptoms that might be consistent with adult ADHD.

    For an accurate diagnosis, one should consult a health-care professional for a formal evaluation.

    1. How often do you have trouble wrapping up the final details of a project, once the challenging parts have been done?

    2. How often do you have difficulty getting things in order when you have to do a task that requires organization?

    3. How often do you have problems remembering appointments or obligations?

    4. When you have a task that requires a lot of thought, how often do you avoid or delay getting started?

    5. How often do you fidget or squirm with your hands or feet when you have to sit down for a long time?

    6. How often do you feel overly active and compelled to do things, as if you were driven by a motor?

WASHINGTON — A few minutes shy of 3 p.m., Michelle Suppers pulls her minivan into the parking lot at a Catholic school in Virginia, where her son Anthony attends first grade. For most of the mothers already queued up in the pickup line, this is probably not a big deal. But for Suppers, who for as long as she can remember has always been late to just about everything, the effort required to plan her day, watch the clock and make it to the school on time is nothing short of Herculean.

"I lose track of time," she says, flushing pink with embarrassment.

On the console beside her seat in the van are two library books she needs to return. Both are overdue.

Anthony, 6, dressed in his nicely pressed uniform blue shirt and gray pants on this crisp fall day, smiles at her as he climbs into the car seat behind his 3-year-old brother, Christopher. Anthony chatters non-stop about the art project he did, what he ate for lunch and how he had a "green" day. A green day means he didn't interrupt the teacher, pester his classmates, jump up from his seat, fidget, forget to turn in his homework, space out wondering about the clouds out the window or stare at the blank paper on his desk that was to be filled with classwork.

Suppers, 30, pulls out of the parking lot and begins to explain that Anthony has attention-deficit hyperactivity disorder, or ADHD.

"Mommy," Anthony chirps from the back of the van.

She says that, although he's smart, he has a tough time sitting still or getting going on things that bore him, such as homework, and that he is easily distracted or frustrated in school.

"Mommy," Anthony says.

And she says that, the more she learns about his ADHD, the more she wonders — "Mommmmmy!" — whether she has it herself.

Suppers quit a job a few months ago that she loved but didn't think she could manage along with the house and the kids. Now she braces herself daily for what is her most stressful time of day: managing to keep their two dogs outside and Christopher downstairs in the playroom so the living room will be quiet. That's where she helps Anthony with the homework that is always a fight to get him to do.

The living room is neat, despite the understandable chaos of toys and balls and piles of newspapers that come with busy family living — the result of yet another late-night effort to tidy for company. But in the kitchen, the counters and table are awash in scraps of paper, kid artwork, opened and unopened mail, bills and toys. For meals, Suppers sometimes shoves the clutter to one end, and the family eats at the other. Lately, they've taken to eating in front of the TV in the living room.

Although parts of the house are a jumble, Suppers makes a big effort to keep the kids organized. She spends hours in their playroom, tidying up. She makes sure their days have the routine that she never had as a child and struggles with still as an adult. Suppers herself often won't make it to bed until after midnight, and then she can fall asleep only after hours of TV or games on her iPod.

Her husband, George, arrives home. He takes over cooking dinner when she gets distracted looking through piles of paper on the counter for a sticky note he left her about a car repair the week before that she forgot about.

He is convinced that she has ADHD. He teases her that she has never made a decision in her life, not even about what to order for dinner. "There's just always way too much stuff going on in my head," she says. "It feels kind of silly trying to make serious conversation about it. Other people have it so much worse. I think if I didn't have the kids, I'd think, this is the way I am, so whatever. But I worry about passing it on."

Largely undetected

The hallmark symptoms of attention-deficit hyperactivity disorder — the inability to pay attention, get organized; start or finish tasks; a penchant for spacing out, forgetting or losing things; and, for some, the inability to sit still, stop talking or be patient; and a tendency to act or blurt things out impulsively — have long been thought to affect only children, particularly boys.

In the 1990s, studies to determine the causes of ADHD began to indicate that it ran in families, and that the disorder could last a lifetime.

Now, surveys by Harvard Medical School, the National Institute of Mental Health and the World Health Organization report that, conservatively, about 4.4 percent of adults in the United States, or 8 million people between ages 18 and 44, have ADHD, making it the second most common psychological problem in adults after depression. With only 15 percent having a diagnosis or seeking treatment, most of them, apparently, don't know it.

Adults with ADHD have been found to be more likely to lose jobs, change jobs or not show up for work, costing an estimated $77 billion a year in workplace failure. They are more likely to get divorced, go broke or be arrested. They have four times as many accidents. They experience more relationship difficulties, sleep problems or substance-abuse addictions. They have higher rates of eating disorders, depression and anxiety than the general population, and lower educational attainment and earning potential. Those with hyperactive symptoms also have been found to be at significantly greater risk for injury, non-surgical hospitalizations and poisoning.

Nearly half of the estimated 5.2 million American in 2005 taking prescription ADHD medicine — the majority of which are classified as Schedule II controlled substances so powerful that they can be prescribed only in 30-day doses — are adults. Women, whose average age at diagnosis is 36 to 38, now account for the fastest-growing group taking prescription ADHD medicine, increasing 164 percent between 2001 and 2009, according to Medco Health Solutions, which tracks prescription drug trends.

Much as the 1950s became the Age of Anxiety, have we entered a new Age of ADHD?

Absolutely, said Dr. Patricia Quinn, a physician in Chevy Chase, Md., who was one of the first to work with girls and women with ADHD 30 years ago.

"Women with ADHD are the true 'desperate housewives,'" she says. "They come to me saying, 'I'm running as fast as I can to do what everybody else seems to do so effortlessly, and I can't keep up.' They stay in the closet a long time, suffering in silence. It's a messy closet. But they work hard to compensate, often staying up late into the night to get everything done. Until they get to the point where they're so overwhelmed, they're no longer able to cope."

It's not that women are suddenly coming down with ADHD. It has been there all along, Quinn says, and no one noticed. As girls, these women were more likely to be spacey, inattentive, easily distracted and disorganized rather than hyperactive — the last of which, for decades, was considered the key to diagnosis.

Quinn, who founded the National Center for Girls and Women With ADHD, has ADHD herself.

Critics of the increasing ADHD diagnoses say the disorder is just the latest medical fad, that it is overdiagnosed and that too much medicine is being prescribed too freely based on the results of studies paid for by large pharmaceutical companies looking to expand their market without understanding the long-term consequences to the human brain.

A moment of truth

Michelle Suppers first began to suspect that she might have it in the summer of 2009. Anthony was 4. He was a sweet, smart kid, but he couldn't sit still. He argued constantly. And he got into impulsive fights with other kids at two preschools. On the advice of a concerned teacher, she took him to a behavioral specialist, who gave her and George reams of questionnaires to fill out.

One night as they completed the paperwork, Suppers began to see not just her son but herself, especially in one question: "Does your child exhibit any repetitive or self-stimulating behaviors, such as spinning, rocking, lining up toys or head banging?" That wasn't Anthony. It was her. She has always rocked. Even now. George just gently puts his hand on her arm to still her when they watch TV.

In December, Suppers finally makes it to a psychologist for a screening. The psychologist goes down a checklist. Difficulty concentrating. Distracted. Disorganized. Restless. Fidgety. Impulsive. Mood swings. Excessive talking.

"There's a party going on in your head. Everything's all jumbled up inside, and you don't know where to begin?" Suppers nods. "And this has been going on since you were a child?" Suppers nods again. "You meet all the criteria," the psychologist says.

"It's kind of a relief, knowing I have ADHD," Suppers says later, at home. "Rather than just thinking I'm nuts."

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