clinically significant ambiguity
October 30, 2012 4:22 PM   Subscribe

How successful is "too successful" for a person to have untreated adult ADHD? On the CDC website one criteria is "IV. There must be clear evidence of clinically significant impairment in social, school, or work functioning." What counts as a "clinically significant impairment"?

ADHD is suppose to inhibit a person's ability to succeed, however you want to define it, in school, their social life, family, work ... maybe a few other areas. But, if you've had some success, can you really be diagnosed with ADHD?

For example, if you graduate high school could it still be said that you have ADHD? What about college? Graduate school? If you can have a job for a one year, does that mean there is no way you can have it?

My point is: where do you draw the line? Is there some standard, or is it just a matter of opinion? Personal stories from people who have been diagnosed with ADHD in adulthood, or people who got checked out, but weren't diagnosed would be appreciated.
posted by cupcake1337 to Health & Fitness (14 answers total) 12 users marked this as a favorite
ADHD is suppose to inhibit a person's ability to succeed, however you want to define it, in school, their social life, family, work ... maybe a few other areas. But, if you've had some success, can you really be diagnosed with ADHD?
Sure. Look at Ned Hallowell - a PhD... who has ADHD. The severity, like many disorders, is on a spectrum - some are lightly affected, some more severely. Some people are fine with some therapy to help them with some coping tools, and some need therapy and medicine to really make a difference.

I'm guessing that a better way of phrasing "clinically significant impairment" would be with the word "measurable." As in, from the person's educational, social, relationship, professional past, are there typical behavior patterns, responses, occurences, and such that are a) typical of people with the disorder and b) that had some negative effect?

And in case you didn't see this thread: Your ADHD stories.
posted by canine epigram at 4:37 PM on October 30, 2012

Part of the problem is that so many people (with and without ADHD) don't get a chance to find a real fit for their skills and talents. Until that happens, they waste a lot of time with coping mechanisms... which may themselves lead to more difficulty.

Some people have success BECAUSE of ADHD. I'm actually much more productive when I'm busy. I've had trouble with lower-level jobs that included a lot of smaller tasks or stretches of free time, but I have no doubt that the higher I go in my career, the more successful I'll be, almost exponentially -- because I will have tasks that draw on my strengths and not my weaknesses, and I'll quite possibly have other people to assist me with the other stuff.

EMTs are a great example of a career in which people with ADHD can really succeed. They're the kind of tasks where quick thinking really pays off, and where you need to not meander but DO SOMETHING, NOW.

As another example, I've described elsewhere that I was very successful on Jeopardy. I KNOW it was because I have ADD. I have a wide breadth of really, really trivial knowledge because one of my coping mechanisms is to keep my mind engaged by reading anything I can see. More importantly, however, my brain makes those quick leaps very easily, without having to recalibrate from category to category.

Bringing that back to being successful in my job, I get a lot of tasks done more quickly than other people because of those logical leaps. So staying busy, then, means that I pack more in.

But my bosses, who love me dearly as a person, have gritted their teeth QUITE a lot when it's come to things as simple as filling out a tmesheet. So... ymmv.
posted by Madamina at 4:58 PM on October 30, 2012 [10 favorites]

Well, first of all, the DSM-IV's ADHD definition is widely considered to be too child-centric, and changes for the next edition are being proposed to describe some of the symtoms adults with ADHD might show.

Second, impairment in functioning doesn't negate the possibility of success. ADHD doesn't preclude intelligence and if a student is bright enough to understand concepts without studying, then they'll do ok on tests (although procrastination might become an issue with assignments). Graduating from high school, college, or being able to hold down a job is a very low bar-- ADHD isn't necessarily *that* limiting.
posted by acidic at 5:00 PM on October 30, 2012

I'm 30, and I was diagnosed by a with ADHD two years ago by my psychiatrist. I completed high school and college, and I've been pretty consistently employed since I left college. None of that seemed to come into play when it came to my diagnosis.

I had some trouble in middle school - forgetting assignments, getting poor grades despite being pretty smart for my age - but I went to a private high school and got lots more individualized attention, and that seemed to take care of a lot of the issues.

For me, my diagnosis came way more from my anxiety, my overly rapid speech and thought pace, and my obsessive thoughts. I've been misdiagnosed over the years - bipolar, depression - but when all my symptoms were re-examined with ADHD in mind, it all made sense.

So obviously my ADHD is way different than someone else's, but it doesn't mean I don't have it just because I did ok in school and work. I was put on Ritalin after my diagnosis, and it helped almost instantly, so I figure that's a good enough indication for me.
posted by dithmer at 5:00 PM on October 30, 2012 [2 favorites]

Madamina has a lot of it. I'd mention a couple of other things:
1. Success-limiting factors are hard to isolate. Someone with ADHD may also have drug issues, anxiety, a touch of depression, whatever. It's hard to pinpoint what exactly is the limiting factor. Or more precisely, which factors in which proportion, in regard to which efforts, are most limiting.
2. Circumstances are important. An independently wealthy person who's passably artistic -- with ADHD or even a heroin addiction -- can produce astonishingly beautiful work. Could they have done better? Hard to know.
posted by LonnieK at 5:27 PM on October 30, 2012 [1 favorite]

My point is: where do you draw the line? Is there some standard, or is it just a matter of opinion?

My experience with people who have had it and gone through the diagnosis process was that there were a few things that mattered

1. the ADHD thing was a problem for them. So while they might be able to be productive, it came at great emotional "expense" and seemed more difficult for them than some sort of average person [I dated an ADD guy who was going through law school and he managed to graduate but he was really tortured by assignments and some of the organizational stuff that, to my non-ADHD mind, was not that impossible but his mind just couldn't grasp it and that made him sad]. So if you feel it's affecting your life, that's a data point even if what you think it's keeping you from is being more successful than you already are. There's a sense in which "working up to potential" is a think you think about.

2. a medical professional agreed with the assessment that ADHD and not some other addressable issue was the core problem (ADHD co-presents with a lot of other things that can really exacerbate the problem, sometimes treating the side issues can made the ADHD manageable with CBT and other non-med options)

3. treating the ADHD with standard treatments lessens or reduces the symptoms. I know this sounds something like a tautology, but if you try Ritalin for your ADHD and it makes you much more able to focus and deal with your life and much less anxious and whatever, then it's easier to say "Okay it looks like we've got it!"

I have a current partner with ADD (diagnosed as a kid, rediagnosed as an adult after a stressful period in his life) and he's decently functioning most of the time [went to college, grad school, has a son, maintains a job] BUT when he's under stress (which can be anything from normal "aaa it's the holidays!" stuff to some sort of problems at home or moving apartments) he basically stops being able to think. Forgets basic things about me, our relationship, time/date stuff, etc. On an average day he can stay focused enough to function. On a worse than average day he sort of falls apart and Ritalin or some equivalent (he already has a healthy eating and exercise routine that helps immeasurably and I think is responsible for his normal day-to-day abilities) helps him deal with that.
posted by jessamyn at 5:30 PM on October 30, 2012 [8 favorites]

For me all it took was having the kinds of problems typically described by people with ADHD, and crying about them in therapy. :)

I graduated from college, but it took me absolutely forever and there are quite a few "wacky ADHD" and "wacky OCD" and "wacky bipolar" stories from those ten years.

I did really well on standardized tests - the only thing that means is that if I ever take another one it'll be harder to get accommodations; they didn't once suggest that meant I "don't have" ADHD.

I respond really well to Vyvanse (primarily in terms of concentration;) they definitely believe me to be ADHD more now than they did before that happened. The ways I've benefited from classic ADHD organizing tips

Oh - and it helped a LOT that my therapist came up with the idea, rather than me agitating for it. She even talked to my psychiatrist and argued for the diagnosis.
posted by Fee Phi Faux Phumb I Smell t'Socks o' a Puppetman! at 8:06 PM on October 30, 2012

High school graduate (top 10 in class), college graduate (Seven Sisters college with a 3.0 GPA), solid work history.

Diagnosed ADHD at age 37.

My diagnosis was kind of reverse-engineered (I've mentioned it a few times before here) - I started taking Wellbutrin for depression and wow, I'm actually sitting and getting boring tasks done rather than flitting off and doing something else OH MY GOD IS THIS WHAT A NORMAL PERSON FEELS LIKE?!??!?!* and then the feeling wore off and the Wellbutrin gave me hives so I went to Celexa for the depression but I really, really, really missed the focus that I had.

A few months later I discovered that Wellbutrin is sometimes used to treat ADHD, so I went to my doctor and the rest is history.

After I'd been on it for a while, I remembered incidents that, with 20/20 hindsight, should've let me know something was up. I had trouble remembering assignments in grade school, I never really learned how to study properly, I got written up a few times at one job because I kept going on the internet instead of doing the BORING tasks I was supposed to be doing. I used to get told all the time (at work and home) that I talked too loudly; this also happens sometimes to people with ADHD.

They were minor incidents, not causing "clinically significant impairment". If I hadn't taken the Wellbutrin and had that experience, I probably never would have even considered ADHD as a possibility. But I am *so* glad I did, because it's made *such* a difference in my life.

*Actually said by me, out loud, when driving from work one afternoon and making a mental list of all the things that needed to be tidied when I got home
posted by Lucinda at 8:25 PM on October 30, 2012 [3 favorites]

Um, I have ADHD. Was diagnosed by a psychiatrist and a gp initially at 11, via medical testing again just after I turned 30, and I have always been a straight A student/engaging in a million extracurricular activities/got promoted and was successful at every job I've ever had. Outgoing, too.

All the hyperfocus that comes with ADHD is great for things like taking standardized tests, long-term research projects, fact-checking, writing essays, reading, etc. Studying was easy, as long as I doodled while I listened to the lectures (multiple stimuli helps, for some reason).

However, that level of obsession and emotional attachment to completing my projects and goals - as well as an inability to sleep/relax until I've reached The End, whatever that means - often had pronounced and frequent drawbacks which flare back up when I'm unmedicated. The worst of it: recurrent, severe insomnia, panic attacks, catastrophic thinking, isolating myself socially in favor of working late or finishing a book in one sitting, and forgetting to eat/drink water for up to 8 hours at a time.

As a child, the most prominent symptom was stuttering. The prevalence of stuttering in children with ADHD is 4-26%; the ratio of male-to-female ADHD sufferers is 2 to 1. I did two years of speech therapy to get rid of it by 3rd grade; before that, it felt like my mouth couldn't go as fast as my brain, and it still kind of feels that way today (my handwriting's shit, but I type scary fast).

While these issues did affect some of my past jobs and interpersonal relationships, I'm managing it well today. But really, many of these symptoms specifically helped me excel, especially in college.

Success has never been an issue; letting things go and taking time to care for myself properly so I don't allow stress to affect me physically is another story.
posted by Unicorn on the cob at 10:25 PM on October 30, 2012 [4 favorites]

I'm another overachiever with ADHD. Diagnosed as a kid, went off meds in high school, went to an Ivy-equivalent college and am currently in a top-5 for my field school. I went back on meds a year ago. I was able to do so well just by putting in way more hours. I was spending much more time on my work in high school, even though I was objectively smarter than most of my classmates, simply because so little of my so called "study time" was spent actually studying. Of course this strategy only works for so long, which is why I got back on meds. Success is relative to your potential, so you can definitely be extremely outwardly successful even while battling ADHD and feeling like a failure because of it.
posted by matildatakesovertheworld at 12:56 AM on October 31, 2012

Yeah, I was diagnosed with ADHD as a kid and again a bit later as a young adult. I took Ritalin for a short while the first time around, basically until my parents let me stop, but I haven't done any sort of treatment for it since.

I'm a pathologically terrible procrastinator, I lose important objects constantly, and I've structured my life to avoid having to pay attention to certain kinds of things, but I got a degree and I make my rent every month (shit what day is tomorrow?) and I hold down a job that feels to me like it entails a decent amount of responsibility. I can't offhand think of any level of personal or career success that would cause me to think "there's no way that person could be within the range of what is very typically diagnosed and medicated as ADHD".
posted by brennen at 1:27 AM on October 31, 2012

Well, I sought diagnosis because I was struggling with grad school. So I got into grad school first? I probably wouldn't still be here if I hadn't sought help.
posted by oceanjesse at 3:27 AM on October 31, 2012

People can certainly be diagnosed with ADHD that are outwardly rather successful. Someone I know very well was diagnosed and prescribed drugs when at the time of the diagnosis they had already gotten a PhD, worked several professional jobs and begun raising a family.

But all those things were a huge struggle for my friend, and they had to grapple with every thing that you might imagine an ADHD person would have to deal with.
posted by philipy at 8:17 AM on October 31, 2012

A clinically significant impairment from ADHD is generally a significant difference between actual and potential functioning for the individual, due to ADHD symptoms, as judged by a trained medical professional with ADHD experience. Your average GP is not necessarily an experienced professional.

It's perfectly possible - and I know people who have - to get a PhD and have ADHD. Or hold down a highly paid job.

Some (real-story) examples:

- someone who regularly managed to burn every third meal they cooked, due to simply forgetting they were in the middle of cooking and had a pan on the stove or in the oven.

- someone with an extremely high IQ, who had every single school report say 'could do better if they tried/made less careless mistakes/did their homework' who was winning national awards in time-limited academic competitions through highschool. Of course, hyperfocusing through a test is an entirely different kettle of fish to long-term academic success. They were diagnosed in their last year of undergrad.

- someone who simply took twice or three times as long (or longer!) to do the same thing as anyone 'normal' due to simply being unable to concentrate. They got everything done - they were just stressed, depressed and unhappy from A) not having any time for relaxation or a social life, and B) feeling like a failure because everything was so 'hard' for them.

There are no hard and fast rules like 'holds down a job,' 'finished x level of education with y mark,' 'enjoys reading books,' 'seems successful,' much as those without experience in the field like to make judgements.
posted by Ashlyth at 7:57 AM on November 1, 2012 [2 favorites]

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