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adhd

diagnosed with adhd: managing treatments and finding support

when heidi bernhardt’s first child was diagnosed with adhd in the late 1990s, she started looking for organizations that offered resources and supports.

by robin roberts

apr 10 2024

10 minute read

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with the right supports, children and adults with adhd can become highly successful. getty images

when heidi bernhardt’s first child was diagnosed with attention-deficit and hyperactivity disorder (adhd) in the late 1990s, she started looking for organizations that offered resources and supports. she found very little. so, in 2000, she founded her own.

toronto-based centre for adhd awareness, canada (caddac) has since grown into a national charity that provides education, advocacy, coaching, conferences, workshops and support groups for those diagnosed with adhd, as well as for parents and teachers of kids with adhd. bernhardt’s organization also works with experts, governments, patients and caregivers to increase awareness around the disorder and decrease the stigma and misinformation that sometimes comes with it.

combined with her background in psychiatric nursing, the process of assembling an abundance of resources and experts helped bernhardt navigate the healthcare system when her other two sons were also diagnosed with adhd (her husband also lives with the disorder).

here’s how you can manage an adhd diagnosis.

learn more about adhd

most children can occasionally be inattentive or excitable, just as many adults can be impulsive, forgetful or have trouble with organization and procrastination. but when those behaviours are chronic and interfere with people’s daily lives and the lives of others, it can fall under the definition of a disorder.

adhd is a neurodevelopmental condition defined as “a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development,” according to the canadian paediatric society . it is the third most common mental health disorder in the world, after depression and anxiety, and the most common neurodevelopmental disorder in children, affecting anywhere from five to nine per cent of children and three to five per cent of adults, according to caddac .

although research has not concluded precisely what causes adhd, the consensus is that it’s highly heritable — if a parent has adhd, it’s more likely their child will have it. and if a child has it, one or more of their siblings are also more likely to have it. other contributors may include exposure to environmental toxins, such as lead and pesticides.

there are three types of adhd: hyperactive, inattentive, and a combination of the two. hyperactivity in children (most often boys) is characterized by fidgeting, impatience, inability to sit still, excessive running or climbing, interrupting others and intruding on conversations or games.

in adults, signs of adhd can include impulsiveness, restlessness, disorganization, poor time management skills, problems focusing on tasks, and difficulty planning.

people with inattentive adhd (primarily girls) have trouble paying attention and focusing and are easily distracted. being in a noisy or stimulating environment can worsen symptoms. ( caddac maintains a more detailed list of symptoms.)

those living with the condition can also become overwhelmed, frustrated or are quicker to anger because they are often unable to express their emotions.

a common misconception is that people with adhd are lazy or not bright, but the condition does not affect iq. they are just as smart as anyone else; they just learn differently and may require extra supports.

more seriously, many people with adhd often experience co-existing mental health disorders and are prone to risk-taking behaviours such as gambling, internet addiction, alcohol and substance abuse, which can lead to tangles with law enforcement. they are also involved in more accidents and injuries, which can result in earlier death.

get an official diagnosis

the first step for anyone struggling with these symptoms is to get a proper diagnosis. but even though adhd has been documented for over 300 years and is one of the most researched mental illnesses, it remains under-recognized and misdiagnosed in canada—mainly because many family doctors are simply not taught it in medical school. it can also present differently from one person to another.

therefore, diagnosing the disorder, following the criteria outlined in the diagnostic and statistical manual of mental disorders , can take time—up to two days.

“it’s a matter of going through a process of eliminating anything else that could be mimicking the symptoms, [such as] hormonal, thyroid, hearing, or eyesight issues,” says bernhardt. “if there are learning issues, [you need to make] sure it’s not caused by a learning disability, or any other mental health disorders, [such as] anxiety or depression, personality disorders or substance abuse, because some of those can also affect attention regulation. and it’s rare, especially by adulthood, that there isn’t a coexisting disorder.”

for kids, symptoms must be present by the age of 12 for a conclusive diagnosis. according to kelty mental health , about two-thirds of children will continue to have symptoms into adulthood.

a primary care physician or psychiatrist can diagnose (and prescribe medication for) adhd by taking your medical history, often with input from family, friends, colleagues and teachers, and evaluating your academic, social and emotional functioning, as well as development level, according to children and adults with attention-deficit/hyperactivity disorder (chadd).

these sessions are usually covered by public health insurance.

a registered psychologist can also diagnose adhd, often utilizing broader assessments by evaluating cognitive abilities, academic skills, and socio-emotional functioning to diagnose learning difficulties. however, according to toronto’s adult adhd centre , a psychologist cannot recommend or prescribe medication. public health insurance does not cover a psychologist, and treatment can run upwards of $3,000.

there are less expensive avenues through different adhd clinics across the country. these clinics can assess, prescribe medication, and provide ongoing therapies such as coaching, educational workshops, and skills development sessions, costing anywhere from $300 to $1,000.

“the health care system can be rather confusing to navigate because of the different medical professionals, and it varies for the age level,” says bernhardt. “a child is generally treated by a pediatrician, but it should be a developmental pediatrician or a pediatrician that’s been specifically trained in adhd and neurodevelopmental disorders.”

she says many kids with adhd also have autism, tourette’s syndrome or other learning disabilities, so a differential diagnosis needs to exclude or include those conditions.

“adhd is a very individualized disorder,” says bernhardt. “we say in the profession, ‘if you’ve seen one kid with adhd, you’ve seen one kid with adhd.’ you can have a very inattentive, hyperactive boy who is very disruptive, moving around the classroom, talking, and climbing on chairs, and you can have a very quiet, daydreamy little girl sitting at the back of the class who is not getting her work done because of issues with attention regulation. they both have adhd, but they look very different.”

she says it’s important to note that attention regulation can go both ways: a child may be inattentive, but he can also be over-focused. “if their brain latches onto something that they’re very interested in—has a lot of stimulus, immediate feedback—we can’t get them to disengage, and they have difficulty switching focus or prioritizing their focus on what’s most important, not what’s most interesting or stimulating.”

with primarily inattentive adhd, which is present more often in girls, it’s less likely to see impulsivity and hyperactivity, which is why these kids are frequently misdiagnosed. she says it’s a challenge to train medical professionals to look for the signs that differ between boys and girls. but she’s optimistic. “twenty-five years ago, we weren’t talking about girls and women with adhd; we just had statistics that showed it was three boys to one girl who were diagnosed. when you get to adulthood, now it’s one-to-one. that’s telling us we’re missing the girls in childhood because you don’t develop adhd in adulthood.”

understand types of treatment for adhd

a combination of medication and therapy has shown to be the most effective treatment. medication doesn’t cure the condition, but it does decrease many symptoms. and while adhd medicine has been around for over 70 years, it has improved over the decades and is less likely to be abused.

broken into two categories— stimulating and non-stimulating, short-acting and long-lasting —adhd medication, like all pharmaceuticals, comes with some risks, including to the cardiovascular system, according to the centre for addiction and mental health (camh). more than half of people stop using their medication because of side effects, and another 10 to 20 per cent just don’t respond to it at all.

“you often have to try two, three, six [kinds] to find the right one that fits you at just the right dose,” says dr. doron almagor, child, adolescent and adult psychiatrist and founder of assessment and treatment centre possibilities clinic in toronto. “it’s important to work with your doctor to find the right medication, and most people can find something that helps.”

almagor says medication should always be combined with lifestyle changes and good organizational habits. maintaining regular exercise, having a healthy diet, and getting adequate sleep are important for managing symptoms.

cognitive behavioural therapy (cbt) specifically for adhd is short-term goal-oriented psychotherapy that targets negative thoughts, feelings and behaviours that interfere with managing time, completing projects, scheduling and organizing.

almagor says these non-pharmaceutical therapies are often underutilized. “people think medication [suffices], but that’s often not the case. [at possibilities], we use multi-modal treatments—coaching, modified cbt for adhd, parenting techniques and therapies, and programs that therapists can work with parents on. those are most helpful when you find a medication that works alongside them. the medication helps the brain focus more, be less hyperactive if there is hyperactivity.”

build a care team

once someone is definitively diagnosed, being under the ongoing care of their family physician for any medication adjustments, a therapist for depression or anxiety issues, and a coach for building and maintaining coping skills is ideal. it’s getting access to these professionals that is a challenge in many areas of the country. according to caddac , the longest waits are for a general pediatrician, which can take up to six months, and a developmental pediatrician, up to eight months. even a family physician with adhd training can take up to eight weeks to see.

“it’s heartbreaking to see people struggling, reaching out, being on a waitlist for a year to see a psychiatrist,” says bernhardt. “they end up seeing a general psychiatrist who tells them, ‘you’re just depressed. you need to get out more, go for more walks.’”

she says a joint study by caddac and its sister organization, canadian adhd resource alliance (caddra), noted that in the last two years in ontario, more women have been diagnosed than any other cohort. “when women get to a certain age, they can advocate for themselves medically, [and] that’s when we see more of the assessment and diagnosis. we’re [also] seeing the awareness improving.”

she says that improved awareness, however, can be a double-edged sword, depending on the information source. on social media platforms, particularly tiktok, she says more than 50 per cent of the information is incorrect.

find support and resources

to avoid misinformation, it’s vital to seek out reputable resources. kelty mental health resource centre at bc children’s hospital , for example, offers a wealth of information and resources, including tips and techniques for parents, caregivers, and teachers. while adhd is not caused by bad parenting, symptoms can be better managed through evidence-based parenting strategies.

caddac offers webinars, adult support groups, parent support groups, and adolescent coaching. “the first step in treatment should always be psychoeducation,” says bernhardt, “which is educating caregivers, parents, adults, adolescents and the child with adhd. we’ve developed animated videos for kids, available on the website and on youtube, that explain adhd to children at a child level, using terms and language as well as correct medical terms.”

“there are also videos on emotional regulation, impulsivity, and adhd in school. there’s also a series on adolescent adhd, including a group talking about how it impacts them at school and the strategies they use [to cope].”

she says there is nothing that helps parents more than talking to other parents of kids with adhd because nobody gets it like they do, which is where support groups are most helpful.

“as soon as they find out it’s hereditary, there’s a lot of guilt, although very often the parent with adhd, especially if it’s being treated, can be very helpful to that child because they understand what they’re going through.”

bernhardt says she warns parents it won’t be an easy journey. “[but] the more work, attention and support you can give these kids earlier, the more you can teach them skills that they will have for the rest of their life. it doesn’t mean they can’t grow into healthy, happy, functioning adults. will their adhd go away? most likely not, according to research. can they manage it well? yes. but again, it depends on things that happen in their lives. the big thing is getting it assessed and diagnosed, and the earlier, the better.”

she says she’s seen people getting diagnosed in their 40s, 50s and 60s who are shocked and angry. looking back over a sometimes troubled life, which may have seen multiple marriages, bankruptcies or other failures, had they known what was contributing to those troubles, and had they sought treatment, they may have avoided them.

on the bright side, most adults with adhd flourish in their lives and do well in their jobs (including famous faces like virgin founder richard branson, olympic gymnast simone biles, and director greta gerwig) because they’re able to utilize their high energy, hyper-focus, problem-solving, and creativity traits to excel at whatever they do, says bernhardt. “they often choose careers that align with their personality or start their own business so they can work in a way that best suits them.”

for more information, resources and supports, check out caddac, caddra, the centre for addiction and mental health, chadd, any of the provincial adhd clinics, or additude, a magazine specifically targeted to those with the condition. good books that focus on the disorder include taking charge of adult adhd by leading expert dr. russell a. barkley, a radical guide for women with adhd by sari solden and michelle frank, and the couple’s guide to thriving with adhd by melissa orlov and nancie kohlenberger.

robin roberts

diagnosed with adhd: managing treatments and finding support