The Cost Of Ignoring ADHD

I interviewed a young man this past week who had recently had to take a second medical withdrawal from a prestigious (and expensive) university because of debilitating symptoms of depression.  It struck him in the spring semester last year (his Freshman year) and then again this fall.  Over the summer, he had seemed to get himself together . . . but life quickly unraveled for him . . . again.  As we spoke, a pattern became clear.  He was a bright young man.  Never had to work too hard to get decent grades in high school.  Was liked by his peers and by his teachers.  But, as I soon uncovered, he had a life-long history of difficulties with his focus and concentration.  He was briefly treated with a stimulant in elementary school (details not clear), but did not seem to need medication to keep up with the expectations . . . until college.

His recent pattern of symptoms were clear.  As the expectations of his high-powered classes ramped up . . . he became increasingly unable to manage it.  He woke every morning with the hope/expectation of catching up and doing well . . . only to have his inability to focus and concentrate undermine his intentions.  He went to bed every night depressed.  And then woke up the next morning with a positive and hopeful mood . . . then went to bed depressed.  The mood symptoms grew as the semester grew . . . until it was in his best interest to withdraw.  Now he is back home . . . not stressed . . . and not depressed.  Hummmmmmm . . . . .?  Is this Major Depression needing the application of antidepressant medicine?

I don’t think so.

This pattern of experience is very common, yet often undetected by parents and school administrators who do not look past the veil of mood and behavior issues to look for underlying patterns.  These kids often get identified as lazy or bad . . . unless they are smart enough to slide by under the radar.  Parents are often frustrated because they KNOW the kid is not working up to potential.  On the inside, these kids often feel pretty lousy, too.  THEY know they could do better.  THEY know something is not quite right . . . but can’t put their finger on the reason.  As the challenges go up, the risk of failure goes up, as does the cost.  Treating the secondary symptoms (such as this young man’s depression) is not the answer.  The core symptoms . . . his ADHD . . . must be treated if there is any hope of turning this around.  This kid has already lost several years of time as a consequence of his untreated symptoms.  The parents have lost tens-of-thousands of dollars in lost tuition.  But that is nothing compared with what many other families face . . .

The effects of ADHD medicine on adult criminal behavior was investigated  in a study based on Swedish medical and court/prison records published in the New England Journal of Medicine this week.  Using the detailed records that are available, they could go back and track medication usage during periods of criminal behavior.  What they found was striking.  Use of ADHD medicine reduced the likelihood of committing a crime by 32% in men, and 41% in women.  The reduction was seen in both violent and non-violent crime.  While this is clearly an indication of the potential benefits of ADHD medicine in an adult population, it is also important to remember that it is not JUST a medication effect.  To get the medicine and stay on the medicine, a patient must be compliant with the system.  He or she will be seeing a doctor, getting therapy intervention, having contact with others who will be providing perspective and help.  That will ALSO be helpful to the man or woman making decisions about life.

So consider the cost of ignoring ADHD vs. the cost of treating ADHD.  Ignoring ADHD symptoms can lead to lost educational opportunities and the potential for earnings and life-enhancing experiences that education brings.  Ignoring ADHD can lead to impulsive and potentially dangerous behavior that can lead to incarceration or worse.  What is the cost of THAT???

It is long past time that we put stigma behind us and stop identifying ADHD symptoms as a character flaw or a sign of something left un-done by either the parents or the child.  If there is any suggestion that ADHD symptoms might be present . . . whether you are a child or an adult . . . it is imperative that all necessary steps be taken to diagnose and to treat the disorder in order to give the person with ADHD the opportunity to make the most of his or her life.

–Dan Hartman, MD

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