Dear Therapist:

My primary care physician recently told my husband that he thinks he has ADHD. My husband never had that diagnosis as a child, though I am not sure that means anything because he had a lot of different issues going on as a kid and that may have slipped through the cracks. Baruch Hashem he is doing fine now but has had trouble staying on track, specifically in work related areas. The doctor would like to prescribe him medication, but my husband is against it. He insists that many very successful people are ADD and he does not want to "mess up his mind" with medication. I am hoping that the panel could address at least some of our current questions. Can an adult with ADHD who is not in an academic setting (vs a kid who is on school) get by without medication? Are there any nonmedication therapies that a social worker or psychologist could help with? If indeed many people are successful in work despite having ADHD, what do you think the key is to that? What types of strategies or jobs do you think work for them? In short, I would appreciate any guidance you could give us in navigating this new diagnosis.

Response:

You are correct in the assertion that many successful people have ADHD. Although this is the case, there is still something of a stigma attached to ADHD and many other mental health diagnoses. Specifically with regard to ADHD, when I have spoken with people who are upset about the label, I often ask them to imagine the following scenario. Imagine that the majority of the people in the world had ADHD. Naturally, all the institutions (like schools, government, and the workplace) would be run differently. They would cater to people who think in the way that those with ADHD think. In this type of world, people with what we now identify as ADHD would be “normal,” and those without ADHD would be viewed as needing help.

Our schools and other institutions are traditionally structured to cater to those of us without ADHD, but this doesn’t necessarily mean that ADHD-type thinking is all bad. There are certainly careers in which some ADHD can be an advantage. I know a few people who work in contracting, for example. Those who are organized and focused naturally tend to work in an organized and focused way. Those who have ADHD work  in a more haphazard fashion, focusing on many things at once. Those without ADHD may focus more on the business end of their job, hiring others to do the day-to-day work and to respond to customers’ needs. Those with ADHD might be more heavily involved in many different jobs—and different aspects of jobs—at one time, constantly juggling parts of each.

While the person with ADHD may be envious of the other person’s ability to focus and to be organized, the other person might well be jealous of the person with ADHD for their ability to handle many things at once. Although there are some people who can properly operate all ends of a business, this is not common. Most people are able to recognize their limitations and work around them.

Some people with ADHD seem to naturally find a way to accept their limitations and work within their capabilities. Others try to force a square peg into a round hole. One reason that some people do this is that they have the sense that they should be able to do things in the “normal” way. This is a sense that has traditionally been supported within the school system, in the workplace, and within society in generally. It can both affect a person’s sense of self (and therefore their motivation) and cause them to insist on working on aspects of a job that are not in their wheelhouse.

Of course, as with most things, the need for help depends on the degree to which ADHD affects someone. This, in turn, depends on the severity of symptoms, the person’s surroundings, and the way in which they are emotionally affected by their symptoms. If someone has low levels and few symptoms of ADHD, has a job and social network that conform to his needs, and is unbothered by the diagnosis, they will likely require little or no help. With an increase in one or more of these factors, the likelihood that some assistance is required will typically increase as well.

A therapist who is well-versed in all aspects of ADHD can help the person to identify the degree to which each aspect is affecting them, and can help them to manage each. There are certainly times when medication can be helpful. Some people remain on medication long-term because of the positive changes that result. Others may be able to use the medication as a crutch to help them work (often in therapy) on their issues until the point at which they are better managing them.

-Yehuda Lieberman, LCSW

 psychotherapist in private practice

 Woodmere, NY

 author of Self-Esteem: A Primer

 www.ylcsw.com / 516-218-4200

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