Attention-deficit/hyperactivity disorder (ADHD) hides.
ADHD lurks in medical fields other than psychiatry, and it wears masks. Rarely will a patient or doctor see the symptom or the diagnosis as a manifestation of ADHD. And less often will either consider evaluation and treatment of ADHD as a pathway to health.
When physicians see recurring infections, we check for diabetes. But when we see recurring accidents we don’t think of ADHD — so we miss the ADHD diagnosis that, like the diabetes, caused the problem. And worse, the patient misses the opportunity to treat the ADHD and the problems it leads to medically, financially, socially and emotionally.
I practiced family medicine for 20 years before I opened my ADHD clinic. It scares me how oblivious I was to the ADHD causing or worsening many medical conditions I was treating.
ADHD is “running away from boredom.” When we’re bored, the kitchen or our favorite fast-food place isn’t far. It’s no wonder, then, that inattentive ADHD is associated with boredom eating, obesity and its complications — hypertension, diabetes, cardiac issues and more. And the inattentive ADHD that is common in women is a frequent cause of obesity. Textbooks list medical causes of obesity, but I’ve never seen inattentive ADHD on those lists.
Smoking-related disease is a huge burden, yet the smoking rate among those with ADHD is twice that of those without the condition. Why? Nicotine turns on the bored brain and relieves its discomfort. We blame smoking for bronchitis, pneumonia, hypertension and lung cancer.
But the doctor who says, “Mr. Jones, you have bronchitis because you smoke” should say, “You have emphysema because your ADHD isn’t treated.” Persistent smoking despite diagnosed lung disease or cancer mystifies doctors, but a desperate, bored brain explains it.
Restless Leg Syndrome (RLS) — sometimes referred to as “ADHD at Night” — is a subconscious way to satisfy a bored, hyperactive brain asked to lie still in a silent room with lights off and eyes shut. So, your brain compels you to roll around, move your legs, toss and turn — and not sleep deeply. I look for ADHD whenever I see RLS. I treat it with stimulants in the evening and the patients go right to sleep. However, neurologists don’t list ADHD among causes of RLS.
Insomnia is common in those who have ADHD. But for them, it would be more appropriate to refer to it as “Restless Brain Syndrome.” The brain revs up to combat the lack of sensory input, leading to insomnia. Rather than prescribe a sleeping pill, treat the ADHD instead.
Roughly 10% of Americans have ADHD, but 40% of the wetting patients in pediatric urologist’s offices do. Kids with ADHD sometimes don’t notice full bladders — or do and don’t want to take time out to solve it. But no urologist has asked me to check into ADHD.
Fibromyalgia can also be tied to ADHD. Brains in people with ADHD run at night, protecting their owners from deadly boredom. But a running brain doesn’t allow the deeper, restorative sleep we need. Muscles never loosen and trigger points form. ADHD is always there so the sleep defect stays, as do the aching trigger points. A rheumatologist diagnoses fibromyalgia though many of these patients have undiagnosed ADHD who can get relief from a trickle dose of stimulant through the night.
How many unplanned pregnancies result from forgotten condoms, missed birth-control pills and plain impulsivity? But I can’t recall an ADHD referral from an obstetrician.
Finally, there’s the question of medication adherence. Do patients with ADHD miss more doses? Do they forget more appointments? I’m sure of it. Multiply that by 10% of the population and many patients won’t be doing as well as they could be.
For a moment, forget ADHD’s classic signs: Hyperactivity, impulsivity and inattention. Instead, seek ADHD hiding in medical conditions — and the medical conditions hiding in ADHD. Let’s aim for reduced disease, better sleep, fewer accidents, less pain, less sick time, lower blood pressure, cleaner lungs and even reduced health costs.
October is ADHD Awareness Month. Let’s start looking for ADHD in more places.
John I. Bailey, MD, is the medical director of the Center for Attention and Learning in Mobile, Alabama. He has been a member of the professional advisory board of the Attention Deficit Disorder Association since 2003.