Identifying masked ADHD

ADHD exists on a spectrum from mild to moderate to severe. At the mild end of the scale, it is difficult to decide where normal everyday distractibility ends and ADHD begins. Many people manage their lives adequately at the mild end of the scale. For others who are between moderate and severe on this spectrum, life is a struggle. This struggle begins once they go to school, and for some even before that. Their challenges can be significantly improved, however, if they are diagnosed and treated correctly for their condition.

If, however, they belong to the group whose ADHD symptoms are masked and they do not get treated, their struggle will almost certainly increase as the demands on executive function increase. Some will manage if they work much harder than their peers, but the effort needed to reach their goals can lead to early burn-out, depression, anxiety, and sometimes addictive behaviours.

This group will invariably try to compensate for their untreated ADHD symptoms by using strategies that will not always be healthy, family-friendly, or ultimately beneficial. Others will stop trying to compensate long before they have finished their education and will end up in low-paying employment that does not satisfy them intellectually. Some will not be able to cope with life at all, resulting in a slew of negative consequences.

This is not a pleasant forecast, nor is it necessary. If enough effort is made to identify even the most “hidden” forms of ADHD as early as possible, the prognosis can be much better.

Children and adolescents with masked ADHD may include the following

• Boys and men with inattentive type ADHD.
• Girls and women with all types of ADHD.
• Women and men with a learning disability and/or who are autistic and who also have ADHD.
• Gifted men and women with ADHD (sometimes called Twice Exceptional).

Children and teens with all types of ADHD may

• Have problems with sleep (falling sleep, staying asleep, quality of sleep, etc.).
• Have very low self-esteem.
• Often feel emotionally overwhelmed.
• Often feel overwhelmed at school.
• Typically experience stress more acutely than their peers, and thus need more time for themselves once they come home from school.

Coexisting conditions often mask ADHD

Coexisting conditions often mask ADHD symptoms. If a child or adult is diagnosed with the coexisting condition first, there is a real danger that the ADHD symptoms will be attributed to the coexisting condition and will therefore remain untreated.

Coexisting conditions include

• Dyslexia, dyscalculia, dyspraxia (DCD), etc.
• Autism.
• Language disorder.
• Anxiety disorder.
• Depression.
• Obsessive-Compulsive Disorder (OCD).
•  Oppositional Defiant Disorder (ODD).

This can happen when a child or adolescent is diagnosed with dyslexia, for example. Parents and teachers are more likely to look for dyslexia solutions for all of the child’s problems, even if part of them are caused by ADHD. This can be avoided by asking for a multidisciplinary diagnostic procedure at the outset.

It is worth bearing in mind that there is a 35-50% chance of a person having both dyslexia and ADHD. Parents and teachers should be especially vigilant about this because the symptoms of inattention are said to also be a feature of dyslexia. However, if the inattention is more than the low-level expected in dyslexia, this is an indicator that a person could also have ADHD; there are other indicators which are listed below that can be also taken into account.

Sometimes, the initial diagnosis is autism. The ADHD symptoms may not be so obvious in these cases, or wrongfully attributed to autism. Further assessment for this condition is necessary.

When an autistic child or adult has ADHD as well, sometimes stimulant medication does not bring the desired results. In such cases, it is important that parents or individuals explore all of the ADHD medication options available rather than giving up on medication entirely. This requires a lot of patience and is not always easy, but it is ultimately well worth the effort in terms of quality of life.

Anxiety disorder is another coexisting condition that can mask ADHD symptoms. It is worth bearing in mind that it is difficult to treat anxiety disorder successfully if the underlying ADHD is not also treated appropriately, especially if the anxiety is the result of untreated ADHD.

Some further indicators of ADHD are

• A child or adult may exhibit other symptoms that are not ADHD-related, but still fit an ADHD profile.
• They may be excessively irritable.
• A child or adult may be very bright, yet underachieving.
• A person will have (severe) concentration problems.
• A child or adult will have pronounced distractibility issues – unless they are hyperfocusing on an area of interest.
• They may not be able to relate to peers in ways that are considered socially appropriate, and may have difficulty with forming and keeping friendships.
• A person may be quick-tempered and aggressive.
• A child or adult is usually disorganised.
• They have little concept of time/money.
• They may be seen as “out of control” at home.
• They may have a poor relationship with teachers or employers.
• A person may have personal hygiene issues.
• They may blame others for their actions, especially when trauma is involved.
• A child or adult may be emotionally cut off from others, as well as have some symptoms of ADHD.
• They may seem depressed.
• A person may seem extremely oppositional.
• They may exhibit obsessive-compulsive traits.

Gifted children or adults with all types of ADHD may

• Spend much longer doing assignments than their equally gifted peers.
• Pick up and drop many activities.
• Get by at secondary school or work by using strategies that are not always positive.
• Have very low self-esteem as a result of their “hidden” struggle.
• May first experience difficulties when they go away to university.
• Drop out of school or university in spite of their intelligence level.
• Experience a lifetime of underachievement, if not detected and treated.

The hidden consequences of ADHD include

• The person becomes demoralised and has low self-esteem.
• They may think of themselves as “stupid”, and chronically under-function.
• A child may become bitter and dissatisfied as an adult.
• An adult may eventually begin self-medicating to blur reality or to elevate chronically low dopamine levels, leading to addiction risks.

It is vitally important that ADHD is recognised, diagnosed, and treated before these problems start.