Subscribe to Anxiety Therapist Podcast today for the latest episodes.
Oct. 11, 2021

How ADHD Presents in Adults

How ADHD Presents in Adults

Adult ADHD is often misunderstood. In this episode, learn more about Attention Deficit Hyperactivity Disorder.

Show Highlights

  • ADHD historical background
  • Understanding the symptoms
  • Interview with Jamie Roberts Nelson
  • Show Sponsor BetterHelp - Get 10% Off the first month of therapy!

Welcome to another episode of the anxiety therapist podcast. I'm your show host Frank Sasso. I'm a clinical psychotherapist out of Chicago, Illinois, if you haven't done so already go ahead and hit that subscribe button now on whatever app you're listening with this way, you never miss another podcast. in today's show I want to talk to you about how ADHD symptoms, mirror, anxiety, and what you can do about it. I'll be interviewing Jamie Roberts Nelson, a therapist who specializes in working with people who are coping with ADHD and other neurodivergent disorders.

You know, that term ADHD or ADD has a lot of negative stigma around it. And it's been like that for a long time. Now I can honestly say that to you because you see when I was a kid back in the seventies, I was told I had something called hyper activity back in those days, which in my mind, it wasn't that long ago, caregivers and teachers really didn't use the term ADHD because the diagnosis just didn't exist.


Like a lot of other kids, I was told that if I'd only try harder, that my grades would improve. Have you heard that before? Are you someone that struggles with ADHD and you've been told, just try harder? You see the problem was, it was hard for me to sit still in my seat for longer than a few minutes. And my mind would just wander off and daydream about all kinds of stuff. Nevermind, all the bad things that were happening at my own home. Many, many teachers just sort of brushed me off as this bad kid. And they didn't want to put in the effort because they just given up. It's like they talked amongst each other and said, well, we're just going to give up on him. He's a bad kid.

I'll never forget it. In my fourth grade class, I was probably nine years old. A teacher said to me, Frank, the reason you can't read the book is because you're lazy. Now imagine that for a moment. Imagine that there's some kid out there. Maybe they're in fourth, fifth or sixth grade. They're sitting in a classroom right now. And they're trying to just soak in the information and some teacher or some caregiver says, you know what, if you would just try harder or if you wouldn't be so lazy, you'd understand the material. You know what happens when a kid hears that over and over again, that message is reinforced in their brain to a point where they convinced themselves that they'll never be able to learn at the same level as other people. 

And by the way, a person with ADHD has nothing to do with being lazy. This is how the person's brain is wired. For example, I went on to get straight A's in my post-graduate studies. And that's because I learned how to cope with my own inattentiveness or my own hyperactivity. I got some help around it. But when people are out there telling these kids that they should just try harder, that's sort of like telling somebody who has an actual hearing problem, that if they would just listen better, they would be able to understand more. It doesn't make sense. It's ridiculous. 

Anyway, luckily these days we have ILPs or individual learning plans, which is a lot different from what was going on during the 70s and 80s. All right, well, today's show is going to focus on the similarities between anxiety symptoms and ADHD. And I do this because I work with so many patients who will ask me, they'll ask me, Frank, do I have ADHD? So I thought it'd be interesting to talk about that here. But before I get into that, I just want to give you a brief evolution of ADHD, where it came from and where it's at today. 

In the 90s It was referred to as hyper kinetic reaction of childhood and believe to be something that just young children dealt with. Then in the 80s, specifically 1980, the third edition of the diagnostic statistical manual of mental disorders, renamed it to ADD or attention deficit disorder. Notice they left out the hyperactive part because during that time, the assumption was that attention difficulties are sometimes independent of impulse problems and hyperactivity. In other words, the mental health world thought it was more of a problem of focusing rather than a combination of hyperactivity and in attentiveness, that's much different from how it's looked at today. Move forward a few years down the timeline, 1987, the third version of the DSM was revised and it had more of a focus on the hyperactivity part, keyword hyperactivity. At that time, they finally threw in that word hyperactivity and named it A D H D attention deficit hyperactivity disorder.

Again, there was a slight problem. They bunched everyone together. If a person had ADHD, then they automatically were thought to have inattentiveness, impulsivity and hyperactivity. And we know now that, that just isn't the case. Move forward on the timeline. 1994, 1994, the DSM releases its fourth edition, which includes three types of ADHD. So this time everyone just doesn't have everything all together. There's three different types type one is inattentive type two hyperactive and impulsive type three combined a combination of number one and two. But here's the most important thing to know in 1994, it was a big, big milestone because the DSM is much as said that ADHD can follow a person into adulthood. Think about that folks. It wasn't until 1994, until the mental health world realized that ADHD can easily follow a person into their adulthood after age 17.

In 2013, the fifth edition of the DSM list, three types of presentations. Now they call it presentation. Presentation 1 predominantly inattentive, presentation 2 hyperactive impulsive presentation, 3 combination of inattentiveness, hyperactivity, and impulsiveness. Now in order to be diagnosed with one of the three presentations of ADHD, a person must meet specific criteria, adult older than 17 need to meet five of the criteria. And then there is young people younger than 17 need to meet six. So adults need to meet five younger people need to meet six. 

Here's some fascinating information from web MD on ADHD. I'll make sure to leave you a link in the show notes. They say that over 5 million children have been diagnosed with ADHD and the majority of these kids are boys. Now this can be a little confusing because I can tell you as a therapist with 100% confidence, that there are plenty of females out there who struggle with ADHD. And since ADHD is a neurodevelopmental disorder, it makes sense that people who struggle with ADHD as kids will continue to experience as adult without any intervention Of course, it's going to follow them into adulthood. 

All right, well, according to this web MD article 4.4% of adults struggle with ADHD, we're talking about, well over a million people out there who are struggling with this diagnosis. And my guess is there are many, many more adults who have ADHD that just haven't been evaluated. And more importantly, they aren't getting any help. to make matters worse or to make more challenging. ADHD symptoms can easily be mistaken for anxiety. And again, I say this to you because I've worked with many patients who, I'm seen for generalized anxiety and they wonder do they have ADHD or some of the symptoms. And so sometimes to just make sure I'll send them out for a psychological evaluation to just rule it out, this happens. 

You might be wondering what are the causes of ADHD? Well, the truth is science isn't completely sure of how a person gets it or how it's evolved. We do know this, that genetics play a strong in, in who seems to get ADHD. For example, three out of every four, kids with ADHD have a relative who has this diagnosis. Now there's some other theories out there that are thought to contribute to ADHD. These include premature birth, the mothers smoking or drinking during pregnancy, and brain injury. Again, these are just theories that suggest a correlation, but not causality. And if you've taken a statistics class, you know, that term correlation does not mean causality. So if you're interested in understanding some of the symptoms and what you can do about it, stick around lots to get to in my interview with ADHD specialist, Jamie, Roberts Nelson.

Hey, before we began, I want to share something with you, you know, I used to be really skeptical of any kind of online therapy or tele-help. I was one of those people that thought therapy could only be done. Face-to-face and wow was I wrong? You see a few months after COVID-19 started, I began to notice that within me, I was starting to feel anxious and depressed. So even as a therapist, I fell prey to those sad feelings that go along with prolonged isolation. When I tried to book appointments with other therapists out there, I quickly discovered that most couldn't take new appointments due to social distancing, or they were completely booked full already. So that's when I decided I needed to start being real about my situation and get some guidance. And the way I got that support was through better help, which also happens to be a sponsor of this podcast. 

To be honest with you, I had been using better help way before the sponsorship started better help is an online therapy service that has earned the number one ranking for quality services. And here's the thing when you contact them, you're offered a variety of licensed therapists to choose from whatever your preference they'll likely have it. The best part is you can choose someone that totally matches your needs and your unique situation. What I love about better help and that's help with a P is that you can have your sessions on the phone or through video, or to get this through text that's right. You can actually text message with your therapist. And I have to tell you, there were times when I needed to talk to a professional and the support was so easy to get because the therapists were so accessible. And I remember during those times during COVID-19 and being alone and isolated and just wanting to talk to someone about my feelings and better help was there. 

If you're ready to start therapy and really want to begin the process of creating the best version of yourself, better help has a special offer to listeners of the anxiety therapist podcast, 10% off the first months of sessions. If you use this link better therapistpodcast, again, that's a better I'll leave a link in the episode notes. Okay. Let's get onto our interview with ADHD specialist, Jamie Robert Nelson. Hello, Jamie, and welcome to the show. How are you today?

I'm great. Thank you so much for having me excited to be here.

That's awesome. All right. Well, could you just maybe start out by telling us a little bit about yourself and your background?

Absolutely. So I, my name is Jamie Roberts Nelson. I am a licensed marriage and family therapist out of Southern California. I a phonetic about ADHD and teens. So a lot of my work has to do with adolescents and teenagers. I started my work, pre-licensed in a middle school on campus. I've worked with an adolescent psychiatrist and its intake process. I've worked in community-based mental health. And in the last couple of years, I founded my own counseling center equilibrium counseling services. And we are a teen mental health center. We also work with young adults and families, providing a lot of resources for that experience of finding your voice, finding who you are. And we use a lot of art based creative processes to do our mental health work, music, painting drawing, coloring, anything to find these nonverbal expressions of emotion, because sometimes you just don't have the words to say what you're feeling, but we can find other ways to do that.

That's fantastic. You know, as a therapist myself, I always like to hear when other therapists have like, sort of earned their stripes in the sense of like been out there, working for agencies, working in different venues, and then eventually get to a point where they can open up their own private practice. It's just so wonderful to hear

Absolutely. We like to stay connected to the community. So we work with the city that our local library has a great program. We're in the schools providing parenting resources and access. So we make sure that mental health is accessible for everyone.

So Jamie if you could, could you just let our audience know what is ADHD? And if you can, could you explain maybe in sort of layman's terms, what the three presentations are? 

Absolutely. So ADHD or attention deficit hyperactivity disorder is a neurotype. It is a type of way that your brain processes information and the three subtypes are hyperactive inattentive and combined. Now we used to say, ADD attention deficit disorder, but that's no longer like the clinical term. It's all under the umbrella of ADHD. So with the hyperactive type, you it's kind of like the classic stereotype we have in our heads of the kids bouncing off the walls, super high energy, hard to sit still, but then there's also the inattentive type, which we actually don't have a most people don't see it. And it shows up as anxiety, which is what I feel like we're going to be talking a lot about today is the hyperactivity is internalized. inside of me there's a lot of thought there's a lot of energy. There's a lot of things bouncing around, but you're not seeing it externally. I'm inattentive in which I'm not paying attention to something, but I don't have the hyperactivity piece. And then the combined type is the two of those where I may present as hyperactive and inattentive. And it kind of alternates.

That's interesting because I worry sometimes that as you know, in the 80s, they were, everybody had add or ADHD. And like you said now it's just under the umbrella. And I worry sometimes that maybe there's parents out there or even adults that they just assume they have ADHD because they hear all the symptoms, but that's not the case, right? Like someone should really be evaluated before having that kind of label.

I'm actually going to disagree with you on that one. 10% of the population is neurodivergent, that's a huge percentage of people. Wow. Only 3% has bipolar only I think it's like 9%. I don't know. It's like 30% for anxiety, but ADHD neurodivergent autism is 9 to 11% of the population. It's a huge chunk of people only like 5 to 6% are being diagnosed so that other percentage of people are experiencing the symptom without kind of knowing why or what, and it is a spectrum. So the level of difficulty that the symptoms present are going to vary for everyone, not everybody needs diagnosis or treatment, but I do think it's actually underdiagnosed.

I agree with you on that. Yeah. I think there is a lot of people out there. A lot of people who may have ADHD, or as you said, a neuro divergent disorder and haven't been evaluated. I was more getting to parents sometimes who they just see that their kid might be just a little bit hyperactive and then automatically, oh, they have ADHD. And it just my opinion sometimes like there needs to be an evaluation before they're just sort of given that diagnosis.

I think it depends like what the goal of it is if your kid is hyper and you're just saying, oh, they're ADHD, are you dismissing that they're being overstimulated and they're trying to work it out of their body. Like, what is the reason they're exhibiting those symptoms? What is behind it that you're seeing what's going on? And is there something else happening? And if you want accommodations that your kids needs at school or their mental health stuff, because ADHD usually goes along with anxiety and depression, then yeah, you need a diagnosis.  but those can be really hard to get for ADHD, to get into a psychologist. The waiting list is long. The assessments are super expensive and insurance may or may not cover it. So there is a bit of gatekeeping when it comes to getting an actual diagnosis. And,, there is a movement in the neuro divergent community of supporting self-diagnosis.

Are you finding that that's the case out where you are? I know here in Chicago at this time, it is really hard for people to get booked with a therapist because they are so overbooked, there was no openings.

Absolutely. That's the case here too. Everybody I know is absolutely full and I'm seeing more, more clients a week than I ever have. So we've been through quite a year and everybody's looking for support, which is awesome. I'm so glad. So many people are seeking mental health services, but it is getting hard to find a therapist and get an appointment.

It really is. I mean, I know like on my own caseload and I feel terrible. I enjoy giving people a referral to other services that may be able to help them. But in the same token, I feel bad because there's only so many people you can see. Jamie why do you think people who struggle with ADHD may mistake the symptoms for, for just say anxiety, right? And as you mentioned before, anxiety and depression, why do you think so many people and also experiencing anxiety who have ADHD?

I think it's twofold. I think the first part is the chemical piece. So ADHD comes from a, it's either a lack of dopamine in the brain or the brain is not absorbing the dopamine and dopamine is that feel good chemical that you get after, like exercising or something you're really excited about? And that's what turns on the part of the brain that helps you executive function plan, organize, start something you maybe don't want to do. And so people who maybe it's very common with inattention that I'm sitting here, like I need to clean, I need to clean, I need to do that laundry. I need to do that laundry, do the laundry, which creates some anxiety, which creates adrenaline, which creates the dopamine to make me do it. And then if I'm like, okay, finally did it.

Or it took you so long to do it. Now I'm starting this cycle of negative self-talk of like the criticism of like, well, why couldn't you do it sooner? Why can't you do it faster? And then we fall into depression. So it's this big cycle of forcing yourself to do something that your brain literally isn't turning on to do. And then the negative self-talk that comes from that. And then you have anxiety, which creates or ADHD, which creates anxiety, which creates depression. 

Yeah. Yeah. We often say ADHD creates anxiety and anxiety masks, ADHD, because people show up because anxiety is distressing. It's uncomfortable. It doesn't feel good. So a lot of people show up for therapy for their anxiety and their depression. And we accept self-diagnosis if somebody comes to my office and says, I have anxiety, I don't question them. Yeah. Okay. Tell me what your anxiety looks like. And we go the mood disorder route. What I think a lot of clinicians need to do is ask the secondary questions of what's behind the anxiety. What is the thought processes? What is fueling it? Where's it coming from? What's leading up to it to be able to determine, is there a neurological piece, is this how your brain is wired? That's leading into the anxiety.

Right? What is the root issue behind the anxiety? And I know for a lot of patients that I work with, I will just refer them out for a psych evaluation if I want to make absolutely sure if there's an ADHD or as you said, another neurodivergent disorder. Jamie, in your experience, or what do you think, how is the brain wired differently for someone living with ADHD compared to just say someone else?

So this is a really great example, a meme that I saw online. And it was saying because a lot of times ADHD is seen as being lazy or you just aren't motivated to do it. And so a big piece of it is that thought process is if I'm laying on the couch and I see the laundry and I know I got to do it, but I just don't feel like doing it. That's neuro-typical. I can, if I wanted to do it, I could get up and I could do it. ADHD is sitting there and being able to turn on that, switch in your brain for that executive function to do a non-preferred task is sitting there.

I need to do the laundry. You need to do laundry and get up and do the laundry. Why aren't you doing the laundry? There's a whole conversation going on in your head and you literally can't get your body up to do it. So without your executive function being turned on in your brain, we literally don't have the stimulation to start something. So that's why we hear a lot of people say, well, my kid can focus on the things they like, but they can't focus on the thing they don't like. well, when our brain is stimulated, we have enough dopamine. And that part of our brain turns on and so that's accurate.

I think you're onto something big there. Now, , when I was a child, they didn't, and this is in the 70s, by the way, in the 70s, that term wasn't there ADHD. And in fact, and I think some of this goes on today unfortunately, kids were called lazy. I was one of them. when I was a kid, I was prescribed Ritalin. And it was very frequent that kids like myself and others, you're lazy. If you could just do, if you would just focus more, you could get it done. You've got all the potential. You just need to do the work. And it's like, yeah, that's easy to say, but it's not so easy to do.

You're absolutely right. A really clear example I like to use with people is thinking about, um, glasses as medications, you brought up Ritalin. without my glasses I can see you. I can take in the information, but it's going to be blurry. I'm going to miss some information and I'm going to have to try really hard. And I'm going to get a headache because it's just so much harder causeI literally can't see you. 

And so if I'm trying to read and I can't see the letters, I'm not gonna be able to read, but you've given me glasses. If you give me the stimulant the dopamine is what I need. Now I can see you. And I don't have to put in that level of effort. I'm not straining myself. And I'm getting every detail of the information without even try it. So we have these kids that are working so hard just to see the letters they're exhausted. How can they comprehend the information if they can't see the words?

Exactly. And I think that's something that people don't really see, whether it's, I think it's changing for the better now, but as I said in the past, it wasn't that way. It was just like you said, you're lazy or you're not trying hard enough. Speaking of which, what are your thoughts? Do you feel like I have my thoughts about this, but ADHD and children, following them into adulthood, if it's never treated, how often do you think that happens? Where it just follows them into adulthood?

Oh, well, ADHD. If it's a way your brain is structured, it will follow you into adulthood. It is a lifelong condition because that is how your brain is wired. I think there are a lot of people who aren't diagnosed as kids. Actually women and minorities are less likely to be diagnosed and the majority of women are diagnosed in their 30s and forties. Um, so there's a big overlooking of different categories of people who just aren't seeing when it comes to it. Especially if you haven't, it's presenting as inattentive. You're the quiet one in class. You're not a disruption. You're not raising your hand. You are, hyper-focused possibly on schoolwork.

That was me. I was so perfectionistic on my schoolwork. And then when I showed up at work, but nobody saw it and I wasn't diagnosed till my early 30s. So, I think that's very, very common. And that's when we see it develop really and see the anxiety and the depression and people are, that's what they're struggling with, anxiety and depression. And I think often then they're given like a bipolar diagnosis because they're seeing these fluctuations of mood and emotion regulation, which are also some parts of ADHD being dysregulated, having extreme mood.

Do you think that there is such a disparity between, because the research shows that yes, more males have ADHD than women, but I'm wondering is that because our society has this image of the young boy bouncing off the walls in school and sort of overlooks that the females absolutely can have ADHD and do.

Absolutely the majority of the research is on white male, young hyperactive boys, and is not on inattentive. It is not, uncombined type. It is not on women and is not on black people is not on Hispanic people. It is primarily white boys that the research is on. And so it misses that whole category. And actually some of the new research coming out is it's equally distributed. It's not more male or more female. We all have it.

Yeah, exactly. And I think that that's something that, that absolutely needs to change because I've worked with female patients and they'll say, oh no, that's just something that guys get. And no, actually, no, it's not okay-

It's also one more on that piece. It's also highly genetic. If it's in your family, if your brother has it, if your dad has it and you're a woman, you would likely have some version or some percentage of it. It is very, very much runs in the family.

I was reading the research on that with the genetic piece. And it was eye-popping just how, how much that is carried on from, from one generation to the next. Okay. So my other question is we know that medication can be prescribed by medical providers to help improve focus, but how can therapy help a person with coping skills for organization or scheduling or managing their emotions? How does the therapy piece help?

I believe that if you are in therapy with a therapist who are firm in what ADHD is and how it shows up in your life, there can be a reframing or like looking at how you approach things differently. Like once you have that label, I love Dr. Dan Siegel says, name it to claim it. I can name what's going on. I have more power in controlling it. So if you know, that's what it is.

Okay, well, let's look at how you're organizing at work. And maybe you need to do it a totally different way because your brain works different. If a neuro-typical person can use the planner on their phones, that doesn't mean you have to, we look and we explore, like, what are the different variety of ways that work better for your brain to keep it simulated? How do you need to also give yourself permission to do things differently or to have it show up specifically for you?

I think another piece is, is we learn how to mask very young, to put a mask on and, and force ourselves to fit in that box and giving people permission to loosen the mask or take the mask off and give themselves their permission to show up as themselves. And that takes a bit of the pressure off. And then it's easier to find those unique ways that show up for them.

Exactly that permission to be your authentic self when you come in. And that kind of leads me to, my next question around this. And it has to do with adults. Let's say you have an adult who comes in and they suspect that they might have ADHD. At work they have trouble concentrating, maybe completing tasks. How do you determine if, if the adult would be, would have ADHD and how would you help the person?

Jamie Roberts Nelson Profile Photo

Jamie Roberts Nelson

Founder of ECS

Jamie is a Licensed Marriage and Family Therapist in Southern California. She is the founder of Equilibrium Counseling Services. Jamie specializes in working with Neurodivergent youth with co-morbid conditions of Anxiety, Depression and self esteem. She is passionate about "Being the person you needed when you were Younger"- Ayesha Sadiqi