How ADHD Adults Cope Before Treatment
Even when compensation strategies work, there is a price to being undiagnosed.
Posted Jan 27, 2018
Coping in the Dark
“[W]hat I always intuitively did, from early on, was to avoid any kind of dependence/commitment…any kind of commitment, even a club membership, where you need to attend meetings five times a year, whatever, even that would have felt restricting."
The above statement is how one adult in a recently published study described attempts to cope with symptoms of undiagnosed ADHD. Another subject described “surrounding myself always with lots of people” as “it never attracted attention when I behaved specially obnoxiously.” Other compensation strategies included being “overly punctual,” studying in a cold basement as a way to mitigate distractions, having “really closely structured check lists for every work step,” and finding ways to work without paper by dealing with workmen who work only on call without written appointments (Canela et al, 2017).
The study, which was based on interviews with 32 patients in a Zürich teaching hospital outpatient clinic, looked at ways that undiagnosed and untreated adults with ADHD attempted to manage their symptoms on their own.
The core symptoms of ADHD often manifest differently in adults than in children. Hyperactivity may be expressed as fidgeting, inability to relax, as restlessness or being unable to sit still for longer periods while studying, at work or in a movie. Impatience, interrupting others in conversations, impulsive behaviour, changing jobs frequently, starting a business on impulse, changing sexual relationships are often expressions of impulsivity, whereas inattention often shows itself as forgetfulness, disorganization, not listening to others in conversations or being late. (Canela et al, 2017)
ADHD symptoms, according to Russell Barkley, PhD, result from brain differences of disordered self-regulation and executive functioning. As such, people with ADHD cannot just try harder or think their way to a fix; like the old Apple commercial, they need to learn to think (and, more important, to act) different.
Estimates for the prevalence of ADHD in adults vary and are certainly fraught with controversy. However, using conservative numbers, on average, in a group of 50 adults, at least one or two will have attention-deficit hyperactivity disorder (known in Europe as hyperkinetic disorder). According to Scott Shapiro, MD, three-fourths of these adults “never receive an accurate diagnosis or effective treatment,” despite having had the condition since childhood.
Over their lifetimes, undiagnosed adults with ADHD may develop a number of coping mechanisms and compensations—some more helpful than others—without being aware of why they are doing so. Another example from the Zürich study is always having several backup plans for any situation that might not go as expected: “I have structured my daily routine myself and have developed strategies for a clear structure. I also always have a plan A, B, C and D. I just couldn't cope with situations, that weren't as I had expected, I used to flip” (Canela et al, 2017).
Some adults with ADHD can look somewhat obsessive or compulsive about what they do, for example checking to make sure that they actually turned off the stove. The difference between that and true OCD is that OCD makes a person less functional--the person with OCD doesn't check the stove once or twice, they check it ten times. For the person with ADHD, the checking is based on an accurate self-assessment that they might have forgotten to turn off the stove, because their experience has taught them that this is the sort of thing that they sometimes do. In this case, these behaviors are helpful, in contrast to true OCD behaviors that really lock the person down and reduce their ability to cope with the world. (Sarkis, 2012)
Coping, Resiliency, and Hope for the Future
Susan Young found that impulsivity may play a role in “adaptive coping” by allowing some ADHD adults to continue to try new strategies:
[I]n the face of stressful events and situations and in spite of the disadvantages they have from cognitive and social problems, they may have an ability to "bounce back". Thus for people with ADHD, the way they interact is associated with their cognitive ability, which may mean they continually assess, re-assess, compensate and adapt. (Young, 2005)
Shapiro (2013) urges that professionals help clients "to see that they have many strengths and that ADHD is just one aspect of who they are. In addition, they have compensated for it most of their lives. Validate that it may have been a difficult struggle and that their lives can improve significantly."
After a correct diagnosis, ADHD adults are in a better position to know which coping behaviors to retain and which are limiting, as well as to know what their specific symptoms are. Authors of the Swiss study argue that “some core symptoms may 'hide' behind well-developed coping strategies or particular working environments and this decreases self-awareness of symptoms.”
Clinical psychologist Ellen B. Littman, PhD, gives the example of ADHD adults being “reluctant to socialize” in venues where they feel they can’t keep up, using self-imposed isolation as a way to deal with what are, in fact, ADHD symptoms, such as difficulty in sustaining attention to conversations, being distracted by social stimuli, or even interrupting others and saying things that are later embarrassing.
They keep their difficulties hidden, and they have very negative conversations with themselves, about their negative self-image. They don’t want to seem needy. They don’t want to ask for help. They want to look like they have it together. But the reality is that your life is not just what’s happening to you, but it’s also the quality of your existence and how hard it is, and if you keep that hidden, no one really gets to know you. (Littman, 2015)
So, even when self-developed strategies are helpful, without an understanding of why they are necessary, adults with ADHD are limited in terms of self-knowledge and optimal quality of life, and they may assume they are being lazy or undisciplined or selfish rather than trying their best to manage an unruly brain.
Barkley, R. (n.d.). The important role of executive functioning and self-regulation in ADHD. Retrieved from http://www.russellbarkley.org/factsheets/ADHD_EF_and_SR.pdf
Canela, C., Buadze, A., Dube, A., Eich, D., & Liebrenz, M. (2017). Skills and compensation strategies in adult ADHD - A qualitative study. PLoS ONE 12(9): e0184964. https://doi.org/10.1371/journal.pone.0184964
Littman, E. B. (Guest). (2015, April 7). Being the best ADHD mom you can be doesn't mean being perfect [Audio podcast]. Retrieved from http://additudemag.libsyn.com/97-being-the-best-adhd-mom-you-can-be-doesnt-mean-being-perfect
Sarkis, S. (2012, May 9). Interview with Dr. Ari Tuckman on adult ADHD. [Web log post]. Retrieved from https://www.psychologytoday.com/blog/here-there-and-everywhere/201205/interview-dr-ari-tuckman-adult-adhd
Shapiro, S. (2013, May). Are we afraid of treating ADHD? [Web log post]. Retrieved from https://www.psychologytoday.com/blog/the-best-strategies-managing-adult-adhd/201303/are-we-afraid-treating-adult-adhd
Young, S. (2005). Coping strategies used by adults with ADHD. Personality and Individual Differences. 38(4):809±16. https://doi.org/10.1016/j.paid.2004.06.005