Identifying Masked AD/HD

AD/HD 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 AD/HD 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 and this struggle begins once they go to school. Their challenges can be significantly modified, however, if they are diagnosed and treated correctly for their condition.

If, however, they belong to the group whose AD/HD 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 AD/HD 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 and will thus always be a burden on their family and/or the government.

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

Children and adolescents with masked AD/HD include the following:

  • Boys with inattentive type AD/HD.
  • Girls with all types of AD/HD.
  • Boys and girls with borderline AD/HD and another condition or conditions.
  • Girls and boys with a learning disability and/or another condition on the autistic spectrum who also have AD/HD.
  • Gifted girls and boys with AD/HD.

Children with all types of AD/HD may:

  • have problems with sleep (getting to 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 AD/HD:

Coexisting conditions often mask AD/HD symptoms. If the child is diagnosed with the coexisting condition first, there is a real danger that the AD/HD symptoms will be attributed to the coexisting condition and thus not treated.

Coexisting conditions include:

  • Dyslexia, Dyspraxia, Dyscalculia, etc.
  • Aspergers Syndrome (AS).
  • High-Functioning Autism.
  • Language Disorder.
  • Anxiety Disorder.
  • Depression.
  • Obsessive Compulsive Disorder (OCD).
  • Oppositional Defiant Disorder (ODD).

This can happen when a child is diagnosed with Dyslexia. Parents and teachers are more likely to look for Dyslexia solutions for all of the child's problems. 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 child having both Dyslexia and AD/HD. Parents and teachers should be especially vigilant about this because the symptoms of inattention are said to be also a feature of Dyslexia. However, if the inattention is more than the low-level expected in Dyslexia, this is an indicator that the child could also have AD/HD; there are other indicators which are listed below that can be also taken into account.

It can also happen when the first diagnosis is Asperger's Syndrome (AS) or high functioning autism. The AS symptoms can be aggravated by the AD/HD and a further assessment for this condition is necessary.

Sometimes, when a child has Asperger's Syndrome as well as AD/HD, the stimulant medication does not bring the desired results. In such cases, it is important that parents explore all the AD/HD 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 the AD/HD symptoms. Again, it is worth bearing in mind that it is difficult to treat Anxiety Disorder successfully if the underlying AD/HD is not also treated appropriately.

Some further Indicators of AD/HD are:

  • Child may exhibit other symptoms that are not AD/HD related, but still have an AD/HD profile.
  • Child may be quick-tempered and aggressive.
  • S/he may be excessively irritable.
  • Child may be very bright, yet underachieving.
  • S/he may not be able to relate appropriately to peers.
  • S/he may be "out of control" at home.
  • S/he may have a poor relationship with teachers.
  • Child may have personal hygiene issues.
  • S/he may blame others for his/her actions.
  • Child may be emotionally cut off from others as well as having some symptoms of AD/HD.
  • S/he seems depressed.
  • The child is extremely oppositional.
  • S/he exhibits obsessive-compulsive traits.

AD/HD is masked when the following symptoms are present and untreated:

  • Severe concentration problems.
  • Pronounced distractibility issues.
  • Difficulty with forming/keeping friendships.
  • Difficulty with teacher relationships.
  • Sleep problems.
  • Not achieving to intellectual level.
  • Disorganized.
  • No concept of time/money.

Gifted children with all types of AD/HD may:

  • spend much longer doing homework assignments than their equally gifted peers;
  • pick up and drop many activities;
  • get by at secondary school 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; and.
  • experience a lifetime of underachievement if not detected and treated

The hidden consequences include:

  • The child becomes demoralized.
  • The child has low self-esteem.
  • S/he thinks of him/herself as "stupid."
  • The child chronically under-functions.
  • The child may become bitter and dissatisfied as an adult.
  • The child may eventually begin self-medicating to blur reality.

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ADHD Europe asks for better provisions for Teenagers with ADHD who continue to need access to mental health services after they turn 18.
This must be a priority across Europe so please sign the Declaration:

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