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 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 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 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 ADHD as early as possible, the prognosis can be much better.

Children and adolescents with masked ADHD include the following

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

Children and teens with all types of ADHD 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 ADHD

Coexisting conditions often mask ADHD symptoms. If the 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 thus not treated.

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. 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 person having both Dyslexia and ADHD. 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 youth could also have ADHD; there are other indicators which are listed below that can be also taken into account.

It can also happen when the first diagnosis is Autism. The ADHD symptoms may not be so obvious and a further assessment for this condition is necessary.

Sometimes, when a child or adult is on the Autism Spectrum as well as ADHD, the stimulant medication does not bring the desired results. In such cases, it is important that parents explore all 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. Again, it is worth bearing in mind that it is difficult to treat Anxiety Disorder successfully if the underlying ADHD is not also treated appropriately.

Some further Indicators of ADHD are

  • A child or adult may exhibit other symptoms that are not ADHD related but still have an ADHD profile.
  • S/he 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.
  • S/he may not be able to relate appropriately to peers, and may have difficulty with forming/keeping friendships.
  • A person may be quick-tempered and aggressive.
  • A child or adult is usually disorganised.
  • S/he has no concept of time/money.
  • S/he may be “out of control” at home.
  • S/he may have a poor relationship with teachers or employers.
  • A person may have personal hygiene issues.
  • S/he may blame others for his/her actions.
  • A child or adult may be emotionally cut off from others as well as have some symptoms of ADHD.
  • S/he seems depressed.
  • A person is extremely oppositional.
  • S/he exhibits 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.
  • S/he thinks of him/herself as “stupid” and chronically under-functions.
  • A child may become bitter and dissatisfied as an adult.
  • An adult may eventually begin self-medicating to blur reality.

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