Mequon psychologist discusses new effort to develop guidance for treating ADHD in adults

The American Professional Society of ADHD and Related Disorders is seeking to develop the nation’s first authoritative guidelines for the disorder in adults.

The organization estimates 11 million American adults have attention-deficit/hyperactivity disorder and many adults remain undiagnosed for decades or are misdiagnosed. The majority receive no treatment.

To learn more about ADHD among Badger State adults, Wisconsin Public Radio’s “The Morning Show” spoke with Alison Kravit, a licensed clinical psychologist and certified advanced ADHD coach with a practice in Mequon. Kravit said she, her husband and two of her three children are diagnosed with ADHD.

This interview has been edited for brevity and clarity.

Kate Archer Kent: How might the new guidelines change the process of obtaining a diagnosis as an adult?

Alison Kravit: Hopefully it makes it so more practitioners are aware of what ADHD looks like in adults right now. In (the mental health field), we’re misdiagnosing about 90 percent of teenagers, adults and females just because it looks different. Like, for example, people who do well in school can also have ADHD.

KAK: How do children and adults express ADHD symptoms differently?

AK: Mostly, children externalize their symptoms. I hear all the time, “I’m not hyperactive (as an adult).” Well, you can’t be an adult and climb excessively on things.

Everything becomes more internal… Because it’s more internal, it starts to look like anxiety or racing thoughts and things like that. So if you’re not externally seeing it, the fidgety-ness… then we assume that it’s not ADHD.

KAK: How does ADHD affect your relationships?

AK: ADHD can affect a relationship (through) something called Rejection Sensitive Dysphoria, which is the tendency to perceive criticism where none in fact exists. So, if I come home and say, “Did you do the dishes?”, my husband hears, “I know you didn’t do the dishes” and responds accordingly.

Is that what I said? No, but you hear this criticism. And that’s because, by the time a kid has reached sixth grade — diagnosed or not — they’ve heard 20,000 more criticisms than a kid without ADHD.

KAK: How common is it for women and girls to mask their symptoms — try to hide their symptoms in order to fit in?

AK: Very, very common. Either because (they’re) born this way or they’re socialized to be a “good” girl. There’s an inherent need to meet expectations. Sometimes with females, school is fine, maybe even perfect. And it’s the emotional regulation issue that you’re seeing the most. This then leads to misdiagnosis of depression, anxiety, bipolar disorder or something else.

KAK: A listener called in and described taking Adderall for the first time as slowing things down for them. This experience with taking the medication — what do you see there?

AK: I hear that a lot. That it’s like, “All of a sudden, I can have one thought at a time,” or “I can make a decision and not function in a now/not now,” which is the ADHD brain.

If you’re always in the now, that means you’re not using past experiences to influence future decisions and you’re not predicting the future. Everything is a surprise. There’s this tenseness that people with ADHD carry with them. The medication slows it down so they can take the thought they want.

KAK: How would you tell people to find hope and find options if they feel like they haven’t been heard with an ADHD diagnosis or they’re still searching for one? What would you say?

AK: There are definitely online resources that have referrals. One is ADDitude Magazine. They have a provider list. There’s (the book) “The ADHD Effect on Marriage” by Melissa Orloff. She has a referral list. Chadd.org has (a referral list) by state. There is the ADHD Coaches Organization. Find somebody in your state that lists themselves in these directories and (ensure) that they are up to date with what ADHD is and how to diagnose it.