Elizabeth’s two sons, ages eight and 10, have both been diagnosed with attention deficit hyperactivity disorder.
asserted
sons → diagnose → disorder
So have Elizabeth, 37, and her husband, 41.
asserted
Elizabeth → have → ?
To manage it all, Elizabeth and her husband have implemented an elaborate system of medications and to-do lists.
asserted
Elizabeth → manage → medications
“I joke that our house is half house, half classroom, half occupational therapist office,” Elizabeth says.
asserted
Elizabeth → joke → ?
(She asked to use only her middle name when discussing her family’s medical conditions.)
asserted
She → ask → conditions
Elizabeth was diagnosed with ADHD two years ago, after recognising some of her sons’ symptoms in her current – and younger – self.
asserted
Elizabeth → diagnose → self
“I didn’t know that the reason that it took me five hours to do my homework every night wasn’t because I wasn’t smart or because I didn’t try hard enough,” she says.
asserted
she → know → homework
“It’s because my brain was working against me.”
asserted
brain → ’ → me
Now, with help from her systems and from medication, Elizabeth has learnt to manage her symptoms and has advanced in her career as an environmental health and safety manager.
asserted
Elizabeth → learn → manager
“I went from bouncing around between random jobs,” she says, to being able to “focus well enough to have some direction.”
asserted
she → go → direction
But despite her own success, Elizabeth still worries about how her sons’ ADHD will affect them as they get older.
asserted
they → worry → them
“As a parent, my job is to teach them how to be a human, how to function in today’s world,” she says.
asserted
she → teach → world
“And they have a harder time than most because their brains don’t work the way most people’s brains work.”
asserted
brains → have → most
Back-to-school season, with its executive-functioning demands and deadlines, can make these types of parental worries even more stark.
asserted
types → function → worries
ADHD is a tricky condition to diagnose, study and track over a person’s life.
asserted
ADHD → diagnose → life
It can present very differently in different people, and there are a wide range of symptoms, which exist on a spectrum from mild to severe.
asserted
which → present → severe
ADHD also often overlaps with other mental health, developmental and behavioral disorders, including anxiety, autism and oppositional defiant disorder.
asserted
ADHD → overlap → anxiety
(With rising rates in children and adults, some psychiatrists worry the condition is now being overdiagnosed.)
asserted
condition → rise → children
It’s also not clear what percentage of children continue to have ADHD as adults.
asserted
percentage → ’ → adults
One frequently cited number is about 50 per cent, with symptoms more likely to persist in adults who had more severe ADHD in childhood and more overlapping conditions.
asserted
who → cite → childhood
But according to a 2021 longitudinal study that followed children with ADHD for 16 years, only about 10 per cent experienced “sustained remission” into young adulthood.
uncertain
cent → accord → adulthood
Another 10 per cent had ADHD for the entire time, and for the vast majority, symptoms waxed and waned.
asserted
symptoms → have → majority
Notably, the study found that at any given time, roughly half the participants met the diagnosis for ADHD, but which people fell into which camp kept changing.
asserted
camp → find → ADHD
While much about ADHD is still up in the air, what has become clear is that it is not a static condition, and the types of symptoms people have, and how they affect their day-to-day lives, can evolve over time.
asserted
they → become → time
How symptoms change
asserted
symptoms → change → ?
To be diagnosed with ADHD, a child must meet six or more symptoms from one category or the other; people 17 and older need five or more.
asserted
people → diagnose → category
If someone meets the symptom requirements in both categories, they are diagnosed as having combined ADHD.
asserted
they → meet → ADHD
Inattentive symptoms include things like poor attention to detail, not finishing tasks, messiness and forgetfulness.
asserted
symptoms → include → tasks
Hyperactive and impulsive symptoms can look like frequent fidgeting, difficulty waiting one’s turn and excessive talking.
asserted
symptoms → look → turn
In general, when children are very young, hyperactive-impulsive symptoms tend to be more common.
asserted
symptoms → tend → ?
Michelle Martel, a professor of psychology at the University of Kentucky, says it is obvious when you’re working with a preschooler with these symptoms because “they’re getting into everything and running around the room”.
asserted
they → say → room
As children age and start to have more responsibilities and expectations at school, inattentive symptoms become more prevalent, and ultimately more persistent.
asserted
symptoms → age → school
And in some children, hyperactive-impulsive symptoms start to decline.
asserted
symptoms → start → children
Between ages 12 and 18, the numbers start to shift, with more adolescents qualifying as inattentive and less than a quarter as hyperactive-impulsive.
asserted
adolescents → start → ages
Very few adults have predominantly hyperactive-impulsive symptoms.
asserted
adults → have → symptoms
One small study put the number at just 7 per cent, while roughly one-third of adults had the inattentive subtype and the majority had a combination of symptoms.
asserted
majority → put → symptoms
Hyperactive-impulsive symptoms also present differently in adults than in children, manifesting more as an inner, mental restlessness rather than an outward, physical restlessness, says Dr Deepti Anbarasan, a clinical associate professor of psychiatry at the NYU Grossman School of Medicine.
asserted
Anbarasan → present → Medicine
For example, adults “may always feel a need to be busy, like they might need to exercise daily or otherwise they don’t feel so good,” she says.
uncertain
she → feel → example
Adults with inattentive symptoms may have trouble with life logistics and with completing chores that don’t have a deadline, or they might lose track of conversations during meetings or with their spouse, Anbarasan says.
uncertain
Anbarasan → have → spouse
Why symptoms change
There is mounting evidence that people’s environments can influence their symptoms.
asserted
environments → change → symptoms
…and 12 more, not listed.
The Aporia
