Categorized | Mental Health

The Shadow Syndrome: Adult Attention Deficit Hyperactivity Disorder (ADHD)

  • Are you easily distracted, cannot keep focus for more than a couple minutes at a time, easily forget things, interrupt people, start tasks but rarely finish them, rarely read or listen to directions, and get overwhelmed if you have to plan and organize a project?
  • Are you verbally and emotionally impulsive, interrupt people, can’t stop talking when you know you should?
  • Do you have poor work and social follow through with friends and coworkers?
  • Do you have trouble relaxing and doing things quietly?
  • Do you have a history of troubles with the law (speeding tickets, getting into physical fights, and legal troubles), history of alcohol or drug abuse, being reprimanded or fired in the workplace because of impulsive, obnoxious, aggressive, and intrusive behavior and performance problems resulting from a high rate of errors through impulsivity?
  • Have you been diagnosed with depression or Bipolar I or II disorders, but every type of treatment in the book, including medications and several trials of different therapies, haven’t worked?
  • Do you have no problems coming up with creative ideas but fail in their development and follow through?
  • Did many these problems start in childhood but have persisted into your adult life?

If you answered yes to most of these questions, you may have an Adult Attention Deficit Hyperactivity Disorder (ADHD). Adult ADHD can be a shadow syndrome; a disorder that insidiously affects people’s functioning and the course of their lives, until there is enough history of unfulfilled goals and interpersonal and occupational problems to make them suspect that something is wrong. Although the disorder afflicts millions of adults, it still tends to remain under-diagnosed (J. Ratey 1997; Shadow Syndromes). Studies by leading ADHD researcher Dr. Russell Barkley and others find that 4.4 of the adult population suffers from ADHD and that only about 10 percent of adults who met the diagnostic criteria for ADHD had been diagnosed and treated for it (Pay Attention To Me, American Psychological Association, March 2013).

Several things may have occurred that allow ADHD adults to slip beneath diagnostic radar. Some people have a milder form of the disorder that allows them to compensate for their reasoning and social difficulties. Other ADHD adults may have found work in fields that complements their gifts and talents (creativity and passion) more than their cognitive and emotional weaknesses. Or, their lifestyles have not forced them into personal and occupational situations in which their widespread functioning problems are apparent.

But, even if they’ve gone undiagnosed, their cognitive, emotional, and behavioral dysfunction is apparent to their families, spouses, friends and employers. ADHD difficulties lead to an unhealthy lifestyle (poor eating habits, smoking, alcohol and drug use), financial mismanagement, social and work problems (reprimands and high rates of being fired), accidents and injuries (speeding tickets, motor vehicle accidents, risky sexual behavior, and early parenthood), legal difficulties, limited education success and marital and family troubles.

The Case of Gino

Take, for example, my patient Gino; he entered therapy, for the first time in his life, because his wife was divorcing him. From his appearance, you’d never expect that 42-year-old, stylishly dressed and collected Gino had pervasive inattention, impulsivity and hyperactivity difficulties. Upon his immigration to the US, he opened an Italian eatery that became very successful. Gino’s cooking talent, creativity, passion and charm was the heart and soul of the restaurant, while his wife Maria managed the business’ finances, inventory, and everything else that made it run well.

For a time, this professional couple was a match made in Heaven. But, Gino’s ADHD made the restaurant and their relationship a house of cards. He was restless. Gino was full of ideas to make the restaurant even more successful than it already was. He set out to package and sell his pasta sauces. Then, he fixed his mind on developing a chain of successful restaurants. There was nothing far-fetched about these ideas; he just didn’t have the focus, planning, organization, and self-control needed to carry them out.

Maria got use to Gino spending ten to twenty thousand dollars on these ideas that went nowhere. But, the straw that broke Maria’s back and led them to divorcing cost the couple $300,000.00. Gino participated in one of those new-age type awareness groups that put forth the idea that great business gains require great risk. Upon this suggestion, he invested his and Maria’s life savings in what turned out to be nothing more than a ponzi-investment scheme. Sadly, I’ve encountered similar situations of poor judgment leading to financial misfortune more than one time in my years of practice. And, at the root of these troubles are people whose impulsivity, poor regulation of emotions, and inability to anticipate consequences of action led them to make faulty decisions that eventuates social, financial, sexual, and legal trouble.

Gino is one of many ADHD adults who do not get diagnosed until there’s a history of social and workplace problems that nearly destroy their lives, financially and personally. He slipped below diagnostic radar because his work, lifestyle, and support by his wife, for a time, hid his ADHD problems. But, he had all of the classic symptoms of childhood and adult ADHD that you are just about to read about.

What is ADHD?

Attention and hyperactivity that makes up the acronym for ADHD are more the two main categories of symptoms that makeup the disorder than what causes it. ADHD is primarily a disorder of the brain’s executive functioning (the frontal lobes of the brain) that interferes with the ability to work with information generated by stimuli arising outside and inside of us. Take, for example, the following scenario. A boss asks you to turn in a report to him/her three hours earlier than its initial deadline. What brain processes are involved in getting this task done? First, you have to hold that question in your mind (attention/concentration) while you reflect upon the nature of the demand (meaning). Then, you need to visualize how you might alter your behavior to meet this new deadline (imagination). You then have to choose between imagined options, make a plan, and regulate your thoughts, emotions, and behavior to see the plan through (self-management). And, while doing all of this, you have to hold off distracting ideas, feelings, and actions that threaten to take you away from fulfilling your goal (inhibition of impulse).

This entire process is called working memory; it is critical to reasoning experience, solving problems, time management, regulation of emotion, and inhibition of impulse. ADHD children and adults cannot hold what is being required of them in their minds long enough to work out a problem. That is because stimuli have a high impact on their brains. Everything grabs their attention. A sound, stomach growl, thought to call a friend gets them impulsively off and running toward those stimuli. Think about my patient Gino. One suggestion that he should take more risks in life got him to invest his life savings in a financial scam. “Is he stupid?,” you may be saying right now. Gino was intelligent, but his ADHD made him a victim to whatever whim came into his head, like a pinball aimlessly bouncing around the brain without an endpoint.

Pervasive executive function problems do not let ADHD people to adequately mature through trial and error learning and consequences of action. They don’t learn from their mistakes. What is more, they often end up with a very low self-esteem, as their history of conflicted work and social experiences makes them feel very badly about themselves. When my patient Gino learned that his problems stemmed from a history of ADHD, he said to me, “Oh my God, I always thought I was the biggest loser.” “I always wondered what was wrong with me.” This is how many ADHD adults feel. The excitability of their brains lead them to behave in ways that can cause people to see them as immature, overly excitable, impulsive, obnoxious, rude, demanding, oppositional, and moody. It is no wonder why ADHD persons are often misdiagnosed as having Bipolar Disorder. Their excitable natures, inability to concentrate, and poor ability to self-manage themselves can make them appear manic.

A Whole Body Approach to ADHD Treatment

1. Why is medication the first line of treatment in ADHD? I appreciate why people would like to treat mental health conditions without medication. But, this is easier to do when cognitive and behavioral problems are not neurobiologically based. ADHD persons cannot easily control their behavior or snap out of their self-destructive ways without a medication to regulate the frontal lobe area of their minds. Also, ADHD is not a problem of moral control, as first thought in the late nineteenth century. It is a pervasive dysfunction of higher brain processes that lead to problems in self-restraint, self-management to time, self-organization and problem solving, self-motivation, and self-regulation of emotions. Medication is needed to control the hyperactivity of their brains so they can concentrate and regulate behavior in the direction of their goals. See and for medication recommendations.

2. Diet and exercise: Diet, exercise, and other health therapies that improve one’s overall physical and mental health are vital to managing ADHD. The goal of treatment is to get the biology working properly so that learning can take place once again. Diet, exercise, and positive change in your life will help you to manage your ADHD. The omega fatty acids are now being used in a variety of mental health disorders that involve brain excitability, like Bipolar Disorder and ADHD. Besides fish oils that are generally used to increase omega 3 fatty acids in the body, there are plant sources, like Chia Seeds that not only are an excellent fatty acid (3, 6, 9s) supplement but also contain other vital vitamins and antioxidants for health, such as calcium, phosphorus, magnesium and have a strong anti-inflammatory effect on the brain and body. And, the nice thing about Chia in contrast to Flax seeds is that Chia seeds are not high in estrogen for those of you who have illnesses worsened by estrogenic activity (

3. Psychotherapy for ADHD: Behavior modification and self-management techniques are vital to managing ADHD. Remember, ADHD people have spent years engaging in destructive behaviors that prevented them from learning adaptive responses to situations. Psychotherapy helps ADHD people to learn adaptive social responses through a modification of their behavior and self-management techniques. Goal setting, reward and consequence, and emotional regulation are other areas that are addressed during psychotherapy for ADHD.

4. Go with the flow of your talents and strengths. The good news is that ADHD persons are generally above average in intelligence, creative, highly engaging, active, and passionate people (Adults with ADHD Score High in Creativity). ADHD has no correlation to actual intelligence. It is a disorder of brain processing rather than IQ. Medication, therapy, and lifestyle change can help ADHD people to work at many types of jobs (Dr. Edward Hallowell M.D., Driven to Distraction). Even so, it is important to find work that is interesting, as boredom can sidetrack ADHD persons, which causes their performance to plummet. When they tie their passions to their jobs and learn coping strategies to cope with their weaknesses on the job, they occupationally thrive.

I hope you see that ADHD is far from just an annoying childhood disorder that is over-treated. It is a chronic disorder that research shows doesn’t go away in adulthood ( and if left untreated can take a toll on a person’s life (ADHD Takes Toll Well Into Adulthood ).

I hope you liked my post today. If so, please let me know by selecting the LIKE icon that immediately follows. You can also Tweet and Google+1 today’s article to let your friends know about it. Warmly Deborah.


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7 Responses to “The Shadow Syndrome: Adult Attention Deficit Hyperactivity Disorder (ADHD)”

  1. avatar Salvatore Maddi says:

    This is another illuminating article. It makes us think through what is going on, without just giving in to what we have been told already. Thanks so much for stimulating our insights regarding this disorder.

  2. avatar sachal bhatti says:

    intresting post and nide artical. everyone have a little or more hADHD probkem due to social influence, like a Gino. my all sympathy with Gino. thanks to sharing valuable ideas and golden tips.

  3. avatar Lita Olmos says:

    I noticed you only referred to ADHD. What about ADD without the hyper-activity? I am sure I have always had ADD and recognized it in my own children to 1 degree or another, but I too have always had this and never had it diagnosed or treated. I am 56 yrs. old and just don’t know how to go about having this diagnosed and treated. Odd, because my son had ADD no hyper-activity growing up and I did everything humanly possible to have him properly diagnosed and treated.

    Thank you for any feedback.

  4. avatar Ali says:

    The article is totally dealing with the work and actions of human being as how they work , how they think , how they perform their duties and how they manage their financial and management sides in daily routines . Further , it also discussed that how the person involve in ADHD . By the way , it was the finest article of you as it helped me to enhance my level of education by removing such hurdles from my study .:)

  5. avatar Eliza Tree says:

    Dear Deborah, Thankyou So Much. At last I Understand!! And will hopefully, finally be diagnosed & get a treatment plan, which may help me deal properly with it all. Until now I was only diagnosed with mild anxiety / depression. But it’s so much more!!
    Many, many thanks, Eliza

    • avatar Dr. Deborah Khoshaba says:

      Hello Eliza, you are very welcome. I’m so pleased that the information in the article helped you to make the diagnosis so you can get the right help. I know that many people are misdiagnosed with other disorders because they share so many of the same symptoms. Let me know how it goes Eliza. Warm regards to you Deborah.


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