Shirah Vollmer MD

The Musings of Dr. Vollmer

Undiagnosed ADHD: A Tragedy?

Posted by Dr. Vollmer on December 20, 2011

  Frank, thirty-seven, comes to see me because he broke up with his girlfriend of ten years. He is often late, forgetful of appointments, disorganized with his payments, and generally a “last-minute” guy. He is also a thrill-seeker. He jumps out of airplanes. He goes paragliding and bungee jumping. He does not like staying idle. “What were you like as a school-age kid?” I ask, realizing that I am not familiar with his childhood history. “I was smart but I hated school. The teachers hated me too. I was always in trouble.” “Do you think it is possible that you have ADHD?” I ask, beginning to think that his current behavior, combined with his self-report of his school history fits an ADHD diagnosis. “Well, yea, I have thought that for a long time,” he says, as if it is obvious.

    “We have never discussed it before, and you have never been treated,” I say, knowing his psychopharmacological history. “Well, I thought I was too old, and besides, I had it so many years ago they weren’t treating it then,” he says with suspicious certainty. “Oh yes, they, meaning I, was treating it then,” I gently contradict him. “We could try a stimulant,” I say, “but I am also thinking about the years of your coming of age where you must have been misunderstood as a trouble-maker, and not someone who was struggling with organic issues which got in your way.” “Well yea,” Frank says, seemingly with minimal impact about the gravity of the lack of a diagnosis in childhood. “I wonder how your relationships would have been if you could explain to your significant other what your struggles are like.”  I say, emphasizing that part of having ADHD is understanding how it impacts relationships. “Maybe I would still have my girlfriend,” Frank says with acknowledgement that his ADHD interfered with his relationship, but also with a tone that lightens the discussion. Three days later Frank calls me. “Hey doc, that stuff you gave me is really helping me. Thanks.” He says, continuing in this light-hearted way, almost as if I gave him aspirin for his headache. “I am glad,” I say, with a heaviness which mismatches his tone. “That is really a big deal.” I say, marveling at the years in which he had no idea why he was so scattered and unreliable.

2 Responses to “Undiagnosed ADHD: A Tragedy?”

  1. Shelly said

    Is it a tragedy if the patient doesn’t feel like it is? If he feels that it really hasn’t impacted his life in a negative way and that you, in hindsight, do? Good thing that the medication you gave him works, but he didn’t feel something was missing before you gave it to him, did he?

  2. Interesting points that you highlight. I would argue that his relationships have suffered as a result of him not understanding his diagnosis of ADHD. He would argue that he has had relationship problems but he is not sure why. Yes, from my point of view it is tragic that no one ever explained to him what it means to have ADHD and how he needs to manage this disorder so that he can have deeper and more meaningful relationships. The medication does help, but the major aid is understanding the meaning of ADHD. I think that he minimized the impact of his diagnosis so as not to feel the depth of the experience of going through so many years of his life feeling like he “messed up” but not knowing that he had organic obstacles that he needed to manage. As usual, I speculate.

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