ADHD: A Family Affair

ADHD clearly runs in families, but the actual pattern of how it’s passed on from generation to generation is unclear.  Researchers have begun to identify a variety of specific genes that show up more frequently in people with ADHD.  This suggests that ADHD is a polygenic problem.  That is, there are probably a variety of underlying combinations of genes that are responsible for the outward manifestations of ADHD that we observe.  This awareness could help explain why there is so much variability in symptoms, severity and response to medications from ADHD individual to ADHD individual.

I anticipate that clarification of the genetic basis for ADHD will lead to dramatic improvements in our ability to diagnose ADHD, define specific genetic subtypes and more precisely treat ADHD.  Until this type of information is readily available and turned into some type of a routine genetic test, we are left with relying on observations, interviews, questionnaires, and attention testing to identify individuals in a family with ADHD.

In my clinical experience, more than 90% of the parents of children with ADHD can identify another family member with similar problems.  It might be a brother or a sister, an aunt or an uncle, or most commonly, one of the parents themselves.  Sometimes it’s not called ADHD…maybe it’s depression, anxiety disorder, delinquency, or perhaps just “ditzy Aunt Sally” or “crazy old Uncle Harry.”  If you look below the surface of these labels, you’re likely to find a history of ADHD behaviors or symptoms.

For many parents, sitting down and hearing that their child has ADHD helps them, for the first time, to understand the reason for difficulties they have experienced in their own lives.  For some parents, accepting the ADHD diagnosis in their child forces them to accept that they have a problem too.  Unfortunately, this painful realization causes a few parents to deny the ADHD diagnosis in their child.

In our clinical practice at The Being Well Center in Pittsburgh, we have many families where we see a child, Mom or Dad (or both), a grandparent and other extended family members.  Based on our experience working with ADHD over many years, we make it a top priority to identify other family members who might have ADHD when we make the diagnosis of ADHD in a child, adolescent, or young adult.  There are two important reasons to take some steps toward screening others in the family:

  • First, when we can get all members of a family unit identified, properly diagnosed, and then appropriately treated, everyone benefits!  Synergy occurs when the home environment is less chaotic, more structured routines are implemented, and systems are put into place to ensure better follow through with rules and responsibilities, use of compensating strategies and adherence to medication regimens…the whole is definitely greater than the sum of the parts when it comes to ADHD in families!
  • Secondly, it’s simply good health care to accurately identify and treat a problem like ADHD which can be an unrecognized contributor to so many serious life  dysfunctions across the life span.  Identifying and properly treating ADHD can change someone’s life today and well into the future.

So, when it comes to ADHD, it’s important to remember:  where there’s one there’s likely to be another.  When I teach pediatricians, family physicians and psychiatrists about ADHD, I strongly encourage them to screen other family members of their ADHD patients and facilitate getting those individuals properly diagnosed and treated.

If you are a parent or close relative of someone with ADHD and your struggling in some aspect of your life, have a high degree of suspicion about ADHD in yourself.  Complete an ADHD screener.  Read Pay Attention! and become more informed about ADHD.  Talk with your doctor or healthcare provider about possible ADHD.  Or, come see us at The Being Well Center in Pittsburgh!

How do you see ADHD connecting in your family tree?

Dr. Craig B. Liden is an internationally recognized expert in the diagnosis and treatment of ADD/ADHD. He is a board certified physician who completed his pediatric training and a postdoctoral fellowship at the Harvard University Medical School/Children’s Hospital Medical Center. Dr. Liden has served on the faculty at the University of Pittsburgh School of Medicine where he started the Child Development Unit.  Since the 1980’s, Dr. Liden has been in private practice evaluating and treating behavioral and developmental issues in more than 9,000 patients with ADD/ADHD and related co-morbidities.  He currently treats patients across the life span at The Being Well Center in Pittsburgh, PA.

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Brain Power Only Goes So Far

When I was first learning about ADHD, the common wisdom was that most kids outgrew “hyperactivity” once they passed through puberty.  Once our focus shifted away from activity level toward “Attention Deficit Disorder” we started to recognize that our patients could carry their attentional weaknesses beyond adolescence.  Recognition of a possible underlying genetic basis for ADHD reinforced our clinical experience that this problem can have an impact on an individual across the life span.

Now, the most common new patient intakes at our clinical program in Pittsburgh are for college students who failed or wound up on academic probation often after doing fairly well in high school.  We also have a substantial number of professionals (doctors, lawyers, teachers, businessmen, etc.) who show up on our doorstep at 30, 40, 50, 60, and even at 70 questioning if ADHD might be contributing to struggles in their lives.  You might wonder, “If it’s ADHD, how did they ever make it that far?”

Well, if you look back it’s not too hard to understand.  Many of these individuals were smart kids and everything came easy early on.  They could be staring out the window daydreaming while the teacher was talking but have the “brain power” to answer the question correctly when called upon.  Homework was rarely an issue because they got all the work done before the end of class and never really had to study for tests.  Because their parents and teachers used grades as the marker of success, everyone felt that things were OK.

When rough edges emerged, their parents stepped in with reminders or constant nagging and never let the natural consequences unfold.  Procrastination became an “art form” that resulted in an adrenalin rushes that allowed them to hyper-focus their “brain power” to produce high quality products at the 11th hour.  High SAT scores obscured signs of underachievement.

For many, the new demands that college presented uncovered inadequate life skills that had been lurking below the surface all along: poor time management and scheduling, ineffective planning and task management, struggles with money management, bad social decision making, poor problem solving, and an inability to self advocate.

When you think about it, it’s not surprising that only 25% of ADHD students graduate from college.  Some have the ”brain power” to make it, but that’s not the end of the story.

The demands of graduate school are even greater, but the carrot at the end is even bigger: M.D., MBA, Esq., etc!  This has been a powerful motivator for some to squeeze out every ounce of “brain power” to successfully reach the coveted goal and many do.  But this is still not the end of the line.

The demands of the real world keep on coming…see 40 patients a day, keep up with charts, manage a staff, pay the bills, be a marital partner, parent a child, take care of your health…where’s “brain power” when you really need it?!!

As the demands of life enfold, there can be ever increasing needs for efficient attention and self-regulation skills…sooner or later “brain power” is simply not enough.

So remember, whenever you, your child, your student, your spouse, your partner, or some other significant person in your life struggles to meet a new demand or expectation, think about ADHD!  It’s one of the most common reasons people fail to make the transition to the next stage of life.

Dr. Craig B. Liden is an internationally recognized expert in the diagnosis and treatment of ADD/ADHD. He is a board certified physician who completed his pediatric training and a postdoctoral fellowship at the Harvard University Medical School/Children’s Hospital Medical Center. Dr. Liden has served on the faculty at the University of Pittsburgh School of Medicine where he started the Child Development Unit.  Since the 1980’s, Dr. Liden has been in private practice evaluating and treating behavioral and developmental issues in more than 9,000 patients with ADD/ADHD and related co-morbidities.  He currently treats patients across the life span at The Being Well Center in Pittsburgh, PA.