Dear Therapist:

Is it possible for someone who never had ADHD to get it for the first time as an adult? I have recently started having trouble just staying focused on work as well as paying attention during shuirim and concentrating in davening. I have never had this issue before and was an excellent student all through yeshiva. My chavrusah actually recently made an offhand comment about how "ADD" I am and it really got me thinking if it's a possibility. If not, I wonder what else it could be and what I can do about it? 

Response:

“ADD” and “ADHD” have become household terms. They are often viewed as descriptors rather than a diagnosis. When someone seems to have a lot on his mind, is forgetful, seems jumpy, or has trouble focusing, they are often told that they “are” ADHD. Certainly, these can be symptoms of ADHD. However, they can also be symptomatic of other issues.

There is a reason that ADHD is typically diagnosed in childhood rather than in adulthood. ADHD almost always begins in childhood; it does not usually present for the first time in adulthood. An adult who is diagnosed with ADHD for the first time likely had childhood symptoms that were undiagnosed.

Most often, when someone initially has trouble with focus and concentration as an adult this is due to something other than ADHD. It can be due to a mood disorder, like depression. It can be due to an anxiety disorder, or a phobia. Or it can be related to drug or alcohol use. There is often a combination of these and other factors.

Other possibilities are more simple. We all have symptoms of ADHD. Similarly, we all have symptoms of anxiety, depression, phobias, OCD, and many other disorders. Of course, this doesn’t mean that we all have psychological disorders. It simply means that we are human. As such, we have human reactions to our environments and situations.

Perhaps something problematic recently occurred. Perhaps you received troubling news. Maybe something as normal as a change in circumstances (even if positive) is occupying your mind. Is it possible that you are not as excited about being in yeshiva as you once were? Is there less incentive (externally- or internally-based)?

You mentioned that you never had trouble with focus and attention as  a child. Assuming that you did not have other symptoms of ADHD as a child, you likely do not have it now. You stated that your trouble focusing began recently. If you can identify a recent change or something that may be weighing on your mind, this may well be the cause. Usually, as the change becomes normalized, or the issue is resolved, symptoms begin to fade. If this does not occur—or if there are no precipitating causes that you can identify—meeting with a therapist for a few sessions can help you to make sense of your symptoms. This can take the form of diagnosis and treatment. Or it can help you acknowledge a normal reaction to normal life issues.

-Yehuda Lieberman, LCSW

  psychotherapist in private practice

  Woodmere, NY

  adjunct professor at Touro College

  Graduate School of Social Work

  author of Self-Esteem: A Primer

  www.ylcsw.com / 516-218-4200

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