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Attention Deficit Hyperactivity Disorder

Multiple Disorders and ADHD

09/10/2007

Question:

I have had ADHD for as log as I can remember; I could never finish anything, was easily distracted, very poor memory, impulsive...etc etc. Sort of superimposed on this was a "sleep disorder" (excessive daytime sleepiness, sort of like narcolepsy, but not as severe) that effected me and pretty much ruined my life..Then in college (1974), I was prescribed Ritalin 20mg for the "sleep "disorder" and suddenly my academics went from flunking out to doing great.. I got a professional degree in 1980. Last year, I decided that my sleep disorder no longer bothered me and stopped the ritalin with no sleep disorder problems but now I find myself right back to 1974 with my ADHD symptoms returning really, really bad. I can`t honestly ask for more Ritalin since I don`t have the original diagnosis; but my life is quickly becoming a wreck again. Is it possible that I had both disorders?

I`m embarassed to ask the neurologist about this, although she has been very patient with me for the last 20 years. ADHD seems like such a kid`s disease.. thanks

Answer:

It is VERY possible to have both a sleep disorder and ADHD. In fact, there are many papers written about just that. The connection between them likely has many variations. I have patients with ADHD who do NOT clearly have any sleep disorder yet do well enough on modifying, a non-stimulant medication mainly used for for narcolepsy, that they use no stimulants. I have also had patients who needed less stimulant medication once they started using a C-Pap machine for their Sleep Apnea.

It sounds like you may have bought into the false idea that ADHD somehow magically disappears when people grow up. There are many, many very good studies showing how people with ADHD tend to improve their impulsiveness and their hyperactivity as they age (just like almost everyone) but not their inattentiveness. If you have problems with the inattentive type, you can make it to 100 years old and it won't help. And please note, I said tend to improve impulsiveness. That does not mean one can't still experience impulse control problems that are a major hindrance to a healthy lifestyle.

Consider seeking help from a health care professional for possible inattentive ADHD if several of the following traits sounds familiar to you: making a lot of careless mistakes, have a lot of difficulty sustaining attention, are easily distracted, find yourself avoiding tasks requiring sustained attention, often don't finish tasks (perhaps shifting from one activity to another), have a lot of difficulty organizing, often lose or misplace things, are frequently forgetful about appointments or other things important to your life, or if others often feel you don't seem to listen to them.

If you don't have more than a few of these traits, or even one, I still urge you to see someone.

Finally, I'm not never really sure how to help via written words with fears about being labeled. It is a common fear and does have some understandable reason behind it. Our society as a whole has not done a very good job at helping each of us understand that abnormal is the norm. Consequently, we can feel quite uncomfortable with diagnoses from a psychiatric text or taking something like Ritalin. However, normal does not mean without a diagnosis. Nor does it mean not taking medication. Many normal people have ADHD, high blood pressure, need reading glasses, get divorced, and on and on. And if one's "life is quickly becoming a wreck again", perhaps it's time to take a chance. If you are uncomfortable approaching your neurologist or she is unsure where to go from here, your family doctor may be a better source. If you don't have one, it's time to get one. S/he can then either help you or point you in the right directions.

I wish you the best.

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Response by:

Susan Louisa Montauk, MD
Formerly Professor of Family Medicine
University of Cincinnati