On the console beside her seat in the van are two library books she needs to return. Both are overdue.
Anthony, 6, dressed in his nicely pressed uniform blue shirt and gray pants on this crisp early fall day, smiles at her as he climbs into the car seat behind his 3-year-old brother, Christopher. Anthony chatters nonstop about the art project he did, what he ate for lunch and how he had a “green” day. For him, having a green day is about as difficult as getting to places on time is for his mother. A green day means he didn’t interrupt the teacher, pester his classmates, jump up from his seat, fidget, forget to turn in his homework, space out wondering about the clouds out the window or stare at the blank paper on his desk that is supposed to be filling up with classwork.
Suppers, 30, pulls out of the parking lot and begins to explain that Anthony has attention-deficit hyperactivity disorder, or ADHD.
“Mommy,” Anthony chirps from the back of the van.
That, though he’s smart, he has a tough time sitting still, getting going on things that bore him, such as homework, and that he is easily distracted or frustrated in school.
“Mommy,” Anthony persists.
And how, the more she learns about his ADHD, the more she wonders —
— if she has it herself.
Without waiting for an answer, Anthony insists they drive by a house that had burned down as a reward for having a green day. Suppers nods. Puts a movie into the van’s DVD player and asks both boys to put their headphones on. She feels bad that the kids watch so much TV in the car, but it’s the only way she can drive with them. It took one fender bender — slamming into the car in front of her in stop-and-go traffic when she’d turned around to answer a question — to realize that she couldn’t afford to be distracted behind the wheel. Before kids, she’d had her share of speeding and red light camera tickets. “It’s so stressful when I drive if there’s any noise,” she says.
Since Suppers quit a job a few months ago that she loved but felt she couldn’t manage along with the house and the kids, she is also bracing herself for what is now her most stressful time of day: managing to keep their two dogs outside and Christopher downstairs in the playroom so the living room will be quiet. That’s where she helps Anthony, sitting at a bright yellow plastic desk, with the homework that is always a fight to get him to do.
Suppers kneels at her son’s elbow and takes a deep breath, making a concerted effort not to snap. She begins guiding him through the spelling words, with an occasional “See? You got it, buddy.” She listens to him read and helps him with the math that she was never good at and always has her husband, an electrician, double-check.
The living room is neat, despite the understandable chaos of toys and balls and piles of newspapers that come with busy family living — the result of yet another late-night effort to tidy for company. But in the kitchen, the counters and table are awash in scraps of paper, kid artwork, opened and unopened mail, bills and toys. For meals, Suppers sometimes shoves the clutter to one end, and the family eats at the other. Lately, though, they’ve taken to eating in front of the TV in the living room.
Though parts of the house are a jumble, Suppers makes a big effort to keep the kids organized. She spends hours in their playroom, stacking the toys neatly on shelves. She makes sure their days have the routine that she never had as a child and struggles with still as an adult. The children get regular exercise, play on sports teams, get a daily dose of fish oil, eat dinner at 6 p.m., have their baths and are in bed early. Suppers herself often won’t make it to bed until after midnight and then can fall asleep only after hours of TV or playing games on her iPod.
When the homework battle has finally finished, her husband, George, arrives home. He takes over cooking the hamburger for dinner when she gets distracted looking through piles of paper on the counter for a sticky note he left her about a car repair the week before that she completely forgot about. He is convinced that she has ADHD. He teases her that she has never made a decision in her life, not even about what to order for dinner. “There’s just always way too much stuff going on in my head,” she says. “It feels kind of silly trying to make serious conversation about it. Other people have it so much worse. I think if I didn’t have the kids, I’d think, This is the way I am, so whatever. But I worry about passing it on.”
Later that evening, after the boys are in bed, George finds an online ADHD screening quiz and has Michelle take it. Based on her score, she is advised to seek out a trained mental health professional. “Immediately.”
To better understand the reach of ADHD in women’s lives and the nebulous point where the stress of modern life ends and a neurobiological disorder begins, I spent months contacting support groups, psychologists, doctors, clinics and ADHD life coaches. Many women called immediately, invited me to their homes and in intricate detail laid bare how ADHD had shaped their lives. One constantly rearranged the furniture. One became addicted to alcohol and ever-higher doses of her ADHD medication. Another got caught up in what she called the “ADHD industrial complex” and spent thousands of dollars on pretty pink and blue brain scans, quantitative brain mapping, 40 neurofeedback sessions at $100 a pop, talk therapy, life coaching, yoga and organic blue algae to try to calm her mind. One woman dreaded spring sports season because she could never keep track of her kids’ schedules and continually mixed up practices and missed games. Many conversations wandered around like so much tangled string.
I spent the day in Owings Mills, Md., with Louise Toler, 43, a onetime high-powered pharmaceutical medical affairs scientist, as she sought to file a multimillion-dollar lawsuit against the University of Maryland Graduate School in Baltimore for kicking her out of a PhD program without, she argued, providing adequate accommodations for her newly diagnosed ADHD or having proper policies for graduate students with disabilities. “They thought I was just being lazy and procrastinating,” she said. Toler later withdrew the lawsuit once the U.S. Department of Education’s Office of Civil Rights decided to investigate.
One woman never got out of bed until after noon. When her doctor diagnosed her ADHD in her 50s and she was put on medication, she changed so completely that she decided to change her name. Only to find that the medication elevated her already high blood pressure and she had to stop taking it. Now, she spends her time mourning the focused and energetic woman she became. “I miss her,” she said.
But, sometimes within hours of talking, many women just as readily changed their minds and asked not to be included in the story after all. Or requested that I not use their names, saying they had acted impulsively. “I know how small D.C. is,” one said. “And this is still something of an embarrassment.” Some kept losing my phone number.
“Welcome to the world of ADHD,” says Patricia Quinn, a physician in Chevy Chase who was one of the first to work with girls and women with ADHD 30 years ago. She shrugged when I complained about my lack of progress.
Attention-deficit hyperactivity disorder has variously been called “minimal brain dysfunction,” “hyperkinesis” or a “defect in moral control.” Its hallmark symptoms — the inability to pay attention, get organized; start or finish tasks; a penchant for spacing out, forgetting or losing things; and, for some, the inability to sit still, stop talking or be patient and a tendency to act or blurt things out impulsively — have long been thought to affect only children. Particularly boys. Particularly disruptive boys in school.
In the 1990s, studies to determine the causes of ADHD began to find that it ran in families. And that, far from disappearing as children grew up, as had been the assumption,, the disorder could last a lifetime.
Now, surveys by Harvard Medical School, the National Institute of Mental Health and the World Health Organization report that, conservatively, about 4.4 percent of adults in the United States, or 8 million people between ages 18 and 44, have ADHD, making it the second most common psychological problem in adults after depression. Though with only 15 percent having a diagnosis or seeking treatment, most of them, apparently, don’t know it.
Adults with ADHD have been found to be more likely to lose a job, change a job or not show up for work, costing an estimated $77 billion a year in workplace failure. They are more likely to get divorced, go broke or be arrested. They have four times as many accidents. They experience more relationship difficulties, sleep problems or substance abuse addictions. They have higher rates of eating disorders, depression and anxiety than the general population, and lower educational attainment and earning potential. Those with hyperactive symptoms have also been found to be at significantly greater risk for injury, nonsurgical hospitalizations and poisoning.
Nearly half of the estimated 5.2 million American in 2005 taking prescription ADHD medication — the majority of which are classified as Schedule II controlled substances so powerful that they can be prescribed only in 30-day doses — are adults. Women, whose average age at diagnosis is 36 to 38, now account for the fastest-growing group taking prescription ADHD medication, increasing 164 percent between 2001 and 2009, according to Medco Health Solutions, which tracks prescription drug trends.
Much as the 1950s, with the rampant prescription of tranquilizers for stressed-out suburban housewives, became the Age of Anxiety, have we entered a new Age of ADHD?
Absolutely, Quinn says. “Women with ADHD are the true ‘Desperate Housewives,’ ” she says. “They come to me saying, ‘I’m running as fast as I can to do what everybody else seems to do so effortlessly, and I can’t keep up.’ They stay in the closet a long time, suffering in silence. It’s a messy closet. But they work hard to compensate, often staying up late into the night to get everything done. Until they get to the point where they’re so overwhelmed, they’re no longer able to cope.”
It’s not that women are suddenly coming down with ADHD. It has been there all along, Quinn says, and no one noticed. As girls, these women were more likely to be spacey, inattentive, easily distracted and disorganized rather than hyperactive — the last of which, for decades, was considered the key to diagnosis. Indeed, for years the disorder was diagnosed in 10 times as many boys as girls. Now it is diagnosed in adult men and women in equal numbers.
Quinn says that what has traditionally been expected of women — keeping house, doing the laundry, grocery shopping, organizing children’s activities, paying bills — are exactly the mundane and organized tasks most difficult, if not impossible, for a wandering and impatient ADHD brain.
Quinn, who founded the National Center for Girls and Women With ADHD, has ADHD herself. She once published a magazine for women with ADHD with features such as, “How Do You Catch a Cloud and Pin It Down: Was Maria von Trapp an ADDer?” The magazine started to expire. “Most of the women forgot to renew,” she says with a sigh.
Critics of the increasing ADHD diagnoses say the disorder is just the latest medical fad, that it is overdiagnosed and that too much medication is being prescribed too freely based on the results of studies paid for by large pharmaceutical companies looking to expand their market without understanding the long-term consequences to the human brain.
Joanna Moncrieff, a lecturer in the department of mental health sciences at University College London, has gone so far as to write in the prestigious British Medical Journal that ADHD does not exist at all in adults, calling the phenomenon the “medicalization of underperformance.” “There are lots of benefits to be had from getting the diagnosis, including sickness benefits, extra time to do exams, maybe laxer conditions or fewer duties at work, and a prescription of a recreational substance,” she wrote. “I am convinced that the increase in women being labeled is because the drug companies are trying to tap the market for ‘neurosis.’ ”
“If you’re feeling very anxious and doing 100 different things at once, your attention is going to suffer, the ability to plan and be goal-directed is going to become increasingly difficult,” says Daniel Goldin, a California psychotherapist who has written frequently about what he calls the “grotesque expansion” of the spacey, forgetful behaviors that psychologists have begun to label as ADHD. “All these women being diagnosed with ADHD are just overwhelmed and anxious. It’s just modern life.”
ADHD has been called alternately, a “disease of civilization” and the “American disease” for the high rates of diagnosis and prescription drug use here. (The United States alone accounts for well over 80 percent of the worldwide ADHD drug market.) One researcher has written that ADHD exists in any culture with compulsory education.
“Look,” Quinn says, “Everyone loses their keys or glasses sometimes, shows up late once in a while or forgets to do the laundry. ADHD is on a spectrum of normal human behavior. To have the disorder, we’re talking about people who do this all the time. To the point where it affects all aspects of their lives, their work, their marriages and their children. People don’t realize how devastating ADHD is for women.”
Though she’d never really heard of ADHD before, Michelle Suppers first began to suspect she may have it in the summer of 2009. Anthony was 4. He was a sweet, smart kid, but he had never been able to sit still. He argued constantly. And he was getting into impulsive fights with other kids at two different preschools. On the advice of a concerned teacher, she took him to a behavioral specialist who gave her and George reams of questionnaires to fill out.
As they sat on the couch late one night completing the paperwork, Suppers began to see not just her son, but also herself. As a child, she was so wild that her Peruvian mother nicknamed her Terremoto Michelle, which in Spanish means “earthquake,” and had a “Hurricane Michelle” T-shirt made for her. She was always racing around, wrestling with the boys, talking a mile a minute and breaking things. She felt different but kept it to herself. And even though she went to a private Catholic school in Arlington and spent hours with tutors, she had so much trouble learning that she thought she was just stupid.
That was what finally got her to take Anthony to the behavioral specialist. “Anthony started to say, ‘I’m just so stupid. I can’t do it.’ ” Suppers says. “That took me back.” Suppers herself had wanted to go to college. She dreamed of being a law enforcement agent for the FBI. But she didn’t last more than a few weeks at Northern Virginia Community College. “I don’t want him to feel different, like I did.”
On the questionnaire, one question in particular hit her: “Does your child exhibit any repetitive or self-stimulating behaviors such as spinning, rocking, lining up toys or head banging?” That wasn’t Anthony. But it was her. She has always rocked. Even now. George just gently puts his hand on her arm to still her whenever they watch TV.
“Does that mean I have ADHD or should have gone to a doctor?” she remembers asking the behavioral specialist at their next appointment.
“No,” she recalls the specialist answering matter-of-factly. “It means you should have been on medication.”
Suppers began reading about ADHD, often late into the night, and discovered that once it is diagnosed in a child, studies have found a 40 percent chance that one or both parents also have it.
It would take her more than a year, but what finally gets her to this nondescript waiting room at Family Medicine of Clifton/Centreville on this fall day, to finally pursue her own diagnosis was hearing about a friend’s brother. He, like Suppers, had always struggled. Then his ADHD was diagnosed, and he began taking medication. All of a sudden, he became the person he always thought he should have been. He was able to concentrate and went back to college and finished his degree. He’d gotten engaged and was working at the State Department. “Even now, I would love to go back to school, but I don’t think my brain would be able to handle it,” she says. “I wonder if medication would help me get things quicker.”
Physician Janine Brown calls Suppers into an exam room. Suppers begins to explain her problems with school, being hyperactive as a child and how the house is a hot mess, how she still talks too much and too fast, constantly forgets things, spaces out in the middle of conversations, rocks and can’t sleep. She had wanted to bring Anthony’s medical records, but she couldn’t find them.
Brown explains how diagnosing ADHD is an imperfect science. And because most evaluations are designed for children, diagnosis is even more imperfect for adults. All that doctors have to go on, Brown explains, is what people tell them about their behavior. And since anyone would benefit from what are, in essence, performance-enhancing drugs, Brown says that doctors have to be particularly careful to prescribe them only to people who really need them. “We all have moments of trouble focusing, but are you okay in your life? It’s when you can’t function that it becomes an issue. If I have a hyperactive kid with straight A’s, well, who cares?” Brown explains. “As working moms, our houses are going to be dusty. They’re going to be cluttered. That’s just the way it is.”
She decides to send Suppers to a psychologist for a formal evaluation and writes a name on a blue sticky note.
Suppers folds the note carefully. “Hopefully, I won’t lose the number,” she says.
Out in the parking lot, Suppers tries to open her blue Honda Odyssey minivan, but the key won’t turn.
“Wait a minute,” she says, rolling her eyes in exasperation. “This is not even my car.”
The ADHD advocacy group known as CHADD, Children and Adults With Attention Deficit Hyperactivity Disorder, has more than 16,000 members and 200 chapters throughout the country. The Northern Virginia chapter is one of the largest. Its support group for women with ADHD meets once a month at the Ballston fire station.
Among the lawyers, graduate students, nurses, retirees, stay-at-home moms and the unemployed gathered around the table one evening sits Kim Rudisill. Rudisill, 46, is an aerospace engineer. She started attending the group sessions when she became so frustrated by her ADHD that she began to cut herself. She works for a defense contractor and designs liquid rockets for things like the space shuttle and other space missions. By all accounts, she is brilliant. But she can’t do the dishes. Or remember to get the mail. Filling out her time card takes more energy than she often has. She is constantly getting lost, even with a GPS device. And until recently, she never got more than four hours of sleep a night.
“I’m coping well with my work,” she says. “But in my personal life — not so well.” On her kitchen table is a complicated array of medication she takes for her ADHD, anxiety, depression and other maladies. But when she forgets to refill her prescriptions, which has happened frequently, even her work life unravels. “My boss will ask, ‘Kim, are you listening?Are you taking your meds?’ ” she says. “He can tell I’m off in my own world, daydreaming, thinking about something else, like my guinea pigs.”
She has learned to bring her own tools to work, ask for a quiet work space and to tape meetings and lectures so she doesn’t have to take notes, which is difficult for her. And she has learned the hard way not to disclose her ADHD until after she has the job. “And they’ve seen what I can do.” In the winter, she began working with Psych Ed Coaches, one of a growing number of organizations aimed at helping people with ADHD organize their lives. Her coach taught her to do just one dish a day.
Sandy Maynard was one of the first ADHD coaches in the Washington area. The youthful Maynard, 60, wears black high-top Converse sneakers and jeans or tights and miniskirts and runs her bustling coaching business out of her studio apartment in Northwest Washington. She keeps a pile of short-term work by her computer or a set of weights by her desk to occupy her when a client is late, as they often are. She does not make judgments, since she has ADHD herself. “You’re talking to someone who mailed her purse twice when she went to put some packages in the mailbox,” she says with a laugh. “I finally just got a bigger purse that wouldn’t go in through that little slot.”
What Maynard, a former chemist, helps her clients learn to do — manage their time, set goals, keep appointments, avoid distractions, get regular exercise and eat protein — she has had to learn to do herself. Now she sets timers, posts sticky notes, religiously keeps her spartan apartment clutter-free and immediately puts all her appointments and to-do lists on the calendar on her iPhone, set with alarms that go off, because she will, no doubt, forget. Because her life is so structured, she says, she has not felt the need to take medication.
On a recent day, Maynard, who charges $150 an hour for her services, helped a woman struggling to finish her PhD and raise two young children at the same time break down seemingly insurmountable tasks into small pieces. She reminded a woman working on her first novel to finish it before getting distracted by the second. And she has been on the phone organizing the day of a young woman who has gone back to college to finish several incompletes.
“You’re going to eat, and what’s the first thing you’re going to work on?” Maynard says into her ever-present iPhone. “The survey? Good, good, good. I’ll give you a call in about an hour.”
Maynard moved to Washington 12 years ago from western Massachusetts. There, she had to supplement her coaching work with other jobs. But here, in the high-stress, fast-paced, overachieving Washington area, she has so many ADHD clients that she works full time. And earns six figures.
To her, the line between ADHD and crazy modern life is clear. “Most people, when they read about the man who left his baby in the car seat on top of the car think, ‘How could you do that?’ ” Maynard said. “People with ADHD say, ‘Thank God that wasn’t me.’ ”
After weeks of meaning to call for an appointment but getting sidetracked, Michelle Suppers finally makes it to a psychologist for an ADHD screening. In late December, Suppers sits stiffly on the edge of one of the cushy chairs and talks fast, interrupting herself, digressing and coming back to elaborate on points she’d made earlier, leaping decades forward and backward as her life story spills out.
The psychologist goes down a checklist. Difficulty concentrating. Distracted. Disorganized. Restless. Fidgety. Impulsive. Mood swings. And, finally, excessive talking.
The psychologist stops Suppers. “There’s a party going on in your head. Everything’s all jumbled up inside, and you don’t know where to begin?” Suppers nods. “And this has been going on since you were a child?” Suppers nods again. The psychologist sets down her notebook. “You meet all the criteria.”
Michelle Suppers is officially diagnosed with ADHD.
The psychologist tells Suppers that now she needs to work on learning life skills to better manage the disorder. She recommends some sessions of cognitive behavioral therapy and coaching. And if Suppers wants to see whether medication can help clear the fog in her brain, the psychologist tells Suppers to go back to her doctor for a prescription. “You help yourself,” the psychologist says, “you help your son.”
Suppers leaves to pick up Christopher from preschool. Only when she gets there does she realize she has forgotten the tuition check that’s due today. She picks up the snack basket and promises the teacher that, this time, she’ll have it filled for the kids by Friday. When she gets home, she sees that she started emptying the trash, but forgot to take the bags outside to the cans. She also forgot to feed the dogs. And the hungry dogs have since gotten into the trash and made a mess all over the kitchen floor. As she cleans it up, she remembers finally what it was she wanted to buy when she stopped at Target: hand soap.
“It’s kind of a relief, knowing I have ADHD,” she says as she sweeps up coffee grounds and broken glass. “Rather than just thinking I’m nuts.”
She meant to call the doctor for a prescription. But then came the holidays. Then her father got sick and was in the hospital. Then, in the spring, Anthony’s behavior in school got worse. She had started to walk more for exercise, but that didn’t help much. She thinks the prescription could change her life. For Suppers, it’s more just a matter of getting around to making the call.
Brigid Schulte is a Washington Post staff writer. She can be reached at firstname.lastname@example.org.