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Adults who don’t know they have ADHD can struggle. Here’s how a diagnosis can help

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Edmonton resident Nikki Houde was 41 when she was formally diagnosed with attention-deficit/hyperactivity disorder (ADHD).

In November 2021, the middle school success coach was working from home during the COVID-19 pandemic, often finding her concentration drifting during video meetings, regularly avoiding tasks and making up distractions to get out of completing her work.

“I was just creating things so I didn’t have to do things that I didn’t want to do,” she said

After speaking with a friend who had been diagnosed with ADHD, Houde decided to seek help and learned that she was one of the thousands of adults who struggle with undiagnosed ADHD.

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If left undiagnosed, experts like Dr. Ainslie Gray — a psychiatrist who founded the Springboard Clinic in Toronto and serves as the facility’s medical director — say that adult ADHD can seriously reduce a person’s overall quality of life.

“ADHD can impact every element of an individual’s life and the stereotype that it resolves by adulthood, even if it has been diagnosed in childhood, is not true,” she said, adding that the majority of people diagnosed in childhood and adolescence continue to experience challenges in adulthood.

Houde works as a success coach supporting school and vulnerable youth. (Submitted by Nikki Houde)

When Houde was finally diagnosed, she said she “felt relief because it explained a lot of things about myself that I didn’t have to feel so bad about myself, because there are things beyond my control.”

Houde’s feelings of relief are familiar to Gray.

“Adults often feel tremendous relief because they gain an understanding of what areas of their life have been responsible for their impairment,” Gray told The Dose host Dr. Brian Goldman.

According to Gray, ADHD is a “usually genetic” neurodevelopmental disorder that can range in symptoms, most often associated with hyperactivity, restlessness and inattention.

According to the Centre for ADHD Awareness, Canada (CADDAC), roughly five per cent to seven per cent of children are diagnosed with the condition, while four per cent to six per cent of adults are diagnosed.

While children may have a harder time processing their symptoms, Gray says adults can “learn to mask their symptoms,” making it difficult to determine if patients have ADHD or other mental health concerns.

A woman in a white blouse smiles at the camera. Her arms are crossed.
Dr. Ainslie Gray is a psychiatrist and founder and medical director of the Springboard Clinic in Toronto. (Submitted by Ainslie Gray)

Still, the life impacts of adult ADHD are very real.

“There’s real concrete stats saying there’s compromised socioeconomic status, there’s lower annual incomes, there’s higher divorce rates, there’s less workplace satisfaction and less job security,” she said.

A study published in 2022 concluded that “adults diagnosed with ADHD and their spouses had more unfavourable patterns in their marriages with regard to the level of conflict, marital adjustment, conflict resolution styles and reciprocal evaluations” compared with non-ADHD couples.

ADHD in girls often harder to spot

Gray added that boys are more likely to be diagnosed than girls, but the ratio shifts to roughly 50/50 by adulthood.

“In children and adolescents, the male individual often presents with more overt emotional dysregulation or physical hyperactivity,” she said.

In comparison, girls are more likely to be inattentive rather than hyperactive — which makes it harder to diagnose their symptoms.

Gray speculates that one of the reasons the ADHD diagnosis ratio shifts in adulthood is because women are often more likely than men to seek medical help.

 

More women are being diagnosed with ADHD. Here’s why.

 

Girls are three times less likely to be diagnosed with ADHD, according to the Centre for ADHD Awareness, Canada. But it has more to do with society than genetic differences.

Looking back at her experiences, Houde acknowledged that she showed signs of ADHD even during childhood.

She would hyperfixate on things, often finishing books in a single night. She would also have trouble following conversations, either getting distracted or interrupting the other person while waiting for her turn to speak.

Additionally, Houde remembers often being told by her mother that she spoke very quickly — which is one of the many symptoms of hyperactivity associated with ADHD.

Since her overall experiences didn’t line up with those of the boys diagnosed with ADHD in her class, Houde didn’t think she had ADHD.

As she grew older, Houde’s experienced difficulty completing tedious tasks — like paying bills — often procrastinated and completed work at the last minute or not at all.

Coping with symptoms

Nonetheless, she found ways to cope with her symptoms.

“Post-its all over my office with to-do lists, things that I need to get done or reminders,” she said. “I have my calendar on my phone, and then I had a paper calendar, then I had a calendar on the wall to remind me of things.”

Dr. Sara Binder, an adult psychiatrist in Calgary, said adults with undiagnosed ADHD often find workarounds to manage their symptoms, sometimes even choosing professions that are “naturally stimulating and interesting for them.”

A woman smiles at the camera.
Dr. Sara Binder is an adult psychiatrist at the Foothills Medical Centre in Calgary. (Submitted by Sara Binder)

Binder said she often treats professionally successful adults with ADHD who are struggling in other areas of their life due to the undiagnosed condition.

“When you dig a bit deeper and you find out what’s going on in the rest of their life, or how hard they have to work just to stay at that level of functioning compared to their peers, you realize that there is actually significant impairment of functioning.”

According to Binder, part of the challenge with diagnosing adults with ADHD is that patients can sometimes present symptoms associated with other conditions — like anxiety, depression and substance abuse.

“By adulthood, if somebody has not been diagnosed and treated for ADHD, about 85 per cent of them will have at least one other psychiatric comorbidity,” she said.

How to treat ADHD

Gray says the first step in treating ADHD at any age is consulting with an appropriate specialist to receive a diagnosis.

Her clinic typically has patients meet with a psychiatrist, clinical psychologist and a coaching therapist.

“When those three interviews get together, along with questionnaires, it’s pretty clear when someone has ADHD and when they don’t,” she said.

After being diagnosed, Gray says a combination of prescribed medication and coaching or behavioural intervention to “deal with their signs and symptoms of impairment” is often best.

She says stimulants are an effective treatment, adding that long-acting preparations are significantly safer than immediate-release pharmaceuticals.

“Prescribing immediate-release stimulants, in my opinion, should never happen,” she said.

 

More adults are taking ADHD medication

 

New data from B.C. shows the rate of adults using ADHD medication has gone up dramatically. It can mean a fresh start for many newly diagnosed adults but physicians warn there can be drawbacks of taking medication.

A better life after diagnosis

For her part, Houde says her life has improved in the two years since her diagnosis, and she no longer struggles with managing her responsibilities.

She pays bills on time, stays in touch with friends and family and has enhanced her overall communication skills.

For those adults who might be worried about being diagnosed with ADHD or worried about the use of medication, Houde says her own journey has helped boost her self-image.

“If you think there’s something going on, there usually is,” she said. “It’s eye-opening and it helps you walk your path that you’re actually supposed to be walking on.”

 

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Public Health Agency urges everyone to get their measles vaccines – CJWW

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The Public Health Agency of Canada is urging everyone to make sure they have their two doses of measles vaccine, especially before travelling. Global health authorities are reporting there was a significant increase in measles last year, and it continues to rise this year, due in part to a decline in measles vaccinations during the pandemic.

A news release from the Public Health Agency says measles is a highly contagious airborne virus that can cause serious disease. Anyone who is travelling internationally and isn’t vaccinated is at risk of being infected. There is a travel health notice for measles in all countries right now.

Symptoms of measles include fever, red watery eyes, runny nose, and cough followed by a red rash that starts on the face and then moves to the rest of the body. As of February 10th, there have been four cases of measles in the country.

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Kingston-area avian influenza confirmed as highly pathogenic variant – The Kingston Whig-Standard

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Dead bald eagle in Kingston tested positive for the virus

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As avian influenza continues to affect local wild bird populations, a Napanee wildlife centre has confirmed that the Highly Pathogenic Avian Influenza (HPAI) variant of avian influenza has been identified in the Kingston region.

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According to the Canadian Food Inspection Agency (CFIA), the HPAI virus, also known as H5N1, was first discovered in Canada in 2021 and has since been found in wild birds in every province and territory.

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Leah Birmingham said Sandy Pines Wildlife Centre received confirmation from the Canadian Wildlife Health Cooperative (CWHC) that the highly pathogenic version of the avian influenza virus has not only been discovered in dead Canada geese from Kingston, but also other scavenger species as well.

“They’ve now found it in a raven, a crow and (a bald) eagle,” Birmingham said on Friday. “That makes sense, because all of those birds would potentially feed off of the carcasses of dead Canada geese.”

Last week, Sandy Pines received four crows from Kingston showing neurological symptoms.

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“That’s often what you see,” she said. “The water birds typically show a variety of signs of a flu-like disease. But the birds that eat them seem to have more of the neurological signs, like seizures, and less of the upper respiratory ailments.”

In an interview earlier in February, Birmingham told the Whig-Standard that birds showing signs of the virus were being humanely euthanized to limit the risk of spread among the birds who live at or are being rehabilitated at the wildlife centre.

Birmingham said the centre has been sending bird carcasses to the CWHC for viral identification, but lately they’ve been told to stop.

“We’ve already shown positives in the scavenger species essentially,” Birmingham said. “So we know it’s in those bird populations as well.”

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But otherwise, Birmingham said that calls to the wildlife centre about sick birds are on the decline.

“The situation has died down a bit, and it’s just sort of in patches now, not the same intensity,” she said. “That’s a good sign.”

Still, it’s been a record-breaking year in the Kingston region for the virus, Birmingham said.

Kingston, Frontenac and Lennox and Addington Public Health told the Whig-Standard on Friday that as of Feb. 22, 12 birds had tested positive for avian influenza in the region, according to a summary report from the Ontario Ministry of Health.

Of those positive tests, eight of the birds were geese, three were crows and one was an eagle.

It’s not clear how many of those tested positive for the highly pathogenic variant.

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The CFIA, which monitors the spread of HPAI with a careful eye to Canada’s poultry industry, keeps a dashboard of active investigations and positive test results from across the country.

Since the end of January, five active outbreaks are under investigation in Ontario, Nova Scotia, Alberta and Quebec.

Max Kaiser, a commercial egg farmer in Greater Napanee, said he treats every wild bird on his property as if it were infected, taking precautions to protect his commercial flocks.

An infection within a commercial poultry flock can take an extreme financial toll on farmers.

“We take every precaution to keep everything out of the barn, whether it’s changing footwear, changing clothes, disinfecting tools, everything we can do to keep our barns clean from whatever’s outside,” he told the Whig-Standard on Friday. “That could be walking through bird droppings in the barnyards, to wild birds perching on the rooftop. It’s concerning at every level.”

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While Kaiser isn’t losing sleep over the presence of HPAI in the region, and while biosecurity measures are standard practice at Ontario poultry farms, he is taking extra precautions.

“It’s just diligence. Changing footwear is a simple one, but then when our suppliers, like our feed truck and the delivery vehicles, come and go from the barnyard, they have to disinfect, too, even the tires on the trucks as they come up the laneway,” he said.

Kaiser Lake Farms’ egg operation is located on the shores of Hay Bay, an inlet of Lake Ontario.

“Migratory birds are starting to migrate north again, so we’re ramping up,” Kaiser said. “I’m seeing geese in the fields now that weren’t there a week ago. Now that we’re seeing them, we’re back up to full precautions.”

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The Feather Board Command Centre, an organization that provides up-to-date information to Ontario poultry industry members about health risks to commercial bird populations, is recommending heightened biosecurity measures on all of the province’s poultry farms as HPAI moves across the country.

“Currently there are 37 active HPAI cases in Canadian provinces, affecting over 11 million birds,” it said in a news release on Feb. 2. “With the unseasonably warmer weather we have been experiencing, wild birds continue to be on the move and we are seeing increases in wild bird die-offs, increasing the potential risk of disease transmission.”

While HPAI has not been observed to infect humans, some mammals have tested positive for the virus, including raccoons, striped skunks, red foxes, cats and dogs, the CFIA stated on its website.

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“While HPAI is primarily a disease of birds, it can also infect mammals, especially those who hunt, scavenge or otherwise consume infected birds,” the agency wrote. “For example, cats that go outdoors may hunt and consume an infected bird, or dogs may scavenge dead birds. In 2023, a dog in Canada was infected with avian influenza after chewing on a wild goose, and died after developing clinical signs.”

KFL&A Public Health recommends on its website that people who discover dead birds on their property wear protective gear while handling bird carcasses, and either bury the bird at a minimum of one metre deep, or double bag and dispose of the carcass in the garbage. Those who discover a dead bird on public property should contact their municipality, the organization said.

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Birmingham said people should try, if they can, to bury the carcasses. This prevents the spread of the virus among other animal populations, as well as protect domestic pets that may come in contact with a dead bird.

Still, with its potential threat to both wild birds and commercial operations, Birmingham is urging people not to panic abut the virus.

“I don’t want the public to freak out about all wild birds,” she admitted. “There are all kinds of diseases that wildlife can be the reservoir for and carry. Some of them are manmade because of people bringing animals from one continent to another. And others happen naturally, because of high-density populations of animals … in a way this is nature’s way of sort of taking care of dense populations of animals, right?

“I just don’t want people to be so petrified that their dog or cat is going to get this virus because there were crows in their backyards. It’s not that simple.”

mbalogh@postmedia.com

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Interior Health concerned by rate of youth vaping – Arrow Lakes News

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Vaping has replaced smoking amongst South Cariboo teens.

These days it’s more common to see young people sneak a hit of their vape rather than light up a cigarette. It’s a trend that worries health professionals like Nicole Hargreaves and Jered Dennis, two of Interior Health’s Legal Substance Reduction coordinators.

“Really what we’ve seen in recent years is there has been an inverse relationship with smoking cigarettes, or commercial tobacco use, to vaping use. As cigarette use has been going down in communities, especially among youth, we’ve seen an uptick in vaping use among teens,” Hargreaves said.

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Substance reduction co-ordinators are responsible for monitoring the use and abuse of legal substances such as alcohol, cannabis, cigarettes and vape products. They take a “population-level health approach” Hargreaves explained and support several programs across the region aimed at reducing cannabis, alcohol and nicotine use. Nicotine use especially has been on the rise in recent years thanks to vapes.

The 2018 BC Adolescent Health Survey found that 36 per cent of youth in the Thompson-Cariboo-Shuswap region had vaped within the last 30 days. While it’s just an educated guess, Dennis said it’s likely vape usage has increased since then. He noted that IH expects to have more up-to-date numbers within the next few weeks following the release of a new survey.

There are a variety of reasons why vapes have become the preferred substance among teens, Hargreaves explained. This includes how easy vapes are to conceal, peer pressure, the stress of everyday life and how normalized it’s been among teens in recent years.

One of the biggest factors, however, is the fact vaping has been perceived as less harmful than traditional tobacco products. Vape companies such as JUUL originally sold their product as a smoking cessation tool.

While vapes are better for smokers than cigarettes, they also became a way to hook a whole new generation on nicotine. Due to how relatively new vaping is, Dennis said doctors don’t truly know what potential health risks could emerge, especially among those who adopted the practice young. He did note however vapes can contain heavy metals and carcinogenic chemicals.

“There is this misconception that vapor products just contain water and that’s absolutely not the case. We know that water vapour contains a variety of different toxic chemicals that are inhaled through the lungs and mouth and then absorbed into the bloodstream,” Hargreaves said. “When that happens the chemicals enter your brain and organs through the blood and can have a really significant impact on adolescent brain development.”

Hargreaves said these effects can manifest themselves as impulsiveness, difficulties learning and paying attention and dependency. Nicotine itself is highly addictive and youth are most susceptible to becoming addicted.

Dennis pointed out that the human brain and lungs aren’t fully developed until the mid-twenties. When you introduce foreign substances to them while they’re still developing they can have a far more detrimental effect than they would on an adult.

“I’m not saying (vaping is) harmless for an adult, but there’s a greater risk of harm for a young person because they’re still in that developmental stage,” Dennis said. “We don’t know what the long-term impacts of vaping are, so we’re trying to play catch up to identify the burdens on health.”

Vapes can only be sold if they contain nicotine or cannabis, with a limit of 20 milligrams of nicotine per one millimeter of vape juice. When sold at a vape shop or convenience store they can only be sold to adults over the age of 19.

Dennis said that typically youth report they obtain vapes via an adult whether they be a friend, an older sibling or even their parents. Online sales have also become a significant way for teens to acquire vapes. The Tobacco and Vapour Act regulates online sales and requires the company delivering the items to verify the purchaser’s age.

According to a test done by the Centre for Addiction and Mental Health, Dennis said Canada Post is most effective at confirming customer’s ages. However, some of the other delivery services were not found to be as diligent.

One of the best ways to reduce youth vape use, Dennis said, would be to ban flavored vape products. Vape shops can still sell vapes flavoured like fruits and candies and he believes if they could only sell methanol or tobacco-flavoured products, like gas stations, use among youth would decline.

“Some of the common reasons why youth vape are flavours. Flavours are a significant appealing factor to youth vaping and I would suggest if the only flavours were tobacco flavour, we would reduce vaping rates,” Dennis said. “I firmly believe that. It’s an intervention or strategy that could be put in place that would significantly impact youth vaping rates.”

If you’re looking to help a teenager quit vaping, Dennis said you should initiate conversations with them about the habit. By talking to them about the risks associated with vaping from a place of education, not fear, you can delve into why they’re vaping and give them the support they need to quit. Hargreaves added that it doesn’t just take a one-off conversation, but instead an ongoing dialogue.

Dennis also recommends people looking to quit make use of the BC PharmaCare’s Smoking Cessation Program which provides everyone 12 weeks of free Nicorette patches and other smoking cessation tools. Youth can also download Quash, an app designed to help them reduce their use of vapes by allowing them to way the pros and cons of the habit.

“We often talk about quitting now, but even the reduction of the quantity and frequency of vaping products is a significant movement towards reducing the harm,” Dennis said. “Instead of hitting a vape five times in an hour, try to hit it once an hour. When you inhale the vape try not to inhale a huge amount of the aerosol.”

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