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.
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.
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.”
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.”
The Canadian government says it will donate up to 200,000 vaccine doses to fight the mpox outbreak in Congo and other African countries.
It says the donated doses of Imvamune will come from Canada’s existing supply and will not affect the country’s preparedness for mpox cases in this country.
Minister of Health Mark Holland says the donation “will help to protect those in the most affected regions of Africa and will help prevent further spread of the virus.”
Dr. Madhukar Pai, Canada research chair in epidemiology and global health, says although the donation is welcome, it is a very small portion of the estimated 10 million vaccine doses needed to control the outbreak.
Vaccine donations from wealthier countries have only recently started arriving in Africa, almost a month after the World Health Organization declared the mpox outbreak a public health emergency of international concern.
A few days after the declaration in August, Global Affairs Canada announced a contribution of $1 million for mpox surveillance, diagnostic tools, research and community awareness in Africa.
On Thursday, the Africa Centres for Disease Control and Prevention said mpox is still on the rise and that testing rates are “insufficient” across the continent.
Jason Kindrachuk, Canada research chair in emerging viruses at the University of Manitoba, said donating vaccines, in addition to supporting surveillance and diagnostic tests, is “massively important.”
But Kindrachuk, who has worked on the ground in Congo during the epidemic, also said that the international response to the mpox outbreak is “better late than never (but) better never late.”
“It would have been fantastic for us globally to not be in this position by having provided doses a much, much longer time prior than when we are,” he said, noting that the outbreak of clade I mpox in Congo started in early 2023.
Clade II mpox, endemic in regions of West Africa, came to the world’s attention even earlier — in 2022 — as that strain of virus spread to other countries, including Canada.
Two doses are recommended for mpox vaccination, so the donation may only benefit 100,000 people, Pai said.
Pai questioned whether Canada is contributing enough, as the federal government hasn’t said what percentage of its mpox vaccine stockpile it is donating.
“Small donations are simply not going to help end this crisis. We need to show greater solidarity and support,” he said in an email.
“That is the biggest lesson from the COVID-19 pandemic — our collective safety is tied with that of other nations.”
This report by The Canadian Press was first published Sept. 13, 2024.
Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.
HALIFAX – The Nova Scotia government says it could be months before it reveals how many people are on the wait-list for a family doctor.
The head of the province’s health authority told reporters Wednesday that the government won’t release updated data until the 160,000 people who were on the wait-list in June are contacted to verify whether they still need primary care.
Karen Oldfield said Nova Scotia Health is working on validating the primary care wait-list data before posting new numbers, and that work may take a matter of months. The most recent public wait-list figures are from June 1, when 160,234 people, or about 16 per cent of the population, were on it.
“It’s going to take time to make 160,000 calls,” Oldfield said. “We are not talking weeks, we are talking months.”
The interim CEO and president of Nova Scotia Health said people on the list are being asked where they live, whether they still need a family doctor, and to give an update on their health.
A spokesperson with the province’s Health Department says the government and its health authority are “working hard” to turn the wait-list registry into a useful tool, adding that the data will be shared once it is validated.
Nova Scotia’s NDP are calling on Premier Tim Houston to immediately release statistics on how many people are looking for a family doctor. On Tuesday, the NDP introduced a bill that would require the health minister to make the number public every month.
“It is unacceptable for the list to be more than three months out of date,” NDP Leader Claudia Chender said Tuesday.
Chender said releasing this data regularly is vital so Nova Scotians can track the government’s progress on its main 2021 campaign promise: fixing health care.
The number of people in need of a family doctor has more than doubled between the 2021 summer election campaign and June 2024. Since September 2021 about 300 doctors have been added to the provincial health system, the Health Department said.
“We’ll know if Tim Houston is keeping his 2021 election promise to fix health care when Nova Scotians are attached to primary care,” Chender said.
This report by The Canadian Press was first published Sept. 11, 2024.
ST. JOHN’S, N.L. – Newfoundland and Labrador‘s chief medical officer is monitoring the rise of whooping cough infections across the province as cases of the highly contagious disease continue to grow across Canada.
Dr. Janice Fitzgerald says that so far this year, the province has recorded 230 confirmed cases of the vaccine-preventable respiratory tract infection, also known as pertussis.
Late last month, Quebec reported more than 11,000 cases during the same time period, while Ontario counted 470 cases, well above the five-year average of 98. In Quebec, the majority of patients are between the ages of 10 and 14.
Meanwhile, New Brunswick has declared a whooping cough outbreak across the province. A total of 141 cases were reported by last month, exceeding the five-year average of 34.
The disease can lead to severe complications among vulnerable populations including infants, who are at the highest risk of suffering from complications like pneumonia and seizures. Symptoms may start with a runny nose, mild fever and cough, then progress to severe coughing accompanied by a distinctive “whooping” sound during inhalation.
“The public, especially pregnant people and those in close contact with infants, are encouraged to be aware of symptoms related to pertussis and to ensure vaccinations are up to date,” Newfoundland and Labrador’s Health Department said in a statement.
Whooping cough can be treated with antibiotics, but vaccination is the most effective way to control the spread of the disease. As a result, the province has expanded immunization efforts this school year. While booster doses are already offered in Grade 9, the vaccine is now being offered to Grade 8 students as well.
Public health officials say whooping cough is a cyclical disease that increases every two to five or six years.
Meanwhile, New Brunswick’s acting chief medical officer of health expects the current case count to get worse before tapering off.
A rise in whooping cough cases has also been reported in the United States and elsewhere. The Pan American Health Organization issued an alert in July encouraging countries to ramp up their surveillance and vaccination coverage.
This report by The Canadian Press was first published Sept. 10, 2024.
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