CCPR: Dr. Katz, how did you get interested in this topic?
Dr. Katz: There’s a body of research exploring the lives of those who overcame a range of adverse childhood experiences, including learning-related challenges. I’ve always been interested in this work. Parents at our center are often surprised to learn that successful adults in every profession have struggled with lifelong attentional, executive function, learning, and other related challenges.
CCPR: What’s the most common issue you encounter?
Dr. Katz: There is still confusion about ADHD, especially the name itself. People with ADHD can pay attention well when they’re interested in what they’re doing. Not knowing this, it’s easy to see why so many people still don’t believe the condition is real. Another concern is that people with ADHD—both children and adults—often know what to do but are inconsistent and unpredictable in doing it. They have trouble executing. We have adults with ADHD who’ve taken course after course on how to be organized. They could write a book on organization, yet they still leave their day planners at our center! With help and support, families, teachers, and others often learn to see the role that understanding can play in rising above a difficult past, and the role that misunderstanding can play in prolonging one.
CCPR: What has been the traditional view of prognosis in ADHD, and what challenges have arisen due to that view?
Dr. Katz: ADHD was once thought of as a childhood condition that kids would outgrow. That’s no longer true. We now view ADHD from a lifespan perspective. ADHD symptoms often do not disappear, and yet people can learn to compensate for the symptoms in a variety of ways.
CCPR: This point of view also helps us legitimize ADHD and decrease the associated stigma, doesn’t it?
Dr. Katz: Absolutely. Stigma is an important and overlooked factor in prognosis. Children and adults with ADHD feel profound shame and embarrassment. The stigma can be harder to bear then the condition itself. If we can help patients and their families learn to legitimize rather than stigmatize the condition, I think we can dramatically improve quality of life.
CCPR: Can you share a case that illustrates this?
Dr. Katz: Sure. I have a 17-year-old patient, “Jeremy,” who was diagnosed with ADHD at age 10. He is currently managing his ADHD symptoms very well, in large part due to his school counselor, who’s helped him learn how to better advocate for himself. As part of his 504 accommodation plan, Jeremy has access to audio recordings of his textbooks, which helps him with comprehension, and copies of class lecture notes, which helps him navigate around his long-standing note-taking difficulties. Jeremy also meets twice daily with another student, who acts as a peer assistant. Before classes begin, they walk through his tasks for organizing and managing the day and then meet again briefly at the end of the day to ensure homework was turned in, assignments were written down, etc. Jeremy is also a peer assistant to a freshman whom he helps specifically with science-related projects.
CCPR: That’s a very creative approach. I would assume these ideas would be applicable to college students as well?
Dr. Katz: Yes. For example, I have another patient with ADHD, “Sarah,” who had dropped out of college, convinced that she would never be able to master her courses. We found a number of difficulties, including ADHD and executive function challenges, but also a range of impressive intellectual, learning, and other strengths which Sarah was completely unaware of. Once Sarah became more knowledgeable about her strengths and challenges, she knew how and what to ask for to level her academic playing field. She learned about different strategies and technologies that other students are using to navigate challenges similar to her own. She now earns “A” grades and has outstanding recommendations from her professors. We’re currently writing a letter on Sarah’s behalf to explain to graduate school admissions personnel that a GRE score will not accurately convey Sarah’s ability to perform in real-world settings.
CCPR: How should we think about the relationship between academic success and adult function in children with ADHD?
Dr. Katz: Children with ADHD are at risk of falling behind in school. But even if they do well, as adults they are at increased risk for driving accidents, work-related challenges, money management problems, and other relational conflicts. Conversely, kids with ADHD who do poorly in school can have excellent function as adults, including in higher education, especially when they are passionate about their career. We need to help them raise their expectations while helping them learn ways to level their academic and personal playing fields.
CCPR: That makes sense—could you elaborate?
Dr. Katz: Recently, we assessed three law school students with ADHD to help them receive accommodations; another law school graduate with ADHD to help her receive extra time on the bar exam; a dentist with ADHD to assist him with the tools to navigate executive function challenges; and two physicians, each of whom suspected that their inability to complete patient notes in a timely manner was related to undiagnosed neurodevelopmental challenges. It’s a new world for those impacted by ADHD, with new possibilities and new pathways to a brighter future.