Brook Ochoa, 42, doesn’t fidget or squirm or bounce off walls like an 8-year-old child with ADHD. That’s primarily because she’s an adult, and adults tend to lack the hyperactivity part. The single mother of two has plenty of other symptoms, however. “I read seven books at a time, have never finished a project in my life, and when I get bored with a job I just walk away. I never knew until recently that that wasn’t normal. If it’s boring, I’m done.”

“Boring” is the kiss of death to adults with ADHD (attention deficit hyperactivity disorder or just ADD if they lack the hyperactivity component). And her inability to stay interested in any one subject for long may explain why Brook quit several jobs as manager and assistant manager of stores like Target and Wal-Mart. Brook is certainly competent enough to handle a heavy workload. She did well in school and earned a master’s degree in human resources; she can focus and finish assignments when they interest her. But around the house, she struggles with such simple tasks as washing dishes after meals. “Every dish in the house has to be dirty before I notice,” says Brook with a sigh. (See also “Symptoms of ADHD.”)

But at least she knows where her demons lie. For adults who were not diagnosed as children—and anyone who was already an adult when ADHD became widely recognized in children in the 1990s is unlikely to have been—having a label affixed to their struggles allows them to finally seek help. Perhaps even more important, it lets them make sense of a lifetime of bewildering experiences, of feeling hopeless or helpless in the face of their mental dysfunction, and, in many cases, wondering why they never achieved what they felt they could have.

“The more she described ADD the more the light bulb lit up for me,” recalls Robin Bellantone, 61, a mental health counselor in Portsmouth, New Hampshire. She had no idea adult ADD existed when she had the life-altering conversation during her graduate-school internship at the Massachusetts College of Art and Design in 1999. It was there that she heard a fellow staffer who specialized in working with artists with ADHD talking about the disorder: “It explained so much about my own history”—her inability to focus, her difficulty paying attention, her constant search for new stimulation.

Stories of adults who finally learn they have ADHD are as unique as the people themselves, but they have at least one thing in common: a sense that what was once shrouded in mystery is now lit with understanding, that a weight has been lifted and a puzzle solved. The National Institute of Mental Health estimates that 4.1 percent of adults have ADHD in any given 12-month period (compared to 9 percent of children). In the young, three times as many boys as girls have ADHD, but by adulthood the prevalence is the same in both sexes.

If it sometimes seems that everyone has some form of ADHD in today’s disjointed world of smartphones, tablets, and the like, the formal diagnosis is indeed on the verge of becoming more common. The newest edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, scheduled for release in May 2013, is expected to loosen the diagnostic criteria for the disorder substantially, lowering the number of symptoms required. (See chart, “Symptoms of ADHD,” next page.) But, even so, there are misconceptions about what it takes to qualify. For example, inability to focus and being easily distracted—with no other symptoms—wouldn’t be enough. You do not have ADHD if you simply like to flit from task to task at work. You do not have ADHD if you get bored doing housework. You do not have it if your mind wanders when reading dense, boring prose on a topic you have no interest in; if you get fidgety during boring sermons or hours-long presentations from a financial planner; or if you start reading another book or magazine before you finish the previous one you’ve started.

Moreover, the symptoms must appear in at least two settings: If you only show these behaviors at work, then you do not have ADHD. You probably just don’t like your job.

Still, the condition is underdiagnosed. Today, for every adult whose ADHD has been identified, there are at least three adults whose ADHD has not, according to Dr. Mary Solanto of Mount Sinai Medical Center in New York. Underdiagnosis reflects that adults can compensate for ADHD by choosing jobs that fit their brains—for instance jobs that present constant new challenges rather than jobs where one does the same task over and over.

That probably explains why Ruth didn’t receive her diagnosis until age 74. As a young woman she had few friends, felt isolated, and often blurted out what she felt without much thought for the consequences. Then, after marrying and raising a family, Ruth—who did not want her full name used—went to nursing school at age 46. She adored her new career. “I was busy all of the time. It’s never boring,” she says.

Understanding Adult ADHD The Saturday Evening Post

Inattention Symptoms
• You fail to pay close attention to details or make careless mistakes.
• You often have trouble remaining focused during lectures, conversations, or while reading.
• When spoken to directly, your mind seems elsewhere even in the absence of any apparent distraction.
• You often do not follow through on instructions and fail to finish work or chores.
• You often have difficulty organizing tasks and activities, so you fail to meet deadlines.
• You often avoid, dislike, or are reluctant to undertake tasks that require sustained mental effort, such as preparing reports or completing forms.
• You often lose things you need for tasks, such as books, wallet, paperwork, or cell phone.
• You are often easily distracted by extraneous stimuli.
• You are often forgetful in daily activities such as running errands, returning calls, paying bills, and keeping appointments.

Hyperactivity-Impulsivity Symptoms
• You often fidget with or tap your hands or feet, or squirm while seated.
• You often get up when remaining seated is expected, such as at work.
• You often run around where it is inappropriate.
• You are often unable to quietly engage in leisure activities, such as reading or gardening.
• You are often unable or uncomfortable sitting still for an extended time, as in restaurants or meetings.
• You often talk excessively.
• You often blurt out an answer before a question has been completed, finish other people’s sentences, or cannot wait your turn in conversation.
• You often have trouble waiting your turn, such as in line at a bank or store.
• You often interrupt others by butting into conversations or activities.

Symptoms of ADHD The Saturday Evening Post

The Post profiles several well-known individuals—Ty Pennington, Shane Victorino, Karina Smirnoff, and Andrés Torres—who share their struggles and triumphs in coping with ADHD, a condition that afflicts millions of American adults, largely underdiagnosed.

But as these celebrities clearly demonstrate, once diagnosed and treated, adults with ADHD can truly thrive.

ABC/BOB D'AMICO

Ty Pennington

America knows Ty as the hyper-energetic man on the megaphone, juggling 18 projects simultaneously to transform homes for deserving families on the former TV program Extreme Makeover: Home Edition. More recently, the same energy surfaced on the daytime show The Revolution. Today, Ty is busy working on a home décor and fabric line.

But the 47-year-old is equally enthusiastic and candid when talking about success in coping with his lifelong battle with ADHD.

“I was diagnosed before they really knew what to call it,” says Ty. “My mom was studying to be a child psychologist. I was lucky because she went to my elementary school to evaluate kids and study the ‘worst’ ones. Everybody was saying that ‘I don’t think you really want to know who that one is.’ Watching through the classroom window, she saw me distract everyone—from hitting Johnny in the back of the head to climbing out the window. I was a constant distraction. It seems comical when you are young. I was an out-of-control kid.”

Ty’s mother tried several different interventions but none worked, and she worried as she watched her young son struggle academically and emotionally.

“The telling thing about ADHD as a kid is that feeling you get when people are saying that there is something wrong with you,” the TV host says. “It’s tough to communicate why (you) are doing something in school and why you are not digesting studies as much as other kids are. However in some categories, you excel. For example, in geometry where graphic shapes are at play I stood out. Today, I promote the arts because it offers kids who might not be academically inclined a chance to find what they are good at. While I was the odd man out, I could focus on my projects until I was pretty well known, then I turned back into Mr. Excitement.”

As with many individuals now and especially then, Ty remained undiagnosed until his late teens.

“It wasn’t until I was out of high school and in my first year of college that my art instructor asked to get in touch with my mom. I was making drawings that were a little dark,” he recalls. “During the early days, doctors put me on antihistamines to calm me down.”

The antihistamines made him drowsy. But nothing seemed to really work. Fortunately, Ty discovered another outlet for his boundless energy—sports.

“I have always been the Energizer Bunny, way before I was medicated,” Ty says. “Sports, for many, is an area where you can gain confidence. You are not going to gain confidence from bringing home a book report with a B on it. With sports, you can define yourself as a certain player in a certain sport. With some kids, it is the only arena where they can find their confidence, as part of a team. Any time you can take a kid and get them out of the isolated ‘odd kid out’ mentality and make them part of something, that’s good.”

At 17, he was finally diagnosed with ADHD and offered effective treatment to manage his symptoms. The diagnosis was literally a true game changer.

“I played soccer my entire life beginning at age 8 and was good,” he admits. “But when finally diagnosed and medicated, I played like I never could. Finally, I could read the field, thinking ahead of the play before I got there. I had no idea how.”

Off the field, he began to notice other changes as well helping him focus and achieve goals that he never thought possible.

“ADHD affects your communication skills as well as your confidence. I no longer spoke in fragments for one thing,” he says. “People began to see a change in me, on the soccer field and in academics as well. Reading has always been a challenge. You get lost after several paragraphs. You realize that your eyes are still reading but you are not soaking in the information. I have always been very visual, so I would draw pictures for a history class so that looking at the picture would help me visualize the information I was reading.”

It was in the visual arts where Ty discovered a place to focus his considerable energy and talents.

“ADHD affects so many aspects of life, including your confidence level,” Ty says. “You have to believe in yourself. When people are challenged with ADD, especially ADHD, they really have to find an outlet where they can shine. For me, that was in art. I put myself through art school and people began praising me for the talent. I had not had that experience before—people praising me for something.”

A familiar face to almost everyone in America, Ty now meets many families who face a situation all to familiar to the artist.

“Families see that I can complete a task, which is a big accomplishment,” explains Ty. “And some of those tasks have been pretty monumental. I can lead a team and build a house in less than four days while keeping my fingers and digits at the same time. ADD and working with power tools is not the smartest choice.”

The challenges of ADHD overshadow personal relationships as well, but medication can help.

“ADHD affects your family life and any relationships because communication is the biggest drawback to ADD,” he says. “Because you can’t get out what you want to say. Sometimes another medium like writing or art can help, you can communicate better. One of the reasons you can get into trouble in relationships is the belief that you are not as good as someone else; you cannot live up to their expectations. Everyone would love not to be on medication, but people do not realize that (it) is so easy to go off your routine. But medication provides an extra helping hand to keep you on your routine.”

ADHD: Living in Overdrive The Saturday Evening Post

“It ruined everything—career, social life, relationships, because I was tired all the time,” Rotherham recalls. With lab results in hand and determined to find an answer, he began researching the Internet for clues. “One thing that kept surfacing was hormone imbalance,” Rotherham found.

The search also introduced him to an Indianapolis physician, noted for success in treating “difficult” cases, who conducted more extensive lab tests that finally revealed a diagnosis—underactive thyroid. Immediately placed on thyroid supplements, Rotherham soon noticed a difference.

“Within a couple of weeks, I felt worlds better,” says Rotherham, now 49, who recently launched his own business. “I went from being literally flat on my back, achy and tired, to being highly functional.”

Rotherham is among the approximately 27 million Americans living with overactive or underactive thyroid, according to the American Academy of Clinical Endocrinologists (AACE). Unfortunately, like Mark Rotherham, many go undiagnosed until something goes terribly awry, at times wreaking havoc on one’s quality of life.

Think of the thyroid as your body’s thermostat. Functioning normally, this butterfly-shaped gland, which sits just below your voice box, releases just the right amount of hormones to regulate your body’s metabolism and keep things running smoothly. However, if the thermostat is turned up too high, the thyroid becomes overactive—a condition called hyperthyroidism. You may feel revved up, overheated, and anxious and notice unexplained weight loss. In contrast, if the thermostat is turned down too low, the thyroid becomes underactive—a disorder called hypothyroidism—and fails to provide enough hormones to meet the body’s demands. As a result, your body slows down, leading to a wide range of ubiquitous symptoms. Of the two, hypothyroidism is the more common—and the more insidious.

Dialing down

The reason hypothyroidism is missed so often is threefold: Doctors don’t always screen for thyroid dysfunction; patients may not know to ask about it; and the symptoms are common to many other conditions.

While some people with hypothyroidism note changes, others overlook symptoms, because they seldom develop overnight and are often subtle. Hypothyroidism is notorious for mimicking changes often associated with aging, such as fatigue and intolerance to cold.

Over time, people may discover that the gland swells 
(see Neck Check) and their eyebrows begin to disappear. Additionally, hypothyroidism decreases sweating and causes slowing of your most vital systems: the heart, the lungs, and the gastrointestinal tract. Patients may experience shortness of breath when exercising, and many develop sleep apnea. Worst of all, hypothyroidism can cause high blood pressure and raise blood levels of cholesterol, two of the biggest aging culprits in America. Identifying the thyroid disorder is crucial, because in rare cases, hypothyroidism can lead to coma or even death. For all of these reasons, I encourage both 
patients and their doctors to have a conversation about hypothyroidism. When left untreated, the complications 
can shave years off your life.

Gauging your risk

Women are especially vulnerable: According to the AACE, hypothyroidism is up to 8 times more common in women than men. But all of us need to pay attention to our thyroids as we age, because underactive thyroid becomes much more common in older adults. By age 60, as many as 17 percent of women and 9 percent of men have an underactive thyroid.

Smoking; exposure to secondhand smoke or large amounts of radiation during childhood or cancer treatments of the head, neck or chest; and some prescription medications (such as the heart drug amiodarone and long-term use of mood-stabilizing lithium) can cause hypothyroidism.

However, the most common culprit in the U.S. is autoimmune dysfunction, when the body’s immune cells start to attack thyroid tissue like it’s a foreign invader. As 
a result, the thyroid gland stops producing hormones the 
way it’s supposed to. Genetics likely play a role; we know 
that people with a personal or family history of autoimmune diseases such as rheumatoid arthritis, type 1 diabetes, 
and psoriasis, among others are at higher risk for hypothyroidism. Researchers are close to discovering which gene types might make us more susceptible to autoimmune thyroid problems. In those who are genetically susceptible, certain environmental factors, such as iodine in our diet, are thought to trigger the autoimmune attack on the thyroid.

Thyroid checkup

If you are worried about your thyroid hormone levels, a simple blood test can help you and your doctor reach a diagnosis. The American Thyroid Association recommends that all adults over the age of 35 undergo thyroid screening; however, there is no firm consensus on mass screening. It’s especially important for people with high cholesterol to ask about having their thyroid levels checked: Many people aren’t screened for thyroid levels and could potentially have hypothyroidism. The good news is that doctors now have a very sensitive “thyroid stimulating hormone” (TSH) test that allows us to diagnose thyroid disorders much earlier—even before symptoms appear. Higher than normal TSH levels can reveal whether your thyroid function is in danger, even if your actual thyroid hormone levels are normal.

If your thyroid blood tests come back sub-par or abnormal, the most common treatment option for hypothyroidism is synthetic thyroid hormone replacements. These oral medications help restore hormone levels that shift your internal thermostat and metabolism back to normal. Evidence suggests that people who take thyroid hormone replacements should do so on an empty stomach. Additionally, certain medications, supplements, and foods may affect your ability to absorb thyroid pills. Talk to your doctor about your present medication regimen to gauge if there is an interaction. For example, generally it’s best to wait about four hours after taking thyroid medication to consume soy and high-fiber products, iron and calcium supplements, antacids that contain aluminium or magnesium, and certain prescription medications such as cholestyramine (Questran). Ultimately, monitoring thyroid hormone levels will determine if there is an absorption problem.

The role of prevention

Even if you’re not a candidate for thyroid hormone medications, dietary changes may help you protect the health of your thyroid. Because both too much and too little iodine can cause hypothyroidism, it’s important to be aware of foods that contain iodine and how they may affect your thyroid. Iodine deficiency is rare in the U.S. because it is added to our table salt. Eating excessive amounts of certain raw vegetables such as brussels sprouts, cabbage, cauliflower, corn, and kale should be avoided because they contain enzymes that can drive down thyroid function. But don’t think I’m telling you not to eat your vegetables—cooking them for just a few minutes deactivates those enzymes and makes them nutritious for your whole body.

In general, to protect the cells in your thyroid and your entire body, I recommend foods rich in:


• Antioxidants (blueberries, cherries, tomatoes, squash,
 bell peppers)

• Omega-3 fatty acids (walnuts, salmon)

• B vitamins (whole grains, fresh vegetables)

Vitamin D is another critical micronutrient that is 
getting a lot of attention for its role in autoimmune disease. We know that up to 70 percent of Americans aren’t getting enough vitamin D and that inadequate levels could put you at higher risk for autoimmune disorders, such as rheumatoid arthritis and multiple sclerosis. Vitamin D also plays a supportive role for the parathyroid glands, four smaller glands located on the larger thyroid, that closely monitor and regulate calcium levels in our blood and bones. One of the best ways to get your daily dose of D is just 10-20 minutes of sunshine each day. Sardines, dark leafy greens, and fortified dairy products are also important sources. I recommend at least 800 international units (IUs) daily for most adults and 1000 IUs for adults over 70.

In addition to warding off problems within the thyroid and autoimmune disease, keeping your vitamin D levels up will also help fight off flu and several forms of cancer.

The key to keeping the thyroid healthy is paying attention to your own body. All too often, we accept that certain changes, such as sluggishness and depression, are just a natural part of the aging process. But hypothyroidism is the secret culprit behind these unexplained symptoms for millions of Americans. When we simply accept weight gain, low exercise tolerance, and mental cloudiness without questioning the cause, we’re risking serious harm to our bodies.

After his hypothyroidism went undiagnosed for a decade, Mark Rotherham is back on his feet.

You can find more information on diagnosing and treating thyroid disease from our exclusive interview with Dr. Jeffrey R. Garber.

Post Investigates: Thyroid Disease The Saturday Evening Post