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.

CCPR: What research is there on adult success in children with ADHD?
Dr. Katz: Dr. Paul Gerber and colleagues studied factors associated with workplace success among adults with ADHD and learning disabilities. McGill University Professor Dr. Lily Hechtman identified resilient qualities among a group of adults with ADHD who were adapting well. In the Kauai Longitudinal Study, Dr. Emmy Werner and Dr. Ruth Smith identified factors associated with later-life adult success among a group of children with learning disabilities. Starting in 1955, they followed the developmental trajectories of two groups of resilient individuals, each exposed to several risk factors associated with negative life outcomes. One-third of these children “beat the odds,” never succumbing to the learning, behavioral, emotional, and/or life adjustment problems expected. Those in the other group had trouble but rebounded decades later, eventually leading meaningful and productive lives. Researchers have identified protective processes in the lives of resilient individuals who currently lead meaningful and productive lives, despite exposure to multiple risks and adverse experiences during childhood.

CCPR: Can you detail some of these protective processes?
Dr. Katz: Sure. Positive parental attitudes and the child’s sense of mastery or locus of control were identified as key factors in those who improved (Werner EE and Smith RS, J Am Acad Child Psychiatry 1979;18(2):292–306). One very important factor is our ability to see adversity in a new light. It’s not easy, especially when those we’re close to do not shift their perspective with us. Another is an awareness of how context can impact a child’s life. We know children with ADHD who struggled mightily in one school, yet thrived when moved to a different school, where they feel they belong and have something important to contribute. Developing a sense of mastery is another protective process. Mastery is the mindset that if we try hard and learn from our mistakes, we’ll achieve our goals. This requires exposure to experiences that we can succeed at if we try our best. In the past, children with ADHD and other learning challenges may not have had an abundant supply of these experiences. The good news is that things are changing. In my recent book, I describe other protective processes and ways to help children, families, and schools access them.

CCPR: What advice can we give parents of children with ADHD to help them best support their children?
Dr. Katz: “There’s never anything so wrong with us that what’s right with us can’t fix.” Those who rise above adverse childhood experiences are living proof that our strengths are more than capable of overriding whatever lifelong weaknesses we might be struggling with. We have a universal need to feel we belong and to have something important to contribute. Work with teachers and others at school to provide the child with meaningful roles and responsibilities and ensure that universal need is being met. There are many different ways of being smart, some of which can’t be measured by how well the child does in formal academic work.

CCPR: So important, seeing things in a better light.
Dr. Katz: Hope is contagious. Try to surround yourself with those who can see ADHD in a hopeful new light. Some who overcame difficult childhood experiences—children with attention, executive function, and learning challenges included—have learned to transform the pain of their past into meaningful action on behalf of others. We help struggling school-age children eventually to do the same.

CCPR: What resources do you recommend?
Dr. Katz: We recommend that parents of children with ADHD, as well as college students and young adults with ADHD, join Children and Adults With ADHD (CHADD) (http://www.chadd.org). I view CHADD as the public health voice for ADHD. For children and teens impacted by ADHD, as well as parents, we often suggest a short YouTube video by David Flink, co-founder of Eye to Eye (https://www.youtube.com/watch?v=q_TmyYY6HAA). Eye to Eye is a college-based mentoring model that pairs successful college students with ADHD and/or learning disabilities with younger students (https://eyetoeyenational.org). Parents, children and teens are also encouraged to log on to the Child Mind Institute’s Speak Up For Kids (https://speakupforkids.org) and view some of the institute’s short video clips of well-known people sharing thoughts about their learning or other challenges.