ADHD & Fibromyalgia: Cognitive Problems May Be More Than You Think

October is ADHD Awareness month, and as someone with the disorder who has a child, parents, and relatives with it, I think it’s important to discuss, given its prevalence in our fibromyalgia Spoonie community. Overall, about 17 million adults and children in the US live with Attention Deficit Hyperactive Disorder.¹ ADHD is a term you probably have heard of, even if you aren’t entirely sure what it means.

In short, ADHD is characterized by “inadequate levels of inattention, hyperactivity, and impulsivity that might persist in adulthood”.² ADHD can cause psychiatric, social, and relational problems, especially in people who aren’t diagnosed and treated.⁵

Here are some quick facts from Children and Adults with Attention-Deficit/Hyperactivity Disorder(CHADD.org): ⁷

• ADHD may have serious consequences, including school failure, family stress and disruption, depression, problems with relationships, substance abuse, delinquency, accidental injuries, and job failure.

• It is a spectrum disorder, meaning symptoms can be mild, moderate, or severe, and the severity can change throughout a person’s lifetime.

• ADHD is not caused by bad parenting, diets, or environmental factors but can be influenced by them.

• It is a neurological development disorder that impacts brain chemicals.

• Research confirms that combining behavioral and stimulant treatments are more effective than either treatment alone.

• Individuals with ADHD can be very successful in life!!! This fact, in my opinion, is the most effective takeaway. Yes, it can be very disruptive, but it also has some benefits, especially when you learn to work with it. (More on that further on)

You may not know that there have been studies showing that an increased number of individuals with fibromyalgia also meet the qualifications when tested for ADHD. One study showed rates as high as 24.5%, and those patients were associated with higher FMS symptom severity and a greater functional impairment, particularly in the work/school domain.² Another study found almost 45% of 123 fibromyalgia patients screened positive for ADHD when administered the World Health Organization Adult ADHD Self Report scale.⁸ Those who screened positive also had higher rates of cognitive impairment.⁸

And yet another study found ADHD rates as high as 62% in fibromyalgia patients compared to another control group.⁴ Of those who tested positive for ADHD, 49% hadn’t been identified in childhood.⁴ While there may be some discrepancies in prevalence, it's safe to say ADHD is another disorder that may be commonly found in fibromyalgia patients, and many may not know it could contribute to symptoms such as memory, organization, and even emotional struggles.

With the higher rate of women with fibro than men, coupled with the high rates of underdiagnosis and misunderstood gender differences in the disorder, it is not surprising that so many were unidentified in childhood.⁵ For example, girls and adults are a lot less likely to display the classic hyperactivity tendencies that are most associated with ADHD and more likely to struggle with attention, mood disorders, and anxiety.⁵

Several issues might contribute to these rates. Mainly, ADHD used to be thought to affect boys primarily, but research shows many girls and women are now increasingly diagnosed with an increased understanding of the disorder, and adulthood rates are the same for both genders.⁵ Additionally, it was once believed that most people outgrew ADHD in adulthood, but it is now thought that 30% to 70% percent of those persist into adulthood.⁵ Lastly, as mentioned earlier, the stigma prevents many women from coming forward.⁵

Recent research in the Pain Medicine Journal suggests that fibromyalgia may be triggered by undiagnosed or untreated childhood ADHD, but it can be difficult to discern because fibromyalgia and ADHD share common abnormal functioning physiological processes, triggering life events and clinical manifestations, particularly cognitively as this chart shows.³

ADHD, fibromyalgia, and pain can also create issues when opioids are prescribed. Opioid use disorder can develop, which shares symptoms with ADHD. Bicycle Health, dedicated to helping people with opioid use disorder, published this great guide about OUD and ADHD you can check out here.

So, I am going to end this article on a positive note. ADHD isn’t, in my opinion, a disorder, as much as it is a different brain structure that makes it difficult to conform to today’s society. Your brain works differently. The point has been made by the author of ADHD: A Hunter in a Farmer's World, Thom Hartmann, that in a hunter-gather society, it may actually serve as a benefit! It's not our neurochemistry and structure, it's society! But don’t just take my word for it. Here is a list of positive qualities and benefits of ADHD that is BACKED BY RESEARCH:⁶

• Out-of-the-box thinkers- Strong innovators! Increased curiosity, creativity, imagination, innovation, and invention are all byproducts of ADHD and are excellent characteristics for leaders and entrepreneurs.

• Ability to Hyperfocus- This is our superhero skill if you ask me. If we want to give something our attention, we are all in. This can translate into work that is far superior to others. Think of Michael Phelps (yes, he has ADHD!). We can complete big batches of work no prob.

• Impulsivity- Yes, this can be an issue, but it can also be helpful when needing to make quick decisions or get creative, problem-solve, and take risks. We have a sense of humor and tackle big challenges. We crave novelty and change, a skill highly valued in management and especially entrepreneurship. When people with ADHD focus on their strengths and develop those skills, finding a career and building a life that plays to them, they will be happy and successful, regardless of their actions.

If you have fifteen minutes, check out this great TED talk by a super cool chick, Negar (Nikki) Amini, a Pharm D. candidate who shares her troubles growing up with undiagnosed ADHD, the harmful messages she received, and how those impacted her. She emphasizes our strengths and how our differences can be used for great benefit.

To recap, ADHD can be debilitating, but research shows with medical treatment and therapy, people with ADHD can be very successful. Many women with fibromyalgia may have ADHD and not know it. If you feel like it could be you, start researching and having conversations. It’s important to talk to your doctor about your concerns and explore CDC.gov and CHADD.org for more information.

References

1. How Do You End ADHD Stigma? Help for ADHD. https://chadd.org/awareness-month/

2. Pallanti, S., Porta, F., & Salerno, L. (2021). Adult attention deficit hyperactivity disorder in patients with fibromyalgia syndrome: Assessment and disabilities. Journal of Psychiatric Research, 136, 537-542. https://www.sciencedirect.com/science/article/abs/pii/S002239562031030X

3. Bou Khalil, R., Khoury, E., & Richa, S. (2018). The comorbidity of fibromyalgia syndrome and attention deficit and hyperactivity disorder from a pathogenic perspective. Pain Medicine, 19(9), 1705-1709. https://academic.oup.com/painmedicine/article/19/9/1705/5056818

4. Moyano, S., Berrios, W., Gandino, I., Soriano, E., & Rosa, J. (2022). POS0025 PREVALENCE OF ATTENTION DEFICIT HYPERACTIVITY DISORDER AMONG ADULT PATIENTS WITH FIBROMYALGIA. https://ard.bmj.com/content/81/Suppl_1/227.2.abstract

5. Hurt, E. A., Arnold, L. E., & Lofthouse, N. (2011). Dietary and nutritional treatments for attention-deficit/hyperactivity disorder: current research support and recommendations for practitioners. Current psychiatry reports, 13(5), 323–332. https://doi.org/10.1007/s11920-011-0217-z

6. Holthe, M. E. G., & Langvik, E. (2017). The strives, struggles, and successes of women diagnosed with ADHD as adults. Sage Open, 7(1), 2158244017701799. https://doi.org/10.1177/2158244017701799

7. CHADD.org. (nd.) ADHD Benefits in the Workplace. CHADD ADHD Newsstand. https://chadd.org/adhd-news/adhd-news-adults/adhd-benefits-in-the-workplace/

8. van Rensburg, R., Meyer, H. P., Hitchcock, S. A., & Schuler, C. E. (2018). Screening for Adult ADHD in Patients with Fibromyalgia Syndrome. Pain medicine (Malden, Mass.), 19(9), 1825–1831. https://doi.org/10.1093/pm/pnx275

9. Myths and Misunderstandings. CHADD. https://chadd.org/about-adhd/myths-and-misunderstandings/