ADD in Adults?
By Jessie Sholl, Experience Life
An estimated 15 million Americans suffer from ADD, the majority of them undiagnosed. Once considered a childhood disorder that’s outgrown by adolescence, it’s now known that 60 to 70 percent of children diagnosed with ADD continue to experience it as adults.
Characterized primarily by excessive distractibility, impulsivity and restlessness, ADD can wreak havoc in one’s personal and professional life. Too often, substance abuse, serious depression, job failure or a broken marriage are the wreckage left in the disorder’s wake.
“Traffic accidents are eight times more common among those with ADD. The prisons, divorce courts and unemployment lines are full of people with undiagnosed ADD,” says Edward M. Hallowell, MD, director of the Hallowell Center, a clinic specializing in the treatment of ADD in New York City.
“Having ADD can be a curse,” says Hallowell — who speaks from personal experience, having both been diagnosed with the disorder himself and raising two sons with ADD. But, he notes, it is not a life sentence. With the right knowledge, skills and strategies, ADD can be a unique gift that helps people thrive.
That was precisely Jennifer Koretsky’s experience. Before her diagnosis, she says, “I was really struggling. It felt like I had to put in so much more work and effort just to keep things together; it was hard for me to get to work on time; there was never any food in my fridge; there was never any time to keep the apartment clean or get my laundry done. It felt like I was constantly struggling to keep up.”
Her diagnosis, she says, “explained so many of my challenges, like disorganization and poor time management, but it also validated my strengths — creativity, compassion and drive.”
What is ADD?
The hectic pace of modern life, the constant techno-interruptions of email and social media, the omnipresence of speakers and video screens in public spaces — it can make anyone feel distracted. And we all misplace our keys or forget an appointment now and then. But, as Hallowell notes in one of his books, Delivered from Distraction: Getting the Most out of Life with Attention Deficit Disorder (Ballantine Books, 2005), occasional periods of distraction do not necessarily mean you’re suffering from ADD.
“Because its symptoms abound in modern life,” he writes, “ADD is a seductive diagnosis; it is easy to imagine that you have ADD when you do not.”
It’s the intensity and duration of symptoms that determine a diagnosis of ADD. The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) lists 18 symptoms for ADD, clustered into two areas: inattention and hyperactivity-impulsivity. To warrant an ADD diagnosis, one needs to have experienced six or more of the symptoms from one or both of the groups for at least six months. The symptoms must impair your life in some way, and they must occur in two or more areas of your life — for example, home and work. (Hallowell has established a distinct diagnosing protocol at his clinic; see the “Diagnosis: ADD” on page 4.)
Attention deficit disorder is something of a misnomer. Someone with ADD doesn’t have a deficit of attention. It’s actually an inconsistency in attention, which allows people with ADD to hyperfocus at times. And contrary to some outdated stereotypes, many people with ADD are often clever and outgoing. But that combination of sociability and hyperfocus can present its own challenges.
Many people also have the misconception that ADD is limited to hyperactive boys. While boys are diagnosed with ADD three times more often than girls, this is likely because, in girls, the disorder typically presents as the “inattentive” or “dreamy” type (staring out windows or drifting off midconversation), as opposed to the “hyperactive” type.
Next: the ‘Dreamy’ type
Gina Masullo fits the description of the dreamy type. She was nicknamed “The Wanderer” in elementary school, she says, and got a bad reputation because she couldn’t stay put in her seat. “My teachers labeled me ‘under-challenged,’ so I skipped second grade,” she recalls. The move didn’t abate her restlessness, but she coped well enough to avoid getting disastrous grades.
As an adult, Masullo job-hopped. “I’d get really excited about a new job or a new opportunity and then all of a sudden just kind of go cold on it and make another job switch,” she says. “My tolerance for job stresses was pretty low, and I would just get frustrated and give up.”
When she was diagnosed with ADD at 30, Masullo promptly put strategies in place to manage it: She exercises daily, eats a high-protein breakfast and has made behavioral adjustments like using to-do lists. She also sees an ADD coach.
And she seized upon the strengths ADD affords her — energy, creativity and drive — to start her own public relations firm. She’s now thriving professionally and accomplishing things she’d never thought possible — like running her first 5K last year, something she says she’d never had the discipline to attempt before.
Diagnosing ADD requires a thorough evaluation with a medical doctor, psychologist or psychiatrist. The evaluation could take one appointment, or it could take a few weeks. The doctor may create a brain map, which is the recording and analysis of brainwave activity through neuroimaging, and a battery of psychological tests. Blood tests can rule out underlying factors such as a thyroid problem.
The most important diagnostic tool, though, is the person’s history. Sanford J. Silverman, PhD, a psychologist at the Center for Attention Deficit and Learning Disorders in Scottsdale, Ariz., has been treating adults with ADD for two decades. Silverman advises bringing along a family member or very close friend to the evaluation. “When you get somebody else’s input — particularly someone close to you that you’re living with — they’re going to point things out that you may not be aware of,” he says.
School records may be helpful, too. Since ADD doesn’t develop in adulthood, a person would have had symptoms dating back to childhood. (Although in rare cases, ADD symptoms can develop after a head injury.)
A proper diagnosis is important, says Silverman, because “you can have ADD symptoms from another disorder. For example, if somebody has an anxiety disorder, they may look like they have some ADD components.”
Sometimes a diagnosis of adult ADD comes on the heels of a child’s diagnosis. That was the case in Melissa Orlov’s family. Her daughter was diagnosed with ADD in 1999 and her husband a few years later. That’s not uncommon, says Orlov, a marriage consultant in Boston and the author of The ADHD Effect on Marriage: Understand and Rebuild Your Relationship in Six Steps (Specialty Press, 2010). “A child is diagnosed because they’re struggling in school; then the parent starts to read up about it and says, ‘Wow, that sounds familiar.’”
For most ADD sufferers, naming what’s been going on brings relief. “When you get the ADD diagnosis, you can finally shed all those accusatory, ‘moral’ diagnoses, like lazy, weak, undisciplined, or, simply, bad,” writes Hallowell in Delivered from Distraction. After the diagnosis, he says, you can begin to “unwrap your gift” — and begin using ADD’s positive aspects to your advantage.
Jessie Sholl is the author of Dirty Secret: A Daughter Comes Clean About Her Mother’s Compulsive Hoarding (Gallery, 2010). She lives in New York City.
Next: Diagnosing ADD
The following characteristics are commonly associated with attention deficit disorder, according to Edward Hallowell, MD, director of the Hallowell Center in New York City, which specializes in diagnosing and treating ADD and other cognitive and emotional conditions.
“If you have exhibited at least 12 of the following behaviors since childhood, and if these symptoms are not associated with any other medical or psychiatric condition, you should consider being evaluated by a professional,” says Hallowell.
A sense of underachievement, of not meeting one’s goals (regardless of how much one has actually accomplished)
• Difficulty getting organized
• Chronic procrastination or trouble getting started
• Many projects going simultaneously; trouble with follow-through
• A tendency to say whatever comes to mind without necessarily considering the timing or appropriateness of the remark
• A frequent search for high stimulation
• An intolerance of boredom
• Easy distractibility; trouble focusing attention, tendency to tune out or drift away in the middle of a page or conversation
• Often creative, intuitive, highly intelligent
• Trouble going through established channels and following “proper” procedures
• Impatient; low tolerance of frustration
• Impulsive, either verbally or in action (e.g., impulsive spending of money)
• Changing plans, enacting new schemes or career plans and the like; hot-tempered
• A tendency to worry needlessly, endlessly; a tendency to scan the horizon looking for something to worry about, alternating with attention to or disregard for actual dangers
• A sense of insecurity
• Mood swings, especially when disengaged from a person or a project
• Physical or cognitive restlessness
• A tendency toward addictive behavior
• Chronic problems with self-esteem
• Inaccurate self-observation
• Family history of ADD/ADHD or manic-depressive illness, or depression, substance abuse, or other disorders of impulse control or mood