ADHD
Attention-Deficit Hyperactivity Disorder

The following are the most common symptoms found in adults with an attention deficit disorder, according to clinical observations of physicians Edward M. Hallowell and John J. Ratey, authors of "Driven to Distraction: Recognizing and Coping with Attention Deficit Disorder from Childhood through Adulthood."

1. Do you have a sense of underachievement, of not meeting goals, regardless of how much you actually accomplish?

2. Do you have difficulty getting organized?

3. Are you a chronic procrastinator?

4. Do you often juggle many projects simultaneously, but balk at follow–through?

5. Do you tend to say what comes to mind without considering the timing or appropriateness of the remark?

6. Do you find yourself in an ongoing, restless search for high stimulation?

7. Do you tend to be bored easily?

8. Are you easily distracted, have trouble focusing attention, have a tendency to tune out or drift away in the middle of a page or conversation yet have an ability to hyperfocus?

9. Are you considered creative? Intuitive? Highly intelligent?

10. Do you have trouble going through established channels or following proper procedure?

11. Are you impatient, easily frustrated?

12. Are you impulsive, either verbally or in action?

13. Do you tend to worry needlessly, alternating with inattention to or disregard for actual dangers?

14. Do you have a sense of impending doom and insecurity, alternating with high risk–taking?

15. Do you experience mood swings, or depression, especially when disengaged from a person or a project?

16. Are you frequently restless, with lots of "nervous energy"?

17. Do you tend toward addictive behavior, be it with alcohol, caffeine, shopping, smoking, eating or overworking?

18. Do you have a chronic problem with self–esteem?

19. Are you inaccurate at self–observation, often misjudging the impact you have on others?

20. Do you have a family history of attention disorder, manic–depressive illness, depression substance abuse or other disorders of impulse control?

Their desks are a mess, and they're constantly misplacing things. They never do today what could possibly be put off until tomorrow. They forget appointments and names, have a hard time organizing anything — especially their time — and are quick to anger and arguments.

They get fired up on ideas but fizzle on follow–through, have a hard time with long lines or small talk. They're impatient, impulsive, and imaginative and find it difficult to get through a book, listen to a conversation without interrupting or sit still without drumming their fingers or jiggling a foot.

No, they aren't hyperactive kids but rather a growing number of adults diagnosed with attention deficit disorders. Experts say the problem affects some 3% to 5% of the population under 18, but estimates on the number of adults with the condition are harder to come by. It is thought, however, that a substantial percentage of hyperactive children continue to have attention deficit disorders as adults,

No one knows the condition's exact causes, but research suggests the problem is a dysfunction in the frontal lobes of the brain, the area that controls and initiates behavior, checks impulses, and plans and organizes. Once thought to be mainly a problem that hyperactive kids grew out of during puberty, it is now thought that 10% to 50% of kids with what is formally known as Attention–Deficit Hyperactivity Disorder (ADHD) continue to have problems in adulthood, says psychiatrist Jeffrey R. Zigun, who is doing research at the Medical College of Wisconsin on, improved diagnostic tests for the condition.

"ADHD doesn't Just Pop up out of nowhere in adults," he says. "Although most of the adults I see today were not diagnosed as kids, they always have had it. They were part of that small group — about which teachers always complained: "They're just not working up to their ability." These adults grew up feeling that something was wrong. It's just that People weren't looking for it then."

Some critics are skeptical of what they consider the snowballing number of people being diagnosed with attention deficit disorders. Is this really a legitimate psychological problem, they ask, or just the profession's latest lucrative catchall diagnosis? Is it a pathology or just a personality type?

THE NAME HAS CHANGED

The answer may well depend on whom you ask — and when.

Changing labels for the condition over the years (including "post–encephalitic disorder," "hyperkinesis" and "minimal brain damage") reflect what seems to be an ongoing confusion and controversy over the nature, diagnosis, causes and treatment of what we can generally call attention deficit disorders.

While the official term currently used by the Diagnostic Statistical Manual of Mental "Disorders of the American Psychiatric Association is Attention Deficit Hyperactivity Disorder, that name is misleading at best. Since many individuals with the diagnosis can focus with unusual tenacity (hyperfocus) on issues of intense interest to them, the problem is not so much a deficiency as it is an inconsistency of attention.

ADHD is thought generally to be a neurobiological disorder characterized by three core symptoms: distractibility, impulsivity and hyperactivity, or excess energy. But hyperactivity is not always present. In such individuals, many of whom are quiet and dreamy, the condition is referred to by some specialists as Attention Deficit Disorder (ADD).

SOME INHIBITIONS ABSENT

"All three core symptoms have to do with inhibition — or the lack of it — an inability to inhibit movement or speech or incoming stimuli," Zigun says. "But you're not going to see a group of adults bouncing off the walls. With them, it's more problems with attention, especially sustained attention, vigilance."

Sydney Zentall, a researcher and professor of special education and psychological sciences at Purdue University, has been diagnosed as ADHD herself She says: "There are two problem areas with attention. One is sustained attention, because we get bored quickly and like new things not rote, repetitive work. The other is selective attention, knowing what to look at and listen to and what to filter out.

"Because we're attracted to what's stimulating, different, exciting and not necessarily what's important, we can get lost in a complex visual field, an auditory environment — and miss the big picture, the main structure.

Zentall stresses that "this is a quantitative disorder" and adds that the diagnosis is based not merely on the presence of symptoms (which are, common to all of us at times) but also on the severity, persistence and crippling effects that the symptoms may have.

Certain medications help control the symptoms, although experts still do not agree on exactly how they work. Why do stimulants, like Ritalin (currently the drug of choice in treating attention deficit disorders), have a calming effect?

Some experts, including Zentall, believe that taking a stimulant increases a person's appreciation of stimuli, eliminating the need to create more stimulation by taking in everything that the environment has to offer — and then some. Other experts believe that stimulants strengthen the ability of the brain to keep a lid on impulses and stay calm.

However they work, these drugs, as well as certain antidepressants, do have a normalizing effect on brain activity.

"But not to cure and not used alone," warns psychiatrist Anthony Meyer, medical director for a new attention deficit disorder treatment program for adults and children at Milwaukee Psychiatric Hospital.

Referring to the confusing rush of stimuli that assaults individuals with attention deficit disorder, he says: "Medication can control the amount of traffic [the amount and variety of stimuli] on the expressway [the nervous system], but the ADD patient still has to learn how to drive. The person has to be able to cope, adapt and manage better — and medication alone will not do the trick."

Experts stress the importance of early intervention, and they recommend behavior–management therapy to teach time–management and organizational skills, awareness: of social cues and courtesies and the consequences and effects that one's actions can have on other people.

Although the worst symptoms can present real difficulties, Zentall points out that, "for many people, [an attention deficit disorder] can be a strength. I'm tired of people looking at us as if we are all in one big black hole.

"For some biogenetic reasons, our physiology doesn't seem to respond to stimulation the same way that most people do. But because we have a greater need for stimulation, we take in and handle more information. We're attracted to novelty — so the beauty in nature or words or people or ideas becomes the unusual. We need intensity to focus and function, but that also makes us more creative, original, intuitive."

She says that adults with attention deficit disorders make great problem solvers because of the number and variety of associations that come to mind as they think and because they can handle multiple projects at once and because of their youthfully high energy.

The key, she says, is to get the help and support that can help turn the liabilities of this unique way of processing and moving through life into assets.

"To me, the rest of the world seems pokey as turtles," Zentall says, laughing. "But it's all so relative. What does a snail say when it's riding a turtle?
Wheeeeeeeeeeeeeeeeeeeeeeee!"

School was never easy for John, but he managed to squeak all the way through college on study skills that consisted of little more than: What? There's a test TOMORROW?

After graduating in 1988, he spent the next five years drifting through a variety of jobs — none of which lasted longer than about six months.

"I'd look at job descriptions and know I could do each individual task required, so I'd apply. But it was organizing all those separate tasks together that was my downfall. I couldn't focus on one project at a time. It felt like I always had too many balls up in the air. If I focused on one, all the others fell down," he says.

If he had a list of six job sites to visit, "I'd inevitably miss one or two spots in the middle and spend the rest of the day backtracking. A whole day shot because of disorganization," he recalls ruefully.

When the responsibilities of a job became overwhelming — and they always did — John quit.

Things weren't much better at home, where John put off dull, routine jobs that he hated until his guilt and anxiety mounted higher than the dirty laundry or the dishes piled in his sink. Searching for an answer to his problems, he was diagnosed by a psychiatrist as having an attention deficit disorder and began treatment, including use of methylphenidate, a generic equivalent of Ritalin, a stimulant.

He has been at his current job for two years now. And with the help of a "boss, who understands my limitations and often helps me organize and follow through on projects," John says he is handling more job responsibilities and life is much easier. "I'm able to stay on a more even keel throughout the day and go from one step to another to achieve a goal."

Quiet form of disorder is tough to be sure

by Mary C. Hanson — of the Journal Staff
The Milwaukee Journal — Sunday, September 11, 1994

Bob's son, now 20, was diagnosed with Attention–Deficit Hyperactivity Disorder and has taken Ritalin since he was 4.

"This was a kid who thrashed and crashed around his crib — even when he was sleeping," Bob say's. "To this day, I pity the girl he marries. He was a hellion at home, couldn't sit down and concentrate on anything for longer than three to four minutes. We're talking really tough on his parents.

"Today, he's got a 3.2 average at the University, of Wisconsin–Oshkosh, and he's a joy to be around. But if not for Ritalin, he'd be in reform school."

It took a lot longer for Bob himself, a 54–year old Milwaukee management consultant, to pinpoint his own attention deficit disorder: "It's so much harder to diagnose without the Hyperactivity," Bob says.

He remembers report cards complaining: "Not working up to ability. Doesn't apply himself. If I only he would work harder. He remembers flunking out of college and having to go back years later to finish. He remembers the banking job he lost.

"They said it was my management style. But, I know it was my difficulty completing those five–year budgets. You're supposed to divide major projects in to smaller chunks, but I could not get organized and do it."

Weekends were filled with lists of things to do and piles left undone.

He had troubles staying focused long enough to read books, but he read all kinds of shorter magazine articles. And there was surely no lack of concentration when he worked on something he liked. With such projects, Bob recalls, "The world could fall down around me."

Still, the nagging feeling remained that something was wrong, that he could be doing a lot more with his life. Then, a year ago, he read a newspaper article about attention deficit disorders, sought professional help, was diagnosed and put on Ritalin.

"There are a lot of misconceptions about the medication, and that's unfortunate," Bob says. Taking the medication doesn't turn you into a lobotomized robot, he says, and, "once the proper combination of medicines is known and stabilized, it can make all the difference."

I'm energized and motivated and much more productive," he says. "I've got greater concentration, and I can get things done in the office and on weekends that never got done before."

His impulsiveness and need for intensity in his experiences affect his social relationships, too. Bob laughs when he admits that he married his wife after only six dates, but says he doesn't have a knack for small talk or casual friends: "People with ADD [Attention Deficit Disorder] have a terrible time shutting up and listening and really hearing what other people are saying."

But Bob, like many other adults with an attention deficit disorder, had learned to compensate and make adjustments on his own. He found the tasks he was good at, learned to delegate to others, developed his own business, raised a family.

So, why bother to seek out a diagnosis after half a century of living with the problem on his own?

"I can't tell you how many ... people [with attention deficit disorders] are walking around, having negative crap happen all around them — their marriages break up, they have alcohol problems. After a while, their self–esteem goes to hell. They seek professional help, saying I'm really depressed and get treated for depression. But they're not dealing with the real cause."

Once you understand a disability, however, it can give you a whole new perspective and handle on what had been just an embarrassing stigma. It's never too late, Bob says.

{Photo caption} Sydney Zentall, a professor of special education and psychological sciences at Purdue University, has been diagnosed with Attention–Deficit Hyperactivity Disorder. She likes to stress the contributions of the condition to problem solving and other creative behavior.