ADD - It’s Not Just For Children
Lisa Grossman, M.A., M.Ed.
Over the past several years, a heightened awareness among parents,
teachers, and health care professionals has helped improve the situation of
millions of children in America and here in Israel. In fact most of us have
become so familiar with examples of young ADD sufferers ( such as the
hyperactive child tapping his foot and pencil, while his mind wanders from
subject to subject-except for the one the teacher is discussing, or the dreamy
child whose may look focused in class while his or her mind is a million miles
away), that we have come to look on the subject as old news.
Despite the natural conclusion that ADD children eventually grow up and
therefore outgrow their symptoms, adults with ADD has become the #1
attention-getter in newspapers, journals and books and You Tube. As early as
September 2, 1997 the N.Y. Times took an in-depth look at how the disorder
affects grown-ups, citing estimates that put the number of adult ADDers in the
US between 5 and 10 million! The Times article documented cases of
disorganized, absent-minded (yet quite often creative and intelligent) adults
who shuffle through jobs and relationships, with no insight into the root of their
problem or hope for their future. They are now benefiting from the professional
knowledge and collective consciousness that has been raised.
Despite the confusion regarding the definition and nature of the problem,
if properly diagnosed and treated, the negative effects of ADD can be
minimized. In the same way that Israeli families and educators are learning to
confront the problems of ADD children, adult ADD sufferers can be helped to
find ways to compensate and succeed- usually through a combination of
therapies.
As with all disorders, recognition is the first critical step. There has been
a growing realization that Attention Deficit Disorder persists into adulthood for
many individuals. The core symptoms of ADD, inattention, impulsivity, and
over activity, which are most evident during childhood, are now known to
continue into adulthood for a significant percentage of (up to 70%) of ADD
children. However, in adults these symptoms of ADD are often obscured by
more prominent difficulties. A number of adults who are now benefiting from
diagnosis and treatment for ADD were first recognized for problems with
substance abuse or other addictive behavior, such as smoking, over-eating,
gambling and alcoholism. In many cases they sought or were referred to
professional help for their inability to succeed in relationships, in staying
organized or in holding a steady job, which often led to depression and other
significant disorders.
A.D.D.ing Insult to Injury
Most adults today grew up at a time when clinicians, educators, parents,
and the general public knew little or nothing about ADD. As a result , adults
living with the condition are generally undiagnosed and untreated and, as noted
above, usually experience a number of problems, some stemming directly from
the disorder, and others resulting from associated adjustment patterns. Their
presenting concerns may include several of the following items: chronic
procrastination, impulsive speech and action, trouble focusing, poor short term
memory, mental or physical restlessness, sleep disturbances, mood swings,
depression, anxiety, and job-related problems, (e.g. interpersonal conflicts,
time-management, and task-completion). In and of themselves, none of these
issues seems to be debilitating. However, the unkindest cut of all may be the
way society regards these people in pejorative terms- as lazy, disorganized, and
undisciplined non-achievers. The painful irony behind these slings is that quite
the opposite is usually true: ADDers generally score high on IQ tests and often
it is their singular motivation which allows them to remain even peripherally
within the mainstream. Beyond the anguish it causes, this type of insult
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perpetuates the low self-esteem of most ADDers, particularly when combined
with overly critical peer and parental pressures.
Diagnosing Adult ADD
The symptoms of ADD may range from mild to severe, affecting several
or just a few areas of functioning. Similarly, there are many successful people
who “happen” to have ADD. The most basic criteria for diagnosing adult ADD
is that the symptoms noted existed before the age of 7, and are chronic and
pervasive. As with children, adult ADD may or may not be accompanied by
manifestations of hyperactivity. According to CHADD (Children and Adults
with ADD), the number one ADD association in the U.S:
“There is no one ADD personality profile. Some people with
ADD can concentrate if they are interested or excited, while others
have difficulty concentrating under any circumstances.”
The above factors raise the importance of compiling as detailed a history as
possible when turning to professional help for diagnosis and treatment.
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ADDers Can Be Helped
Sarah (a pseudonym), a 21 year old with a history of school failure and
family problems, came to me looking for special accommodations for her
matriculation exams, which she was retaking following an abbreviated and
largely unsuccessful military service. Although she had an awareness of her
difficulties in concentration, she had no idea that she might have a learning
disorder related to specific cognitive functioning. Since there had been no
glaring behavioral manifestations, she had continued to suffer silently, isolating
herself from the demands of school and society, taking a path that would
ultimately lead to her dropping out of both.
The psychologists who had tested Sarah in the third grade reassured her
parents that because of her high IQ, there was nothing to worry about. Years
later, when Sarah began to “drop out”, another mental health professional
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categorized her problem as teen depression. Had ADD been suggested, she
might have received medication and been provided with practical suggestions
and coping strategies that could have helped her overcome her difficulties
related to concentration, planning, and focusing on the task at hand. These
elements, utilizing the combined talents of professionals, eventually helped her
return to the mainstream. Earlier diagnosis might have spared her from years of
failure and frustration.
Recently, Sarah has been accepted to a major university. It is interesting
to note that she began a course of study in computers, a field that is often
recommended for ADDers, among other reasons, because it allows the student
to work at his own pace. However the story is far from any “happy ending.”
Sarah knows that she must fight an uphill battle against forces that constantly
threaten to lead her astray. Hopefully, with continuous monitoring and proper
“coaching” she will be able to enjoy a modicum of success.
What Causes ADD
In the mid-80’s, when parents groups began forming to advocate for the
needs of their children, many people realized that they shared the same
characteristics seen in their children. Subsequent genetic research bore out their
claims. According to Dr.
Russell Barkely, Professor of Psychiatry and
Neurology at the University of Massachussetts Medical Center, approximately
40% of all youngsters with ADD have at least one parent who has the condition.
The main thrust of research has focused on finding a physiological basis
for ADD. In November 1990, the New England Journal of Medicine published
the first article documenting evidence of a physiological basis for ADD based
on the work conducted by Dr. Alan Zametkin of the National Institute of
Health. Zametkin’s research suggested that the areas of the brain that control
the “executive functions” - attention , self-monitoring, emotional restraint,
judgment, sequencing, planning organization and task-completion - are under
functioning in persons with AD/HD. Subsequent research points to constant
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under arousal of these areas (the premotor cortex and superior prefrontal cortex)
producing what may be thought of as an Environmental Dependency Syndrome,
wherein the ADDer is dependent on consistent cues from the environment in
order to act appropriately.
Research regarding the brain’s neurochemical system have suggested an
impaired ability to use dopamine and norepinephrine, the chemicals messengers
linked to self-regulation, attention, concentration and memory, being related to
symptoms of distractibility, impulsivity and cognitive impairments. The
medications most commonly prescribed for ADD affect the production or
absorption of these neurotransmitters.
Treatment
Treatment usually involves a multi-modal, or integrative approach,
combining therapy, medication, and self-awareness training. It is also important
to build a support system by educating and involving others close to the ADD
patient in the process.
Several pharmaceutical options have proven themselves to be effective.
However, as with children, there is no “quick fix” that will magically eliminate
all symptoms. Finding the right medication or combination of meds requires
patience, self-observation, and careful monitoring - because each person
metabolizes medication differently.
Many individuals have reported
improvements in concentration, and find that they are less distracted, less
forgetful, and have less mental fatigue while on medication. However, because
so many non-productive habit patterns need to be unlearned, solution-oriented
therapy should accompany the medical approach. Adult ADDers need to
develop insight into the nature of their problems and reshape lifelong adaptive
behaviors to more effectively cope with the demands of daily routines, which
are anything but mundane for them.
Because adults with ADD often experience enormous difficulty in their
efforts to overcome entrenched behavior patterns, there is a growing need for
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professional
ADD coaching. ADD coaching is a supportive, practical and
concrete process in which the coach and the client work together to identify the
client’s goals, and chart a course towards accomplishing them. ADD coaches
provide strategies for dealing with issues such as time management,
organization, and self-advocacy. Most importantly, the coach helps the person
with ADD sustain the focus and motivation necessary to follow through.
Coaches act in lieu of the ADDer’s deficient cortical executive functions, not
only by reminding them of the consequences of impulsivity and procrastination,
but by helping them to structure their environment so they learn to form good
habits, and a better outlook on life.
The ultimate goal, no matter what the treatment, is to allow people with
ADD to emerge with a new perspective, to provide opportunities for redefining
and restructuring their lives, and offer hope where none was before.
Women’s Issues
While ADD is, in the words of Sari Solden (author of Women with ADD,
1995) an “equal opportunity disorder” - affecting young and old, males and
females alike - it has been traditionally overlooked as a malady affecting
women. The majority of writing and research on ADD has focused on males.
Along with the recent recognition of adult ADD, as well as a greater awareness
that ADD includes subtypes both with and without hyperactivity, researchers
have also begun to look seriously into the special issues confronting girls and
women with ADD. Studies looking at genetic issues, metabolic/neurological
functioning, and coexisting psychiatric disorders that often accompany ADD in
females, have all confirmed that that women with ADD often suffer equally, if
not more than their male counterparts from cognitive impairment, emotional and
relationship problems. However, their problems may often go unnoticed,
especially when their behavior is tempered, rather than marked by the outgoing,
oppositional activities classically associated with boys or men with ADD.
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According to Kathleen Nadeau, editor of a newsletter for women with
ADD, many women with ADD “escaped” into marriage at a young age,
believing that they would not be able to cope with the demands of the
workplace - only to find that the requirements of running a home - supervising
and monitoring others, doing repetitive, boring work, and being the “emotional
command center” with no clear guidelines, feedback or reward -
are a recipe
for potential disaster. At the workplace, the same cultural expectations that
requires women to be in charge of organizational issues - often prevent highly
capable and creative women from reaching their professional goals.
Whether male or female, adults with ADD deserve the help and
understanding that can enable them to overcome their difficulties and bring out
their true potential.
The author is an educational psychologist and ADD coach working in
Raanana. For more details call: 050-248220.
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