WHAT IS ATTENTION DEFICIT DISORDER?
Attention Deficit Disorder is a neurobiological disability characterized by inattention and impulsivity with or without hyperactivity. It has been only recently that ADD/ADHD was recognized as an adult disability because it was believed that the troublesome characteristics or symptoms began to "get better" or disappear after adolescence. However, follow up studies by researchers document that 30-70% of children with the symptoms characterized by ADD continue to have those symptoms as adults. It is estimated that 2-5 million adults are affected by ADD. Adults and children have similar characteristics and can vary in type and severity.
Many adults with the characteristics of attention deficit were never diagnosed as children and have been baffled by and struggling with the characteristics and consequences of those characteristics all their lives. The characteristics can cause problems with friends and family, in marriage and employment, in emotional well being and self esteem, and with functioning successfully in daily life.
Many adults with these characteristics often have a sense that they just can't get their life together and don't know why. Please note that we are all inattentive and impulsive at times. We may not follow through on projects, may procrastinate at times, be moody, etc.; but if these characteristics are consistent and persistent throughout daily life, read on.
CHARACTERISTICS OF ATTENTION DEFICIT DISORDER Inattention/Impulsivity with or without hyperactivity
The following DSM IV and Adult ADD Checklists are presented for information and education purposes only, nor are they tools for self diagnosis.
IT IS IMPORTANT THAT AN ACCURATE DIAGNOSIS BE MADE BY A QUALIFIED PROFESSIONAL.
American Psychiatric Association's Diagnostic and Statistics Manual (DSM IV) criteria for Attention Deficit/Hyperactivity Disorders
A. Either (1) or (2)
(1) Inattention: At least six of the following symptoms of inattention have persisted for at least six months to a degree that is maladaptive and inconsistent with developmental level:
a. often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities.
b. often has difficulty sustaining attention in tasks or play activities
c. often does not seem to listen to what is being said to him or her
d. often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the work place (not due to oppositional behavior or failure to understand instructions)
e. often has difficulties organizing tasks and activities
f. often avoids, expresses reluctance about, or has difficulties engaging in tasks that require sustained mental effort (such as schoolwork or homework)
g. often loses; sees things necessary for tasks or activities (e.g., school assignments, pencils, books, tools, or toys);
h. is often easily distracted by extraneous stimuli;
i. often forgetful in daily activities
(2) Hyperactivity-Impulsivity. At least five of the following symptoms of hyperactivity - impulsivity have persisted for at least six months to a degree that is maladaptive and inconsistent with developmental level:
Hyperactivity
a. often fidgets with hands or feet or squirms in seat
b. leaves seat in classroom or in other situations in which remaining seated is expected
c. often runs about or climbs excessively in situations where it is inappropriate (in adolescents or adults, may be limited to subjective feeling of restlessness)
d. often has difficulty playing or engaging in leisure activities quietly
e. is always "on the go" or acts as if "driven by a motor"
f. often talks excessively
Impulsivity
g. often blurts out answer to questions before the questions have been completed
h. often has difficulty waiting in lines or awaiting turn in games or group situations
i. often interrupts or intrudes on other (e.g., butts into others' conversations or games)
B. Some symptoms that caused impairment were present before age seven.
C. Some symptoms that cause impairment are present in two or more settings (e.g., at school, work, and at home).
D. There must be clear evidence of clinically significant impairment in social, academic, or occupational functioning.
E. Does not occur exclusively during the course of a Pervasive Developmental Disorder, schizophrenia or other Psychotic Disorder, and is not better accounted for by Mood Disorder, Anxiety Disorder, Dissociative Disorder, or a Personality Disorder.
CHECKLIST FOR ATTENTION DEFICIT DISORDER FOR ADULTS
1. A short attention span, especially for work or activities not intrinsically interesting to the person.
2. Easily distracted, trouble focusing attention, tendency to tune out or drift away in the middle of a page, conversation, or task.
3. Impulsive, acts before thinking. Impulsively spending money, changing plans and jobs. Saying something before thinking of the appropriateness or timing of the remark. Hot tempered.
4. Disorganization
5. Poor planning ability
6. Good beginnings, poor endings. Lack of follow through. Many projects going at the same time but never finished.
7. Underachievement in school, work, and relationships.
8. Chronic procrastination.
9. intolerance of boredom
10. Often creative, intuitive, highly intelligent.
11. Trouble following proper rules, guidelines, and procedures. Do it my way--it's better.
12. Excessively impatient. Low frustration tolerance. Get to the bottom line; cut to the chase.
13. A tendency to worry needlessly, looking for something to worry about (a sense of doom), alternating with inattention or disregard for actual dangers.
14. A tendency toward addictive behavior.
15. Seeks high stimulation.
16. Restlessness
17. Mood swings
18. Lethargy
19. A sense of insecurity
20. Chronic problems with self-esteem.
21. Motor is always running.
22. Limited or distorted sense of time.
There are other more detailed checklists that break the symptoms down into sub categories, and the lists go on and on. I could also ask if you cut the tags out of your clothes, if you're oversensitive to bright lights and noise, or if the seams in your socks bother you! This list is not a tool to diagnose attention deficit but a beginning look at some of the symptoms.
Talking to others knowledgeable about the characteristics will provide a better understanding of those characteristics and their consequences in daily life. A support group can also be a resource for referrals to professionals who know and understand ADD. This benefit to a support group in identifying experienced clinicians is essential. Since it has been only recently that ADD was recognized in adults, finding a doctor with experience with attention deficit may be limited. In addition, in several instances, many adults with these characteristics have previously been to a psychiatrist or psychologist for treatment for depression, anxiety, conduct disorders, and substance abuse without much success because the ADD was not recognized and treated.
WHAT IS THE TREATMENT FOR ADD?
First Step:
Diagnosis
Go to a professional who has specific training and experience in diagnosing and
treating ADD. **Call local support groups and hospitals for referrals.
Professionals
who can make the diagnosis:
Psychologist can diagnose ADD and provide
counseling or training, but cannot prescribe medication, if needed. He
or she can make recommendations to family physician for medication.
Psychiatrist can diagnose ADD, provide counseling or training, and prescribe medications, if needed.
Family physician can diagnose ADD, can prescribe medication if needed, but does not provide counseling or training,
Treat the symptoms - not the label. Once an adult is diagnosed with ADD/ADHD, many already feel better. Finally, there is a name and a reason for why they are the way they are. They want to solve the problem NOW. Beware of great beginnings. Think of this process in racing terms. The track to successful management of the symptoms is a marathon course rather than a sprint. Careful management of your time, talents, and resources to run the course with positive results is essential. Think through your individual plan and do not take shortcuts. Don't cut to the bottom line now, because you will be setting yourself up for failure again.
WHAT DOES THE PROFESSIONAL DO TO MAKE THE DIAGNOSIS?
He or she gathers information. Take your checklist with you, and if possible, checklists done by your parents indicating behavior as a child and as an adult and a checklist done by your spouse, friend, or roommate. These people sometimes see you better than you see yourself (another characteristic?). There is no one "ADD Test" for children or adults. The health care professional may use a combination of lists.
Be patient (not one of your strong suits?). It is important to make a proper diagnosis so that proper treatment can be implemented; you cannot take short cuts to diagnosis. You may think based on your checklist, that you ARE ADD, but you need to follow the proper steps for long term success of your treatment. A correct diagnosis will let you move foreword in your life, and if you are ADD, you can start to receive the educational, structural, emotional, and medical treatment you need to be more successful with your life.
An
individual treatment plan recommended by professionals usually
includes a combination of the following:
1. Education
2. Structure and practical strategies
3. Counseling
4. Coaching
5. Education/workplace accommodations or plan
6. Medication
If you have been diagnosed with ADD you do not need to read ten more books that describe your characteristics (been there, done that, although you are relieved that you are not the only one), but you do need to read information that will help you to manage your symptoms. There are a number of books available, the following is a short list of recommendations.
Driven to Distraction by Edward Hollowell, M.D. and John Ratey, M.D.
Attention Deficit Disorder: A New Perception by Thom Hartmann
You Mean I'm Not Lazy, Stupid, or Crazy? by Kate Kelly and Peggy Ramundo
The Hyperactive Child, Adolescence, and Adult: Attention Deficit Disorder Through the Lifespan by Paul Wender
Attention Deficit Disorder in Adults by Lynn, Weiss, Ph.D.
Women With Attention Deficit Disorder by Sari Solden, MS, MFCC
Answers to Distraction by Edward Hollowell, M.D. and John Ratey, M.D.
Adventures in Fast Forward by Kathleen Nadeau PhD.
STRUCTURE-PRACTICAL STRATEGIES FOR COPING
1. Keep a daily agenda of what you have to do. Write down each appointment and task. When you complete something, check it off. It is important not only to see what you have to do but also to see what you have completed. Too often the emphasis is totally placed on those things that have to be done rather than tackling and completing one task at a time. Your agenda is also the place to write down shopping lists, mileage, or expenses. You can design your own agenda or daily planner to fit your needs.
2. Get a watch with a timer. Many adults with characteristics of ADD are chronically late because of their distorted sense of time. They are late to work, for appointments, church, social occasions - not because they do not want to attend these functions, but because they are side tracked by other things or even their own thoughts. Something gets their attention, that reminds them of something else, and they are off in a mind journey that makes them late for life's daily journey by which they are accountable.
3. Plan your time. Set the alarm for five minutes before you have to leave for an appointment or meeting. If you are on the computer, turn it off. If you are on the phone for business or pleasure, politely excuse yourself, make a notation in your daily agenda (which should be as important as your clothes) to call the person back, if applicable, and then leave. Be realistic in how much time it is going to take you to get to work or school, set your alarm, and leave.
4. Use a beeper to alarm at regular intervals to get you back to task. Many times people with ADD get over focused and loose track of time - another reason they are late for appointments, etc. A regular reminder will help you get back to task.
5. Have a tape recorder in your car. You can record the tasks you need to do, shopping lists, or the ideas for that great next project. It's also a good time to record those things you have completed- and give yourself a compliment. You can also blow off steam. Instead of just thinking about a situation that made you mad or frustrated, talk about it into your recorder. When you have had time to reflect, listen to what you said - then erase it.
6. Structure your work or study environment. Work in a quiet environment but not necessarily a noiseless one. Get a fan or listen to soft background music, because this consistent noise often blocks out other distracting sounds. Close your door if possible. Use headphones if you are in a wide open space. If possible, face your desk away from the traffic pattern.
7. Try to do one task at a time. Work on one file. Study one subject at a time. Clean one room. Unpack one box. Get rid of one stack. Unclutter one thing at a time.
8. Eat a balanced diet.
9. Know what ADD is not.
10. Break a large project into smaller tasks and add deadlines for completion. The whole project may seem overwhelming, but breaking the whole into parts is manageable. This applies to packing for a trip, cleaning the whole house, submitting a department budget, preparing for exams, etc.
11. Exercise. Have an exercise routine daily. Find something that you enjoy. Exercise helps work off that excess energy and aggression in a positive way - and it's good for you.
12. Get enough sleep. Many people with ADD symptoms get their second wind at 11 PM and they finally decide to clean out that closet, get started on that project that has been on their mind for days, complete the assignment that is due tomorrow, plan a new project. They may stay up all night to complete the task, but they may also not get up the next morning on time to turn it in or show up for school or work.
13. Use some kind of filling system or organizer to help you structure the different tasks in your life. Do not just buy one, use it.
14. Have a reward system for the goals that you have set up and accomplished.
15. Develop your sense of humor.
16. Continue to be educated about how the characteristics affect your life. Continue to read about and talk to others. It is equally important to be an educator yourself- to help family, friends, teachers, and co-workers understand the symptoms.