How many of us know people who are always trying to get organized? Are some of these people so freaked out by their inability to organize that they just put it off and put it off and put it off? Do they often seem unable to sit still or unable to keep track of a conversation? Maybe you find you often come upon them while they are in the midst of a daydream, and maybe just as often you have said to yourself, "He/She is so bright, if only he/she could get his/her act together." Often we label these people "spaceshots", "ditz's", or just lazy. Maybe you are the person in question and are feeling thoroughly frustrated with yourself and that you are at the end of your emotional rope. Well, don't give up. Have hope. You may be one of millions of people suffering with an undiagnosed case of ADD, Attention Deficit Disorder.
Surprised that there is a name for this malady? Well, so are many of us. ADD, although studied more and more in the past two decades, is still largely a little understood disability and a disability with many symptoms that are common to so many people that it is not at all easy to diagnose correctly. It is officially termed as attention-deficit hyperactivity disorder in the "Diagnostic and Statistical Manual of Mental Disorders" although hyperactivity need not be present for ADD to be diagnosed. It affects many aspects of our daily lives, and while many people believe it is a malady that is simply grown out of, for two-thirds of the afflicted it often persists into adulthood, creating havoc with our personal and professional lives.
But what is ADD? Dr. Edward M. Hallowell's definition is, "ADD is a neurological syndrome whose classic defining triad of symptoms include impulsivity, distractibility, and hyperactivity or excess energy."1 I'm sure that many of us can find each of these symptoms in our everyday lives. ADD is not diagnosed simply by the presence of these symptoms, but also by the severity and duration of each, and the amount they interfere with our lives. Wandering through our history in past report cards, letters home from school, and past experiences on the job is an integral part of a thorough diagnostic review. ADD can be hereditary and it is neurological, not just psychological. It makes no distinction of skin color, ethnic background, or economic status. It is estimated to afflict fifteen million Americans alone. Having ADD does not mean you are stupid. To the contrary, many people with ADD have high IQ's, are very creative, have vivid imaginative capabilities, and are very compassionate and intuitive.
So what are the qualities of impulsivity, distractibility, and hyperactivity that are looked for in a diagnostic review? In the book, "Driven to Distraction", by Dr. Edward M. Hallowell and Dr. John Ratey, one patient describes situations he would get into at work. "I would get into these discussions with my boss, and I'll see my way is right, and the next thing you know, I'm calling him a stupid jerk for not seeing that I'm right. Tends to get you fired, calling your boss a stupid jerk."2 Then there was the time, "in a conversation with a female colleague he referred to his boss as a 'pinhead' only to realize almost as he was saying it that the female colleague was his boss's wife."
People with ADD sometimes do not use language that is appropriate for a given situation or will bring up inappropriate topics or subject matter (often "inappropriate topics" means topics completely outside of the current ongoing conversation, giving the conversation a lack of sequentiality). This is not a lack of feeling or care on the part of this person, but rather impulsivity manifesting itself as a lessened ability to recognize what is considered appropriate at the time and/or a lessened ability to keep from stating what is on one's mind. Impulsivity can also manifest itself through "thrillseeking", which can be driving too fast or, as another of Doctor Hallowell's clients relates, reading books while "sitting on top of the water tower" with her legs dangling over the side. 3
Distractibility is another symptom of ADD. We all get distracted throughout our day. But the level of distractibility of people afflicted with ADD is greatly increased. They may completely forget about the task at hand and switch to a second task, only later to remember the first task which they go back and resume and maybe complete, leaving the second task unfinished as they move to a third or fourth task. They may need to read a paragraph three, four or five times before they can get through it and not only have read it, but also paid attention to what they were reading from beginning to end. Sometimes they may seem to drift off in the middle of a conversation and be lost in the stars when, in actuality, something that was said triggered a thought in which they are now thoroughly engrossed. Other times, all it takes is a look out the window and they could drift in the sea of imagination for a few minutes to a half hour or more.
Then there is the hyperactivity. This is an inability to sit still for any duration of time. It could be minutes, it could be half hours. Someone may have to reposition themselves in their seat every 30 seconds. At work he/she might be up from his/her desk every 15 minutes to half an hour. Then there is the story of one of Dr. Hallowell's clients who did most of his daily business on the phone. He had an office he almost never saw. Since he had to be on the move to be focused, he drove around and used his car phone.
This triad of symptoms is fairly broad and in the book Driven to Distraction has been broken down into a more detailed list of twenty criteria titled "Suggested Diagnostic Criteria For Attention Deficit Disorder In Adults". It is not suggested that you diagnose yourself. There are many symptoms that are common to other problems and learning disabilities. There is also testing that can be done that supports the diagnosis. Another set of criteria, called the "Utah Criteria for Adult ADD", lists hyperactivity as a symptom that must be present, while the list by Doctors Hallowell and Ratey does not require hyperactivity. Another aspect of diagnosis is personal history. As I stated earlier, old report cards, letters home from school, past work experiences, even a history of addictive behavior such as excessive drinking or smoking marijuana need to be looked at (people with ADD sometimes self-medicate). As you can see just from these few points, diagnosis should be done by a qualified clinician.
Is ADD a learning disability? Technically speaking, no. But it can interfere with, the way we learn and the level to which we concentrate. Dr. Hallowell states, "The syndrome is not one of attention deficit but of attention inconsistency; most of us with ADD can in fact hyperfocus at times."4 The inconsistency can make it hard to pick up where we left off, causing feelings of frustration. People with ADD thrive on fresh situations, situations that bring newness to activities. ADD is characterized by "low tolerance for frustration or boredom."5
When dealing with interpersonal relations, ADD can cause us to miss subtle cues like body language and changes in the intonation of voice of the people with which we are dealing. This can be a problem at all stages of life as it tends to make the people we deal with uncomfortable. It alienates people. When young, it may be hard to make and keep friends and when older it may be hard to sustain professional business relations with clientele and co-workers. Difficulty interacting with other people can alter how we learn. ADD will often exacerbate other learning disabilities such as dyslexia. As the syndromes pile up we are labeled "lazy," "slow" or "stupid" and often end up with emotional problems such as low self-esteem. People with ADD can be very hard on themselves and this often sets the stage for a fall.
It should also be understood that ADD is not all bad. Dr. Hallowell reports, "Although ADD can generate a host of problems, there are also advantages to having it, advantages that this book will stress, such as high energy, intuitiveness, creativity, and enthusiasm..., The disorder didn't keep me from becoming a doctor."6 Of the pros and cons many of the cons can be treated with psychological counseling to deal with associated problems such as low self-esteem and lack of self-confidence. Once all of the disabilities have been identified we can deal with them singularly and also dissect how they affect one another. We can be taught to alter some of our behaviors to enhance our abilities to perform many tasks and there are also some medications which can help us to focus. These treatments may work singularly or in combination. All in all, there are many syndromes worse than ADD and there are characteristics of ADD that are truly wonderful and can enhance our lives.
The way we relate to this syndrome can be a love-hate relationship. But with
proper diagnosis and treatment, any person afflicted with ADD can live a happy,
productive and fulfilling life.
1 Edward M. Hallowell, MD and John J. Ratey, MD, Driven To Distraction
(New York: Pantheon Books, 1994) p. 6
2 Ibid, p. 8
3 Ibid, p. 22
4 Ibid, p. x
5 Ibid p. x
6 Ibid p. x