Attention Deficit Disorder / Attention Deficit Hyperactivity Disorder

Frequently Asked Questions:

Friday, December 4, 1998 Article from the ADDult listserv

ADD/ADHD And Depression

In many cases, ADD is accompanied by depression. Given the life stories of many ADDers, it is easy to see how this could be. (There may even be a neurological connection between ADD and depression.) In many cases, as the ADD is treated and becomes manageable, the depression will reside.

There is a powerful sense of loss when we look back over friends, lovers, and family members who we have alienated over the years. This is a humbling time.

There are some very real problems which the ADDer has to contend with. If you think that your spouse doesn't understand you, just try using ADD as an explanation of why you missed your car payment! The two biggest problems with structure are procrastination and impulsivity. We procrastinate on paying the bills and meanwhile spend the money on impulsive purchases. To break this cycle, you need some means of structuring your cash flow.

Structuring the way you handle money and pay the bills is just one of the life skills that are unnatural to an ADDer.

Many ADDers, especially those who weren't diagnosed until they were older, have developed coping skills to compensate for this lack of self monitoring. They watch those around them and learn to read non-verbal clues about what is appropriate and what isn't. Rather than speak out, they will remain silent- even though it may almost kill them.

Several medications are used to treat ADD: Ritalin, Dexadrine, Zoloft, Imipramine, and many others.

Hyperactivity in adults often translates to insomnia

We love this "secret" world we create, a world which is sometimes more real to us than the treadmill of the day. It meets some very basic needs of the ADDer, such as a having a place where he is in control and does not have to fear being reprimanded or criticized. This "world" of the ADDer does not have the often harsh limitations that are found in everyday life. For a time, at least, anything is possible.

The most basic need of all humanity is self expression. The ADDer, for whom self expression is often either repressed or rejected, finds it in this place.

Because of his fear of rejection, the ADDer may or may not share this world with others. "Do not cast your pearls before swine" (Matthew 7:6) certainly applies here. There is nothing more personal than something created by you. For that to be rejected is tantamount to a personal rejection of the creator.

We know that while all hyperactive people have ADD, not all ADDers are hyperactive, or at least not physically hyperactive (mental hyperactivity is certainly a possibility).

Many times, there are other factors, such as obsessive-compulsive disorder or, more commonly, depression, which co-exist with the ADD. ADD really comes down to a breakdown in the brain's ability to filter and process information. Even hyperactivity and impulsivity can be seen as the brain failing to process what is appropriate, what will be allowed, and what is not.

The ADDer, especially the undiagnosed ADDer, doesn't realize that others around him literally do not think as he does; he only knows that he often feels out of place or different. At the same time, he often is unaware, or unable to verbalize, his unique perceptions of the world around him.

Those who wish to understand this group also have to understand these differences. You can't think like an ADDer anymore than an ADDer could think like you. That doesn't mean that you can't agree or even understand each other. It just means that the thought processes themselves operate in significantly different ways.

ADDers are on a different wavelength!

ADDers are keenly aware of their environment. They see things that others people seem to naturally screen out. How many other people will drive through town and actually read all the billboards, store fronts and street signs. This becomes a problem when he is so distracted by a billboard for the zoo that he runs a red light. In restaurants, he overhears conversations several tables away (assuming his hearing is capable), yet doesn't seem to be able to hear his wife, who is sitting just across the table.

His senses are doing their job of gathering input very well. He becomes distracted by things that those around him don't even notice. The trouble is that the scanner is receiving on too many channels at the same time, letting too much information get through, all competing for his immediate attention, some canceling the others out.

Traits Common to ADD / ADHD

A typical person with ADD will only have some of these traits. No one has all. Some of these are mutually exclusive.

1. Thinks visually.

2. Daydreams.

3. Easily destractable.

4. Aware of everything.

5. Able to do multiple things at the same time.

6. Seeks stimulation.

7. Highly creative.

8. Immature social behavior, says what comes to mind.

9. Poor penmanship.

10. Difficulty remembering names.

11. Seeks immediate gratification.

12. Impulsive and impatient.

13. Suffers from motion sickness.

14. Can see patterns into the future.

15. Capable of intense short-term focus.

16. Quick decision maker.

17. Bored by ordinary tasks.

18. Risk taker.

19. Have had problems with ears.

20. More independent than a team player.

21. Sees the big picture.

22. Curious.

23. Experience thoughts as reality.

24. Subject to disorientation.

25. Sometimes has psychic - extrasensory abilities.

26. Highly intuitive.

27. Short attention span, inattentive.

28. Has a vivid imagination.

29. Artistic.

30. Has a sense of under achievement.

31. Have spatial orientation problems (left/right, north/south)

32. Talks excessively.

33. Reverses letters and numbers.

34. Slow reader when young.

35. Difficulty with math concepts.

36. Problems with self-esteem.

37. Problems mastering phonics and spelling.

38. Problems understanding the rules of grammar.

39. Reads best by memorizing, the "Look-Say System."

40. Always active-constantly thinking.

41. Learns best by hands on, rather than lecture or reading.

42. Low tolerance for frustration.

43. Realize that they are different from others.

44. Take longer to think and respond than others.

45. Able to create a complete mental picture from pieces.

46. Somewhat disorganized.

47. Capable of changing on a moments notice.

48. Have phobias: like fear of dark, heights, speaking in public.

49. Prefer unstructured situations with freedom.

50. Feels like they see problems from the perspective of a helicopter flying above forests of problems rather than working from the root of trees in one forest.

51. See things that others don't.

Defining ADD/ADHD

The University of California subscribes to the definition of attention deficit disorder and the diagnostic criteria for it expounded in the Diagnostic and Statistical Manual of Mental Disorders: Fourth Edition (DSM-IV), published in 1994. DSM-IV establishes a new name for the disorder, calling it "Attention-Deficit/Hyperactivity Disorder" (AD/HD) and distinguishing between three types:

The type primarily characterized by inattention (difficulty sustaining attention to tasks);

The type primarily characterized by hyperactivity-impulsivity (excessive fidgeting or talking, or difficulty in refraining from saying or doing whatever comes to mind); and

The "combined type" in which symptoms of inattention are present, as well as symptoms of hyperactivity - impulsivity.

Diagnostic Criteria

According to DSM-IV (p. 78), the following five criteria must be met in order for a diagnosis of AD/HD to be made:

The person must display "a persistent pattern of inattention and/or hyperactivity-impulsivity that is more frequent and severe than is typically observed in individuals at a comparable level of development";

"Some hyperactive-impulsive, or inattentive symptoms that cause impairment must have been present before age 7 years . . .";

"Some impairment due to the symptoms must be present in at least two settings" (for example, in the academic setting and in the workplace, or in the academic setting and at home);

"There must be clear evidence of interference with developmentally appropriate social, academic, or occupational functioning"; and

The "disturbance" is not better accounted for by another diagnosis (for example, autism, schizophrenia, chronic depression, chronic anxiety, a dissociative disorder, or a personality disorder).

II. THE NATURE OF ATTENTION DEFICIT DISORDER.

It was once assumed that attention deficit disorder was a disability limited to children or adolescents. It is now evident, however, that ADD can--and often does--persist into adulthood, creating multiple problems for those who have it. In an academic setting, adult students with attention deficit disorder may face some common problems such as the following:

Often seems inattentive to details, and makes frequent errors in academic work;

Has difficulty sustaining attention;

May seem not to listen when spoken to directly;

Has difficulty "following through" on instructions, or fails to complete tasks;

Has trouble organizing tasks and activities;

Dislikes or avoids tasks requiring sustained mental effort;

Tends to lose things necessary for tasks or activities (for example, keys, textbooks, assignment sheets);

Easily distracted by features of the environment (for example, background noise, light, or motion);

Frequently forgets appointments and other daily activities;

fidgets or squirms restlessly;

Has difficulty remaining seated;

Often has subjective feelings of restlessness;

Displays an inability to engage in leisure activities quietly;

Is frequently "on the go" or acts as if "driven by a motor"'

Talks excessively;

Blurts out answers before questions have been completed;

Has difficulty waiting in line; and

Often interrupts or intrudes on others.

Academic Accomodations:

Attention deficit disorder may affect the academic performance of students in different ways. For this reason, every student with ADD requires individualized determination of appropriate accommodations and services. For example, some students with ADD can sustain attention during a 50-minute class and therefore do not require notetakers; but other students with ADD have attentional problems that make notetakers an important accommodation. Some students with ADD require no assistance with writing tasks; others may need proofreader, tutorial assistance, or the opportunity to meet with their instructors to review early drafts of an assigned essay.

Each student with attention deficit disorder should be provided with accommodations and services that are appropriate to the student's disability-related academic needs. It is the responsibility of a Learning Disabilities Specialist, the Program Director, or other staff member designated by the Director to determine appropriate accommodations and services. This determination will be made after interviewing the student and reviewing the information furnished by the diagnosing professional(s). If the University's disability specialist does not find appropriate and sufficient evidence on which to base decisions concerning accommodations and services for a student with attention deficit disorder, the student should be referred for additional assessment (tests of intelligence, cognition/information-processing, and academic achievement).

Further assessment may also be required if the disability specialist finds indications of co-existing learning disabilities or other disabling condition(s).

Appropriate academic accommodations may include, but are not limited to, the following:

Part-time enrollment with reduced fees;

Continued eligibility for financial aid despite reduced course load;

Subject to availability, substitution of University-based financial aid for Federal- or State-based aid, to accommodate exceptions to minimum course-load requirements; and

Alternative examination formats, including extended time and a private test-area.

Psychological treatments

Treatment for depression & anxiety

Improve self-esteem

Refine social skills

Anger control

Vocational counseling

Building a success identity

ADD/ADHD Characteristics

Think of someone you know that you may have labeled forgetful, lazy or hyper. Although these labels could be true, these are also signs of attention deficit disorder, commonly referred to as ADD. ADD is often misunderstood and frustrating to parents, teachers and co-workers.

ADD is genetically transferred, most often from the father. For most people, information enters the brain, they process it and formulate a response. There should be a delay where the neurotransmitters in the brain connect. This point is called the synapse. For the ADDer, certain parts of the brain are less active. There is no delay...so, like a car running without brakes through a red light, a thought occurs and instantly we're speaking - often the comments are inappropriate.

This disorder comes out in 3 ways: hyperactivity, impulsivity and distractibility. Most people think you outgrow ADD, but much to the contrary, many adults suffer from this disorder as well. The following are some characteristics that profile the ADDer.

Hyperactivity or Risk-Taking

ADDers are often bored and understimulated. They love and crave adrenaline. When they can't get it, they create situations that produce it. This person is always walking around...never in his seat.

Undiagnosed ADDers may participate in destructive activities, including self-medicating with drugs and alcohol.

They feel they're operating at 78 RPMs, while the rest of the population's at 45; they try to slow down so they can fit in.

Tragically, we have a disproportionate number of ADDers in our prison population.

Impulsivity

This person always looks really busy, but rarely accomplishes anything.

They interrupt other people's conversations.

They act without thinking, spout-off, are impatient and make snap judgments.

They are impulse buyers.

They are jokesters and always want to be the center of attention.

Distractibility

ADDers have difficulty focusing on the task at hand.

They don't manage their time well and are frequently late.

They have difficulty remembering verbal instructions.

Don't even try to talk to them while the TV is on -- its futile.

They're visual -- they'll keep piles of papers and Post-it notes everywhere.

They're usually working on a million projects at once.

They lose their keys or lock them in the car.

They never read instructions - that's way too much detail. They would rather you show them how to do it.

They're a jack of all trades...master of none.

ADDers love to do several things at one time...and they're usually good at it. It's how they're wired, and it allows them to produce the adrenaline they crave. Their methods only appear insane. Suggestion: Don't get involved unless they miss deadlines.

ADDers are very visual in terms of memory. Suggestion: Encourage the usage of flashcards, outlining or whatever method is needed to push the information from their inadequate short-term memory into their long-term memory. Learning new concepts is challenging to the ADDer, but once they "get it," watch out...they don't forget it.

ADDers tend to procrastinate (the hallmark of ADD) and are easily overwhelmed (often because they're perfectionists and don't know where to start). Suggestion: Help them break the projects that span several days, into smaller bite-size pieces. Sometimes a little hand-holding is in order to help the ADDer tackle the bigger jobs.

ADDers can hyper-focus and exhibit short bursts of energy on high-priority projects...it's the day-to-day maintenance that they struggle with. Also, getting organized isn't as difficult as staying organized. Suggestion: Set goals/deadlines for them on the less-interesting work and keep them accountable.

Most ADDers struggle with remembering auditory instructions (a left-brain language processing function).

Suggestion: Allow them to get a pencil and paper before you rattle off a series of verbal directions. Encourage this visual reinforcement.

ADDers need lots of structure (not necessarily routine). Suggestion: Use a whiteboard or list which you can refer them to when they get distracted. This takes you out of the "bad-guy" role of constantly reminding.

Personality Traits

ADDers are generally intuitive and sensitive individuals. Suggestion: Be gentle, but firm in your interactions.

Consistency and a clear understanding of the rules and boundaries play a key part in the success of their relationships. Stay current with grievances; they can't remember what happened last week.

ADDers like and need feedback

Suggestion: Encourage--encourage--encourage. The sky's the limit with their ability to perform, given a positive, safe environment. Reward, rather than reprimand. Build in simple perks such as: if you achieve "xy," then you'll get "z." The "z" reward could be: leaving work early, taken to lunch . . . whatever's suitable.

ADDers love to have fun! Suggestion: Keep the environment stimulating...if it's reduced to the left-right-left atmosphere, their interest will wane.

ADDers struggle with time management. They tend to be too helpful and generous with others, often to the detriment of performing their own job responsibilities. Suggestion: Guide them back to handling their priorities first.

Obviously, ADDers have a short attention span. Suggestion: Don't lecture. Say it in 25 words or less (or you've already lost them). Be "The One-Minute Manager," a great book on management style by Kenneth Blanchard, Ph.D. and Spencer Johnson, M.D. Make sure you make eye contact when talking.

The Top 10 Behavioral Strategies that ADDers Need to Know

1. Develop your true nature and personality. Not what you think others want you to be.

2. Never worry by yourself. Talk to someone, a designated person, friend or relative about what is bothering you or else you'll ruminate or obsess over the issue.

3. Develop strategies for dealing with anger. Take a jog or vigorous run, play a competitive sport in a organized league, Yoga, breathing techniques, karate. Get a punching bag or anything that relieves the negative feelings stimulated by adrenaline.

4. Don't talk excessively. If you are going to communicate, organize your thoughts, write them down in bullet form and then practice, practice, practice!!!

5. Show compassion for yourself instead of blaming yourself for everything that goes wrong. Remember the Optimal Functioning Associate Coach program slogan: "If The Shoe Doesn't Fit, Don't Blame The Foot."

6. Get things done vs. doing things right. Stop procrastinating about starting or completing a task because you can't do it perfectly. Black and white thinking will paralyze progress. Create ACTION and JUST DO IT! You'll feel great and you'll learn by getting things done.

7. Be an active listener. Focus on a single aspect of what the person is saying. What is the person missing?, persons strengths, emotions, mood? etc. Also, learn to be a neutral listener, and listen without making any judgments.

8. Heap sincere PRAISE on those people you feel deserve it. One enthusiastic statement of praise is a gift that stays indelibly ingrained in the memory of those individuals who rarely receive any positive feedback.

9. Find a cause or create a mission that reflects your true values or nature and focus that high ADD energy towards achieving it.

10. Learn to say NO.

ADDers have a tendency to bite off more than they can chew and in the process overwhelm themselves with too many promises they can't deliver. There is a charge neutral way of saying NO that will not offend anyone. If you do decide to say yes to something that interests or motivates you, then UNDER PROMISE and over deliver. It will immediately alleviate any pressure you feel. You'll be more productive and you will surpass everyone's expectations.

Medications

The stimulants, the drugs most commonly used, have been shown to be effective in improving behavior, academic, work, and social adjustment in anywhere from 50 to 95% of children with ADHD" (Barkley, 1995, p.249).

Dr. Bruce Pasch, M.D. has outlined the use of drugs for use with ADD/ADHD.

Stimulants such as Ritalin, Dexedrine, Cylert, and Adderal are used. Side effects include headaches, stomachaches, insomnia, rebounding moodiness, anorexia, and agitation. Antidepressants such as Tofranil, Norpramin, Anafranil are used. The side effects are dry mouth, constipation, anorexia, tremor, insomnia, cardiac arrythmias, and seizures in Anafranil. A new line of antidepressants are successfully being used including Prozac and Zoloft. Side effects include nausea, headache, anorexia, insomnia, and panic attacks. Wellbutrin is used to block reuptake of serotonin and dopamine. Its side effects are seizures, agitation, insomnia, headaches, and anorexia.

Adderall/Ritalin Comparison*

ADDERALL has a more convenient dosing schedule - ADDERALL - 1-2 times a day - Ritalin - 2-3 times a day* ADDERALL's convenient dosing schedule may eliminate in-school administration of the product.* ADDERALL's half life is 7-8 hours compared to 1-3 hours for Ritalin*

ADDERALL is indicated for younger children - ADDERALL - 3 years and up - Ritalin - 6 years and up*

ADDERALL tablets are scored for more flexible dosing*

ADDERALL tablets contain no harmful tartrazine dyes*

ADDERALLs name has a low profile with potential abusers* ADDERALL is more cost effective than Ritalin

Adderall is consistently longer-acting than Ritalin 20 SR (Sustained-Release), and much more predictable since it is more completely absorbed. (over 90% fully absorbed, compared to 30-60% Ritalin absorption).

Brand name: Dexedrine

HUMOR

From Gigi: The following seem to have originated at The ADDictionary from HADD-IT . Check them out for more goodies.

...you go to put something away in the other room and forget to take it with you.

...you get up at 6:30 to be ready to leave for work by 8:30, you're ready in 45 minutes but you're playing on the computer and you leave late anyway.

...you make a cake and when it should have been ready to take out of the oven, it didn't get done because it wasn't there...the pan of batter was still sitting on the counter.

...you forget what you're looking for, but continue to look for it hoping you'll recognize it when you see it.

...you can't remember if you took your medication and wonder whether or not you should take them in case you didn't or leave well enough alone in case you did.

...you are sitting here reading and relating to all of the "YOU KNOW YOU'RE ADD WHEN" stories and are still in your night clothes and should be leaving the house in five minutes.

ADD Dictionary:

ADDOSECOND (ad' o sek and) n.

the smallest unit of time ever measured, which is the length of time from when an ADDer promises to do something, and then forgets about it.

ADDVENTURE (ad ven' cher) n.

what it is like living with someone who has ADD.

CARNESIA (car ne' zhi a) n.

1. not being able to remember where you parked the car. 2. forgetting which car you drove 3. forgetting that you actually walked. 4.forgetting that you don't even own a car.

COUNTER CLOCKWISE (koun' ter klak wiz) adv.

Clock dumb. Unable to get anywhere on time, but then does it really matter, anyway?

DOMINANT JEAN (dam' a nant jen) n.

the clean pair of jeans that always ends up on the top of the dirty clothes pile.

EFFICIENT (a fish' ant) a.

having to do with fish. Or at least sounding like fish in the middle. Must have something to do with being smelly and slimy or just plain, well, fishy. As in "her house isn't very neat; she must be very efficient."

FLOOR (flor) n.

a storage area for clothing.

GAB (gab) v.

the gift bestowed upon those with ADD.

GOING POSTAL (go' ing po' stul) n.

the anger an ADDer feels when they have arrived at home or at work, still holding that letter that they were supposed to mail on the way.

HEREAFTER SYNDROME (her af' tar sin' dom) n.

the habit of standing in the middle of a room (or shopping mall) and asking "What am I here after?"

HINDSIGHT (hind' site) n.

the habit of always looking back before sitting down on any chair in the house to make sure you are not going to sit on something.

HUHWHAT (hu' hwut) interj.

the initial response to any request or conversation directed at anyone with ADD, once actual contact has finally been made.

LISTLESS (list' las) a.

how an ADDer feels after they have gone grocery shopping without a list and have come home with everything except what they went for.

NUMNESIA (num ne' zhi a) n.

1. a condition that manifests itself in having to look back and forth between the phone and the local phone number 2-3 times before dialing is completed. 2. that which results in repeating a phone number that someone has just told you over and over until you reach the telephone, pick up the receiver, and forget the whole thing completely. 3. the act of trying to figure out whose phone number is scribbled on that piece of paper.

ORGANIZE (ar' ga niz) n.

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POSTSCRIPT (post' skript) v.

having to carefully space out taking your meds, because you forgot to fill your prescription before it expired and will have to wait before you can get more.

PRE-MED (pre' med) n.

the foggy state of mind ADDers are in until their meds kick in.

READPEAT (red pet') v.

having to read something over and over before it finally sinks in.

SLEEP TIGHT (slep tite) n.

having to sleep in a confined area on the bed because the rest of it is covered with clothes, books, etc.

TIME RELEASE (time re' les) n.

how an ADDer feels when they are hyperfocusing and lose all concept of time.

TRIPOMETER (trip o' me ter) n.

1. a device which counts the number of trips an ADDer makes into a room to get something before they actually do get it, or 2. the number of times an ADDer trips over something on the floor before they pick it up (or at least kick it out of the way).

Depression is not something to be ashamed of.

Depression is not the same thing as feeling "blue" or "down."

Depression is not a character flaw or the sign of a weak personality.

Depression is not a "mood" someone can "snap out of." (Would you ask someone to "snap out of" diabetes?)

Depression is not fully recognized as an illness by most health care insurance providers. Most will only pay 50% of treatment costs for out-patient care, as well as limiting the number of visits.

Adults with Attention Defcit Disorder frequently experience a state of internal disorganization that may lead them to crave high intellectual charge and be either positive or negative.

The exact nature of the stimulus is not as important as the need for the experience to be of high intensity. Our clinical experience indicates that the intensity of the experience organizes the individual and thus induces an inner state of calm.

The disorganization, emptiness, and boredom (in the form of lack of directedness) that follows the resolution of conflict and trauma can lead again to the internal state that adults with ADD find intolerable.

The notion of failure has often become a life theme for adults with attention problems, especially those whose disorder went unrecognized and therefore untreated during childhood and adolescence. Distractibility, hyperactivity, impulsivity, and the frequent inability to learn from past experience (due, perhaps, to the failure to attend to relevant cues from the environment) have all interfered with the individual's ability to accomplish any number of life's important tasks. As a result the adult has internalized an image of failure that manifests itself whenever he/she is called on to begin anything new.

The repeated image of failure and the constant fear that all will not come out as planned eventually causes the adult to avoid beginning the new project, the new job, the new school, or the new relationship.

Ironically , achieving success holds its own type of danger for those ADD adults who have the ability to see a project (or crisis) through to the end. The reason for this is as complex as it is simple-accomplishments lead to a sense of completion. This poses a threat to the individual because closure and the loss of the project or crisis is accompanied by the loss of goal-directedness. Thus the ADD adult becomes trapped in a terrible bind: one cannot finish what one cannot even begin, and one does not wish to begin what cannot be finished.

Perhaps the biggest reason why previously undiagnosed adults with attention deficits seek treatment is their chronic failure to form healthy intimate relationships. One reason may be that ADD characteristics, such as physical jumpiness and the constant need for intense and/or multiple sources of stimuli, make it nearly impossible for the adult to sustain the emotional and cognitive contact that intimate relationships demand. Even a firm desire to commit to a relationship often is not enough to prevent the adult from becoming bored, distracted, or discouraged within the relationship.

Intimacy in relationships can also be difficult to achieve because the nature of the attention deficit proves very hard on the partner. The partner can feel undervalued due to both the distractibility of the ADD adult and the tendency of that adult to throw existing energy into activities other than the relationship in repeated attempts to achieve order. Also, the distractibility and impulsivity of the ADD adult can lead him or her to underact or overreact to the requests, needs, and problems of the partner.

The repeated failures in intimate relationship may prompt the ADD adult to develop an attitude toward intimacy that further hinders the possibility of achieving it. In addition to difficulties in achieving intimate, one-to-one relationships with others, ADD adults face difficulties I being effective in the wider social world. Such difficulties can be subtle, yet still impair the quality of the adult's experiences. Some ADD adults have reported a history of antisocial behavior such as cheating while some feel they do not know how to treat people properly.

Paradoxically, most adults with attention problems cannot tolerate being alone despite their occasional disregard for other people or their inability to get along socially. Being alone can be most difficult because ADD adults feel empty and lacking if they are not focused or driven by a stimulus. As we know, this may prompt them to seek or create conflict or trauma. Thus, for many, it becomes imperative to avoid being alone.

A common complaint of the adults in treatment is their sense of being immature, childlike, and lagging behind peers in their achievement of life tasks.

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