Adult Attention Deficit Disorder
Adult Attention Deficit Disorder is not well known or recognized, yet it is estimated to affect more than 4 percent of the population. However only 10 percent of that population is actually being treated for the illness. Characteristic symptoms of ADD include impulsivity, easy distraction, disorganization, forgetfulness and inability to perform tasks requiring sustained concentration. Restlessness, or hyperactivity, does not have to be present to make the diagnosis. One of the easiest ways to make the diagnosis is to have a child diagnosed with AD/HD, since ADD appears to be highly genetic. In fact in my practice it is usually when the child is brought in for treatment that it becomes obvious one of the parents also shares the diagnosis.
Adult ADD is a very common cause of marital strife, financial problems, job failures, drug abuse, felonies, traffic accidents and low self esteem, which is why diagnosis of AD/HD in adults is important. Recent studies have found that approximately 50 percent of felons have ADD. Untreated ADD sufferers have a higher incidence of motor vehicle accidents, speeding tickets, citations for driving without a license and suspended/revoked licenses. More than 50 percent of untreated teens and adults abuse alcohol and drugs.
People with ADD typically have problems doing routine, unexciting tasks. Oftentimes they procrastinate or never finish the project. Many times people with ADD will say “I can pay attention….as long as I am interested.” This plays havoc with keeping jobs or running households. People with ADD often have erratic work histories despite being quite bright and often creative and innovative. Most employers will not tolerate missed deadlines and unfinished projects. At home the problems continue. Although the majority of ADD sufferers are men, about 15 percent are female. Partners of ADD sufferers frequently complain that they get to do everything “that’s not fun” which usually includes disciplining the kids, remembering their appointments, handling all the finances including making budgets and keeping records, organizing the household including finding lost items and in general being the “grownup” in the relationship.
SPECT scanning is a brain imaging technique which can show the brains’ activity. Dr. Amen, a psychiatrist, has shown that many ADD sufferers have low activity in their prefrontal cortex. The prefrontal cortex is the “executive” of the brain. It is involved with planning, impulse control and decision making. It is not fully developed until the mid 20’s in most people. It is why children need parental supervision – they lack the brain capacity to fully understand the longterm consequences of their actions, and the discipline to not act on impulse alone. The prefrontal cortex allows one to make goals and to achieve them in the absence of external structure. This is considered to be an essential aspect of a mature and effective personality. In many people with ADD this center shuts down the harder they try to concentrate, which is seen as an inability to focus and pay attention. It also creates poor impulse control. Often times in stressful situations people will think thoughts that are better not said such as “You idiot. A person with an IQ of 10 could have done a better job”. Most people realize that saying such thoughts will only make the situation worse. However a person with ADD often lacks the ability to censor his thoughts, blurts out whatever he is thinking, and escalates the situation or argument.
Successful treatment for adult ADD involves recognition first of all of the problem, and then acceptance of the diagnosis. Most other people around the patient recognize the problem before they do, although they may not know what to call it. The employer and the spouse may both recognize that the adult ADD sufferer cannot be depended on for being on time, for finishing projects, for paying attention to details or for paying bills. Employers deal with it usually by firing the employee. In the marital situation the relationship troubles may simmer for years without treatment. Many marital counselors are actually treating ADD relationships, often without recognizing it. There are many questionnaires on the web for diagnosing ADD. One that is useful is Dr. Amen’s at http://www.amenclinics.com/cybcyb/online-tests-calculators/add-test/. It should be added that the online tests are screening tests only and the professional confirmation of the diagnosis should be obtained.
Once a diagnosis is obtained treatment is essential. Successful treatment has several components. The first again is accurate diagnosis and overcoming denial. Many do not move beyond the denial, preferring to believe that their behavior is not a problem. Often times this comes from low self esteem. By the time an ADD patient reaches adulthood he has endured extreme amounts of criticism from parents and teachers. Often he has internalized the idea that he is lazy and dumb. Actually admitting finally that there is a real problem simply adds to his poor self image, and he finds it easier to ignore the message, and perhaps to try to kill the messenger who is usually the longsuffering spouse. However effective treatment does exist and it is highly worth obtaining. The most effective treatment programs consist of psychological interventions, exercise, diet, nutritional supplementation and medication. These options will be covered next month.
Mary Ackerley MD, MD(H), ABIHM is a classically trained psychiatrist and homeopathic physician who specializes in the holistic treatment of depression, anxiety, bipolar disorders, digestive disturbances and hormone replacement therapy.
She can be reached through her clinic MyPassion4Health at 520-299-5694 or online at www.MyPassion4Health.com