By Cyd Marckmann, ARNP
According to the National Institute of Mental Health, approximately 4.4% of the United States population currently has Adult Attention Deficit/Attention Deficit Hyperactivity Disorder. We live in stressful times. Many of our neighbors are struggling financially and many are commuting longer hours to work (resulting in longer work days/less free time). As a result, many adults are struggling to juggle all the tasks needed to function daily. The result looks sometimes like ADD but often is from other causes and ADD treatments do not address the problem. Additionally, many adults with ADD have learned to successfully utilize their ADD and do not require medication to treat it.
So what exactly is Adult ADD?
First and foremost, for an adult to be diagnosed with ADD the symptoms MUST be present in childhood and persist into adulthood. This does not mean that the symptoms must have been diagnosed as a child (especially because women may not have been), but they had to be present. The provider must take a very careful history and may even have patients take self-assessment tests to help determine whether the symptoms are from ADD or something else, such as depression or anxiety. ADD (like depression and other mental health illnesses) has a genetic link, so taking a careful family history is also important in determining whether the symptoms are related ADD or another source. There are no blood tests that are available to diagnose ADD. There are a few claims that brain imaging can be used to diagnose this condition, but it is expensive, not covered by insurance and the results are not widely accepted as accurate. Finally, ADD has absolutely nothing to do with intelligence, and many with ADD are highly intelligent, despite (possibly) not performing well in school.
What are the symptoms of ADD in children?
According to the National Institute of Mental Health, children who have symptoms of inattention may:
• Have difficulty focusing on one thing
• Become bored with a task after only a few minutes, unless they are doing something enjoyable (in which case you may have difficulty stopping them-like video games)
• Be easily distracted, miss details, forget things, and frequently switch from one activity to another
• Have difficulty focusing attention on organizing and completing a task or learning something new (also difficulty changing from one activity to another)
• Have trouble completing or turning in homework assignments, often losing things (e.g., pencils, toys, assignments) needed to complete tasks or activities
• Not seem to listen when spoken to
• Daydream, become easily confused, and move slowly
• Have difficulty processing information as quickly and accurately as others
• Struggle to follow instructions.
Children who have symptoms of hyperactivity may:
• Fidget or squirm in their seats
• Talk nonstop
• Dash around, touching or playing with anything and everything in sight
• Have trouble sitting still during dinner, school, and story time
• Be constantly in motion
• Have difficulty doing quiet tasks or activities.
Children who have symptoms of impulsivity may:
• Be very impatient
• Blurt out inappropriate comments, show their emotions without restraint, and act without regard for consequences
• Have difficulty waiting for things they want or waiting their turns in games
• Often interrupt conversations or others’ activities.
As a parent, your child (or yourself) may have many of the above symptoms at one or more times of the day, depending on the age of the child. There must be six or more of these symptoms present at the same time and they must be problematic for the child in home and school. For an adult, these symptoms must be present and problematic at home and work.
How is Adult ADD treated?
Children are often treated by medications (especially stimulants) to lessen the symptoms of ADD because they need to sit still in a classroom for long periods of time in school, in order to learn. Adversely, adults may or may not need medication. Unlike children, adults may not need to sit still for long periods of time. They may work at jobs that allow them to move about frequently and allow them different stimulus during the day to keep their focus while working. Often, adults need counseling to discuss the challenges of living with ADD: failed relationships from not keeping their emotions in check, learning how to control impulsive behavior (such as gambling, shopping), being impatient (such as road rage) or having poor social skills. They may require a life coach to teach them how to organize their home, maintain their checkbook, live under a budget, and be on time for work/appointments. Exercise is critical to successfully treating ADD whether in an adult or child, especially repetitive, purposeful exercise such as walking, running, swimming and tai chi. Some require anti-depressant medication because they have lived for so many years believing that they were lazy, crazy or stupid and a failure. The anti-depressants work well, especially if used in conjunction with counseling. It’s important to note that few adults end up experiencing a benefit from stimulants, especially if attending school.
I still see myself with many of these symptoms, now what?
Make an appointment with your Sound Family Medicine provider and allow enough time before your appointment to complete several self- assessment tests. Try to bring in as much history as you can, such as report card comments from school, or a family member (if possible) to help complete an accurate history. Don’t go into the visit expecting to receive stimulant medications because they may not be appropriate. Be open to counseling and changing behaviors to improve your symptoms. Exercise! This truly is a miracle drug. There are multiple research studies on the benefit of exercise and the brain, especially in regard to mental health, and exercise is often prescribed by ADD providers to decrease symptoms. Read (or get books on tape) on this subject so that you can be a partner in your treatment with your provider. Finally, don’t expect overnight miracles. Unlike a sinus infection that can be easily treated with one antibiotic, ADD and mental health issues are complex health problems that often require more than one avenue of treatment, and may take time to maximize treatment outcomes. Good luck on your journey!