What I've Learned From A.D.D

ADD is not what you think it is. In a modern world, our lives are full of distractions—with all distractions removed, true cases of ADD still suffer while the rest of us thrive.

By Edward M. Hallowell, published on May 01, 1997 - last reviewed on September 08, 2006

Educating the individual and his or her family, friends, and colleagues or schoolteachers about the disorder. Two of the largest national organizations providing this information are CHADD (Children and Adults with Attention Deficit Disorder, www.chadd.org, 800-233-4050) and ADDA (Attention Deficit Disorder Association, www.add.org, 484-945-2101).
Making lifestyle changes, such as incorporating structure, exercise, meditation, and prayer into one's daily life. Structural approaches include using practical tools like lists, reminders, simple filing systems, appointment books, and strategically placed bulletin boards. These can help manage the inner chaos of the ADD life, but the structure should be simple. One patient of mine got so excited about the concept of structure he impulsively went out to Staples and spent several thousand dollars on complex organizing materials that he never used. An example of simple structure: I put my car keys in a basket next to my front door so that I do not have to start each day with a frantic search for them.
Exercise can help drain off anxiety and excess aggression. Regular meditation or prayer can help focus and relax the mind.
Coaching, therapy, and social training. Often ADD sufferers complain that structure is boring. "If I could be structured, I wouldn't have ADD!" moaned one patient. A coach can be invaluable in helping people with ADD organize their life, and encouraging them to stay on track. If a psychotherapist is the coach, he or she needs to be actively involved in advising specific behavioral changes.
Therapy itself can help resolve old patterns of self-sabotage or low self-esteem, and may help couples address long-standing problems. For example, setting up a simple division of labor between partners can prevent numerous arguments. Social training can help those with ADD learn how to avoid social gaffes. And merely under standing the condition can promote more successful interactions.
Medication. The medications used to treat ADD constitute one of the miracles of modern medicine. Drugs are beneficial in about 80 percent of ADDers, working like a pair of eyeglasses for the brain, enhancing and sharpening mental focus. Medications prescribed include stimulants like Ritalin or Dexedrine, tricyclic antidepressants like Tofranil and Elavil, and even some high-blood pressure medicines like Catapres.

All of these medications work by influencing levels of key neurotransmitters, particularly dopamine, epinephrine, and norepinephrine. It seems that the resulting change in neurotransmitter availability helps the brain inhibit extraneous stimuli—both internal and external. That allows the mind to focus more effectively. There is no standard dose; dosages can vary widely from person to person, independent of body size.

Ritalin, by far the most popular drug for the treatment of ADD, is safe and effective. Of course, Ritalin and other stimulants can be dangerous if used improperly. But Ritalin is not addictive. Nor is it a euphoric substance—people use drugs to get high, not to focus their minds. For example, you would not cite, "I took Ritalin last night and read three books" as an example of getting high. Using stimulants to cram before exams, however, is as inadvisable as overdosing on coffee. Students do it, but they should be warned against it. Ritalin should only be taken under medical supervision and of course should not be sold, given away, or otherwise misused.

The diagnosis and treatment of ADD represent a triumph of science over human suffering—just one example of the many syndromes of the brain we are at last learning to address without scorn or hidden moral judgment. As we begin to bring mental suffering out of the stigmatized darkness it has inhabited for centuries and into the light of scientific understanding and effective treatment, we all have reason to rejoice.

Anatomy of A.D.D.

The official definition of ADD is found in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association in 1994. Keep in mind that ultimately the DSM is a fair attempt to systematize—through extensive empirical fieldwork and data—a field that is almost impossible to systematize. It's also important to remember that ADD is not a condition that you either have or don't have, like pregnancy. It is condition that, like depression, occurs in varying degrees of intensity. That said, for a patient to be formally diagnosed with ADD the following should be true:

1. Six or more of the following symptoms of inattention have persisted for at least six months to a degree that is maladpative and inconsistent with development level: