Betty W. Phillips, Ph.D., Psychology
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Do YOU have ADD (Attention Deficit Disorder) ?

Do YOU have ADD (Attention Deficit Disorder)?

Last month's column introduced basic concepts about ADD. This article will provide more information about ADD diagnosis: what ADD is and is not. While many people suffering from attention problems are resistant to this diagnosis, others may be seeking an ADD label to explain their life problems. Accurate diagnosis is quite important for appropriate treatment planning. While ADD treatment strategies are designed to enhance ADD brain functioning, these treatments may be counterproductive for individuals with problems other than ADD.

So let's start by understanding ADD. The puzzling thing about this condition is that there is in fact no overall attention "deficit." In fact, the condition should really be called attention "inconsistency." Any diagnostic evaluation will find that the ADD condition is manifest sometimes and not other times. When an individual's excitement and interest are high, when the stimulus in question is novel and interesting, the ADD characteristics are nowhere to be found. Individuals properly diagnosed as ADD often have very good attention skills under the right conditions. Attention can be quite sharp and focused when brain waves and neurotransmitters are maximized. At other times, however, attention difficulties will be quite evident and in fact can in fact pose major life difficulties.

Most ADD diagnosis starts when someone like you reads an article like this and wonders about ADD. The next step is usually completion of a screening test with general questions designed to tap into ADD characteristics. I'll include a sample screening test on my website when this article is published. Relatives with this condition, parents, children or others, may signal the possible presence of ADD for you. The next step is a careful evaluation by a clinician well trained in understanding and establishing this diagnosis. Because ADD is a lifelong condition starting in childhood, the examination should include an extensive history. It should be noted that the life history may include inaccurate conclusions about the presence or absence of ADD. While some children are diagnosed with this condition early in life, too many are labeled ADD because of noncompliant, even "bad" behavior. Children with conduct problems may be misdiagnosed as ADD, while others who experience this problem may be called unmotivated, overly social, lazy or a daydreamer. Intelligence is always a plus, but bright children may achieve well in school despite being handicapped by ADD. The clinician diagnosing ADD usually conducts a careful discussion of the individual's lifestyle and difficulties in the home and work environments, often with checklists designed to measure ADD characteristics. Computer based tests of attention performance may be helpful but are not considered definitive. Brain imaging analysis does reveal functional characteristics of the ADD brain but is quite expensive and is unnecessary in establishing this diagnosis. In the past it was thought that the ADD brain is over-stimulated, often because of erratic and hyperactive behavior, although brain imaging results have now established that the ADD brain is in fact under-stimulated when the typical ADD problems are manifested. Other tests such as IQ tests, achievement tests, neuropsychological or personality tests may be useful in gathering additional information, but they are not definitive of ADD.

Although the underlying condition of ADD is similar in children and adults, the observable characteristics may be different. Children may experience more difficulty with demanding school routines, while adults may find themselves in more stimulating or high activity jobs where ADD characteristics may not be handicapping. On the other hand, children usually have parents and teachers to help organize and motivate them, while adults need to organize their own lives. Adults may have learned to conceal or cope with ADD characteristics, while children may still be struggling with these problems openly.

A careful diagnosis will include an evaluation of factors which may simulate ADD-type behaviors although they are in fact diagnostic of another condition. Sleep problems may certainly cause ADD-type symptoms as long as the sleep deprivation lasts. Chronic stress is another modern-day condition causing various types of attention problems. Anxiety, depression and substance abuse can certainly cause symptoms similar to ADD. Medication reactions, brain dysfunctions, seizure disorders or dementias may also cause attention problems. If you do have one of these other conditions, it will be very important to pursue appropriate treatment. Of course, it is possible that you may still have ADD and may qualify for such treatment after the other conditions are remediated.

It is important to realize that ADD presents a challenge to individuals while often providing them with high energy and creativity. ADD individuals may see many possibilities in life and are often enthusiastic and energetic in carrying out life projects. These same strengths may create paradoxical difficulties. Creative ideas may tumble one to another, creating new insights and inventions or causing chaos and disorganization. Inside the ADD mind, many individuals feel overwhelmed and in constant turmoil, and they long for the time when they can "get it together" and find their life organized. Self-esteem issues and feelings of chronic failure are often evident, along with irritability, anxiety, mood swings and sleep disorders. Procrastination and perfectionism often hamper work efforts. ADD presents a challenge to partners and spouses, and a later article will address this issue.

In my history of working with ADD and in my review of the current literature I have found much to be optimistic about management of this condition. ADD coaching by a well trained therapist or life coach is a very promising approach, and I will be describing new ADD management strategies in the next article.

Now for a little humorous advice. If you find this sign on your therapist's door, "Out of my mind. Back in five minutes,"; run as fast as you can the other way!

Adult ADHD Self-Report Scale (ASRS-v1.1) Symptom Checklist

Complete this screening checklist, rating yourself with the descriptor "Never; Rarely; Sometimes; Often; Very Often" which best describes how you have felt and conducted yourself over the past six months. Give this screening checklist to your therapist, coach or health care professional to discuss whether a more extensive diagnostic evaluation should be completed.

Part A.
1. How often do you have trouble wrapping up the final details of a project, once the challenging parts have been done?
2. How often do you have difficulty getting things in order when you have to do a task that requires organization?
3. How often do you have problems remembering appointments or obligations?
4. When you have a task that requires a lot of thought, how often do you avoid or delay getting started?
5. How often do you fidget or squirm with your hands or feet when you have to sit down for a long time?
6. How often do you feel overly active and compelled to do things, like you were driven by a motor?
Part B
7. How often do you make careless mistakes when you have to work on a boring or difficult project?
8. How often do you have difficulty keeping your attention when you are doing boring or repetitive work?
9. How often do you have difficulty concentrating on what people say to you, even when they are speaking to you directly?
10. How often do you misplace or have difficulty finding things at home or at work?
11. How often are you distracted by activity or noise around you?
12. How often do you leave your seat in meetings or other situations in which you are expected to remain seated?
13. How often do you feel restless or fidgety?
14. How often do you have difficulty unwinding and relaxing when you have time to yourself?
15. How often do you find yourself talking too much when you are in social situations?
16. When you're in a conversation, how often do you find yourself finishing the sentences of the people you are talking to, before they can finish them themselves?
17. How often do you have difficulty waiting your turn in situations when turn taking is required?
18. How often do you interrupt others when they are busy?