by Dr. David Sitt

OMG, do I have ADD!?

Which of the following appears most often in your daily lingo: OMG, LOL, or ADD? In a recent text apologizing for his lateness to dinner, my friend hit the trifecta, “Running late…OMG, I’m soooo ADD, LOL!” These days Attention Deficit Hyperactivity Disorder seems so commonplace that we use its acronyms, ADD or ADHD, as descriptors for any slip in attention, organization, or punctuality. So what exactly is Attention Deficit Hyperactivity Disorder, is there an upside to ADHD, and where can one begin in terms of assessment and treatment?

ADD and Me

Having been diagnosed with ADHD and mild dyslexia in college, I can speak firsthand to the challenges and benefits of being an ADDer. Prior to my diagnosis, navigating life was like walking on a tight rope with clown shoes over a minefield in the middle of a heavy fog. Learning to deal with the specific weaknesses and strengths of my ADD became my daily challenge. Along the way, I handed in most papers at the last minute, ran late to classes, fidgeted during lectures, and was hardly able to get through readings at first glance. However, as a result of the same ADD brain, I have an out-of-the box thinking style, ability to organize and lead with lasting enthusiasm, and a knack for rapid multitasking under pressure. Living with ADD requires a dedication to understanding the ins and outs of a collection of traits and tendencies which define a truly unique way of being in this world. When the disarray, frustration, and pain dominate, this way of living can become a disorder. With persistent motivation, discipline, understanding and support, the disorder can be transformed into an asset.

The Basics

First off, Attention Deficit Hyperactivity Disorder is referred to as ADHD, AD/HD, and ADD interchangeably- the only reason ADD is used at times is because it’s easier to say! With nearly 7% of school-aged children and 4-5% of adults diagnosed, ADD is among the most prevalent neurological disorders in the United States. Common symptoms include difficulty sustaining attention to tasks and conversations, taking action without thinking, difficulty waiting in lines, impulsive and/or overly verbose speaking, fidgeting, trouble staying seated even for a short time, difficulty organizing, beginning, and finishing tasks, and losing/misplacing belongings. For the many of you who read this brief list and immediately identify your child or yourself as an ADDer, know that we ALL exhibit these behaviors at various times. The important difference is the frequency and degree to which the combination of symptoms impairs one’s ability to function in school/work/home/relationships relative to one’s peers. Furthermore, with society’s growing dependence upon technology and resulting instant-gratification mentality, pseudo-ADD is growing at exponential rates. For the untrained eye, it can be difficult to tease out an organic, biologically based ADD from the artificial yet equally challenging pseudo-ADD.

How to Diagnose

ADD is generally diagnosed between the ages of 6-12. During the diagnostic process, a child should be screened for other problems including learning disabilities, depression and anxiety disorders, which can either mimic the symptoms of ADD or possibly coexist with ADD. An evaluation by a psychologist should ideally include input from parents, teachers, and others who have regular contact with the child. For adults, a consultation with a mental health specialist (e.g., psychiatrist or psychologist) can be the first step. Across all ages, a more in depth neuropsychological assessment is warranted if the person wishes to receive accommodations from a school or work setting, or to assist in determining a treatment plan in more complicated cases. As for the causes of ADD, the jury is out. We know it tends to run in families, implying a genetic link. Biological, environmental, and parenting styles also contribute to the condition’s development.

Treatment Options

Like many other developmental disorders, there is no cure for ADD. So while ADD cannot be turned on and off like a light switch, its intensity and impact can be more readily controlled like a dimmer through various treatment efforts.  Treatment options include medication, cognitive therapy, behavioral management, social skills training, parenting skills training, nutritional counseling, and mindfulness training, among others.  Finding the right combination of tools is a trial and error process that can take several months to determine, and can shift as a person develops. In children, stimulant medications (e.g., Ritalin, Adderall, Concerta, Vyvanse) are often the primary avenue for treatment, leading to a significant reduction in symptoms in up to 70% of patients. Side effects to be aware of include loss of appetite, insomnia, tics, short-term growth inhibition, headaches, increased heart rate and blood pressure, drowsiness and social withdrawal. The side effects are short term and are alleviated by adjusting dosages, shifting or discontinuing medications. For the 20-30% who do not respond to stimulants, non-stimulant options exist as well (e.g., Strattera/atomoxetine). While symptoms of hyperactivity, inattentiveness and impulsivity may be curbed, medication will not solve all of your child’s behavioral problems, especially once the medication’s effects wear off.  Developing a comprehensive plan with complimentary treatments is key to achieving more extensive gains. For parents who struggle with the notion of medicating their children at a young age, a balanced review of the pros and cons with a treatment specialist is crucial. It is important not to blindly negate treatment options, as the impact of untreated ADD can lead to poor school performance, poor peer-relations, symptoms of depression, and low-self esteem in the short and long term. Holding regular, supportive conversations with your child about their symptoms as well as their feelings about their treatment can provide a sense of collaboration and confidence crucial for the child’s navigation through their ADD.

Adults with ADD

Among those diagnosed with ADD as children, 50-60% will continue to exhibit disruptive symptoms into adulthood. Aside from the symptoms mentioned earlier, adults with ADD typically are impatient, short tempered, physically restless, have racing thoughts and speech, have difficulty managing their time, struggle with prioritizing and/or organizing tasks, engage in stimulus seeking behaviors (e.g., impulsive shopping, gambling, substance abuse, arguing for the sake of arguing), and impulsively “leaping before they look.” Untreated teens and adults with ADD are at higher risk for job loss, speeding, car accidents, drug abuse, and marital discord. For adults with ADD, medication remains a primary treatment tool and is most effective when combined with other treatment efforts such as cognitive behavior therapy (CBT) and nutrition management. The therapy arm is particularly important when the impact of years of personal frustrations, academic/professional mishaps, and interpersonal difficulties results in negative thinking patterns, low self-esteem, and debilitating anxiety. Attending to untreated ADHD can often lead to a reduction in depression and/or anxiety symptoms and a greater sense of control can be gained.

Among the more recent treatment tools receiving preliminary support in the literature is mindfulness meditation. Mindfulness is the art of bringing awareness to the present moment with an open and accepting attitude towards one’s experiences. Mindful meditation practices include sitting meditations, mindful movements, deep breathing, stretching, and bringing purposeful attention to daily activities. Through training individuals to become more aware of the flow of their internal states, mindful meditation training in both children and adults can provide noticeable control over depression, stress and ADD symptoms.

The Upside of ADD

My colleague, Dr. Edward Hallowell, author of the most widely read books on ADD (e.g., Delivered from Distraction), refers to ADD as a gift that one must learn to unwrap. While ADD certainly comes with significant challenges, the ADD brain brings along several strengths. Such characteristics include being innovative and out of the box thinkers, working well under pressure, being energetic, creative, charismatic and interpersonaly savvy. High rates of ADD are found among CEO’s, politicians, artists, and creative entrepreneurs (e.g., David Neelman, former CEO of Jetblue). As a clinical psychologist specializing in adult ADD, I work with patients on developing a keen awareness of weaknesses and strengths so that they can achieve greater degrees of their potential. Though the work requires continual motivation and mindfulness, the results can be life changing.

ADD and You

Living within a judgmental and unsupportive environment can significantly impair the confidence and creative light of an individual with ADD, from age 7 to 70. If someone you care about is diagnosed with ADD, try to suspend your judgments of the condition and uncertainty with its treatments long enough for the person to learn that it is not a curse. This is particularly true for children, for if you allow your negative emotional reactions to lead your actions, you may trigger the exact stigma in the child that you wish to protect them from. Allow time for the professional opinions and steps laid out to unfold and give your child a chance at living more fully. Along with love and support, a continual exploration of strengths and weaknesses, and a diverse treatment toolbox, those with ADD can live happy, productive lives and realize amazing achievements.