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March 15 - March 19, 2024
Of the people who consult with me for problems related to ADD, probably about a half are either late for their first appointment or miss it altogether. I have come to expect it. It comes with the territory. My patients, however, usually feel very bad about it and so begin the session thinking that I am going to reprimand them in some way.
“It’s part of the impulsivity. If you think of ADD as a basic problem with inhibition, it helps explain how ADD people get angry quicker. They don’t inhibit their impulses as well as other people. They lack the little pause between impulse and action that allows most people to be able to stop and think. Treatment helps with that but it doesn’t cure it completely.”
in case anyone hasn’t told you, the best way to fall out of love with something is to write a Ph.D. thesis about it.
there is more to the treatment for ADD than just medication. Education, behavioral modification, and psychotherapy all can help.
People with ADD do look out windows. They do not stay on track. They stray. But they also see new things
or find new ways to see old things. They are not just the tuned-out of this world; they are also tuned in, often to the fresh and the new. They are often the inventors and the innovators, the movers and the doers. Good Do-Bees they may not always be, but we should be wise enough not to force them into a mold they’ll never fit.
It is important to dispel any notion that ADD is someone’s fault. While inadequate parenting can exacerbate the situation,
it does not cause it. We don’t know for sure what causes it—as stated earlier, our best evidence says it’s genetic—but we do know it is not the result of bad mothering or fathering.
When a child is obviously bright and gets good grades, one often fails to consider ADD as a possibility. This is a mistake. Many very bright children have ADD. Missing the diagnosis in these bright children can lead them to use their intelligence and creativity in the service of gett...
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the child becomes the scapegoat for everything that’s wrong in the family. This same process can happen in the classroom. Two or three children with undiagnosed ADD can turn a happy classroom into a war zone and a kind and competent teacher into a burned-out
out wreck. ADD is almost never a one-person problem. It affects whole classrooms and entire families.
The prevalence of ADD is higher among foster children and adopted children than it is among the general population.
As is so often the case, once one diagnosis is made, it is terribly difficult for those who made it to revise that diagnosis.
While we all need external structure in our lives—some degree of predictability, routine, organization—those with ADD need it much more than most people. They need external structure so much because they so lack internal structure. They carry with them a frightening sense that their world might cave in at any moment.
the ADD therapist must offer concrete suggestions concerning ways of getting organized, staying focused, making plans, keeping to schedules, prioritizing tasks to be done, and, in general, dealing with the chaos of everyday life. The therapist should not do this for the patient, but with the patient, so that the patient can learn to do it for himself.
A complete list of these tips is included in chapter 8, but I will mention here some that particularly helped Sarah:
List of recommendation s
most people who have adult ADD aren’t floundering. Many successful people have it. It is particularly common among creative people—artists, actors, writers—scientists, people in high-energy or high-risk jobs, and people who work on their own.
you have the kind that especially affects mood. You organize around a bad mood and you don’t let go. You hold on to it for dear life. You don’t dare give it up for fear that chaos will replace it.”
“I organize around a bad mood. Interesting idea. Say more.”
If you can ignore the content of the ruminations, hard as that may be to do, and look instead at the process of ruminating, it may become easier
to wriggle free of the trap. Instead of engaging in the argument, instead of answering back to the preacher in the pulpit, you need to ignore him. And the only way you can do that is by leaving his church. Go for a run. Call someone on the telephone.
they struggle with the secondary symptoms that years of living with undiagnosed ADD created. These are symptoms such as impaired self-image, low self-esteem, depression, fearfulness of others, mistrust of self, skittishness in relationships, and anger over the past. These wounds heal very slowly.
The average duration of treatment for adult ADD is about three to six months.
There are many conditions that look like ADD, from too much coffee to anxiety states to dissociative disorders to hyperthyroidism. Before embarking on a treatment for ADD, consult with your physician to make sure what you have is really ADD and not something else.
The first step in the treatment of ADD—whether it be your partner’s or someone else’s—is education.
11. Put notepads in strategic places like by your bed, in your car, in the bathroom and kitchen.
People with ADD frequently need a certain amount of “down time” every day to recharge their batteries. It is better that this time be negotiated and set aside in advance rather than struggled over each time it comes up.
25. Don’t use ADD as an excuse. Each member of the couple has to take responsibility for his or her actions. On the other hand, while one mustn’t use ADD as an excuse, knowledge of the syndrome can add immeasurably to the understanding one brings to the relationship.
As children grow older, negotiation becomes more important in all families. Negotiation is key to managing
any family’s or any group’s behavior. But getting on the track to negotiation in a family with ADD is very difficult. Don’t get discouraged if you keep falling back into a struggle as you try to negotiate.
25. Keep up hope. Hope is a cornerstone in the treatment of ADD. Have someone in mind whom you can call who will hear the bad news but also be able to pick up your spirits. Always bear in mind the positive aspects of ADD—energy, creativity, intuition, good-heartedness—and also bear in mind that many, many people with ADD do very well in life.
Families in general have tremendous power both to heal and to inflict pain. If the family is willing to cast a new eye upon a chronically wounded member, if the family is willing to help heal him, it can be more effective than all the medications, therapies, and incantations ever devised.
As the person with ADD seeks to change, he is also asking his family to change with him.
Getting to Yes: Negotiating Agreement Without Giving
Book to read about negotiation.
We do not yet have one concise definition for ADD. Instead, we have to rely on descriptions of symptoms to define ADD.
formal diagnostic nomenclature recognizes only two subtypes of ADD: ADD with hyperactivity and ADD without hyperactivity. ADD in children and ADD in adults constitutes another broad classification.
Perhaps due to the manner in which the ADD gene is expressed, or due to the absence of the Y chromosome, girls seem to have ADD without hyperactivity more often than boys do. It can occur in both sexes, but it is more common in girls or women.
Sometimes the first symptom that brings a person with ADD to a psychiatrist is some form of mood disorder, particularly depression.
Samuel Johnson, a man for whom there is ample evidence of having ADD and depression. Johnson observed that “life is a process not from pleasure to pleasure, but from hope to hope.” Elsewhere he wrote, “Life is a state everywhere in which there is much to be endured and little to be enjoyed.” He also said that “we live in a world that is bursting with sin and sorrow.”
And he exhibited symptoms of Tourette's syndrome.
persistent sadness, or lack of pleasure, often accompanies ADD. Sometimes, when the ADD is treated, the sadness lifts.
The pain of a learning disorder resides not only in the strain one feels in trying to function but in the disconnections one can suffer, a disconnection from language and from thought, from expression and creativity, from books and from words, as well as from people and from feelings.
Too often, practitioners in the field of learning problems and ADD confuse rather than clarify through their use of arcane terms or references. One should be able to gain access to the important information in this field without the use of a translator’s dictionary.
The most common learning disorder, and the one about which we know the most, is dyslexia. Its prevalence in this country, depending on how it is defined, is from 10 to 30 percent.
According to the work of Albert Galaburda at Harvard, the brains of dyslexics appear to be different from normal brains in that they have aberrant nodules on the cerebral cortex.
A streak of Puritanism runs deep within American society. Permissive and pioneering as we may be on the one hand, we are strict and conservative on the
other. As much as we may be a country of mavericks and entrepreneurs, we are also a country of finger waggers and name callers. As much as we may be a country of compassion for the underdog, we are also a country that believes in self-reliance.
In my work with adults with ADD I hear many stories of school days gone wrong. People tell these stories much in the same manner as victims of trauma.
the self-medication hypothesis advanced by Edward Khantzian, a psychoanalyst as well as a specialist in the field of substance abuse. He proposes the idea that people use drugs to treat some underlying bad feeling.
one of the cardinal symptoms of ADD is impulsivity. What is creativity but impulsivity gone right?
the term “attention deficit” is a misnomer. It is a matter of attention inconsistency.
