Driven to Distraction: Recognizing and Coping with Attention Deficit Disorder

by Edward M. Hallowell

Plus I get distracted in the middle of a page and there’s no telling when I’ll come back.”

While psychological testing can be very helpful, it is not definitive. Children who have ADD can appear not to have it when psychologically tested. This is because the structure, novelty, and motivation associated with the testing procedure can effectively, for the moment, “treat” the child’s ADD. The child may be focused by the one-on-one structure of the testing, focused by the novelty of the situation, and be so motivated to “do well” that the motivation overides the ADD. For these reasons, the clinical data—the teachers’ reports, the parents’ reports, the evidence of human eyes and ears over time—must take precedence over the data garnered through psychological testing.

Most adults with ADD are struggling to express a part of themselves that often seems unraveled as they strive to join the thought behind unto the thought before.

In our experience (and in the experience of many others) we have seen a host of individuals, particularly women, who fit the clinical picture of ADD perfectly, by both sets of criteria, except that they do not have a history of hyperactivity. They do respond well to treatment with stimulant medication or other standard medications used for ADD. Their symptoms cannot be explained by any condition other than ADD, and they do not respond as well to any medical treatment other than the treatment for ADD. Therefore, we include this nonhyperactive group as meeting our diagnostic criteria for adult ADD.

These are a few of the areas in which mild ADD may interfere with an adult’s life: underachievement; reading one’s interpersonal world accurately; getting started on a creative project, or finishing it; staying with emotions long enough to work them out; getting organized; getting rid of perseverative, negative thinking; slowing down; finding the time to do what one has always wanted to do; or getting a handle on certain compulsive types of behavior.

In the medical community and the mental-health fields, knowledge of adult ADD is not widespread. As our awareness of the disorder increases, this will change. But for now, looking for help, as an adult, can be a frustrating and time-consuming process.

reading problem, which essentially involves starting to read a page, getting through about three lines with comprehension, then all of a sudden finding myself at the bottom of the page not recalling any of the words I just read.

I always feel as if describing how I feel and think about myself is too complicated; it’s as if I can hear the whole conversation in advance and I know all of the twists and turns it will take before they happen, so why bother? The effort just isn’t worth it.

“I always feel as if describing how I feel and think about myself is too complicated—it’s as if I can hear the whole conversation in advance, and I know all of the twists and turns it will take before they happen, so why bother? The effort just isn’t worth it.” It was not that he couldn’t think it through. He certainly could do that. It was bearing with the tension of explaining himself that so upset him. The tension of constructing an explanation, from A to B to C to D, apparently so simple a task, irritates many people with ADD. While they can hold the information in mind, they do not have the patience to sequentially put it out. That is too tedious. They would like to dump the information in a heap on the floor all at once and have it be comprehended instantly. Otherwise, as Douglas says, it’s just not worth the effort. It’s too boring.

‘my whole life is like that. I see something that I mean to do and then I don’t do it. It’s not only trivial things like the cough drop; it’s big things, too.’

Like novelty, lots of changing interests.

Have lots of ideas but have a hard time structuring things so they actually happen.

Often have a hard time finding the right word so impulsively say any word or just stay silent and feel stupid.

Have always felt that I think differently from most people.

Handwriting: sometimes I write things I don’t mean to; skip letters or form them wrong.

Lose what’s in my head very easily.

4. When it comes to paperwork, use the principle of O.H.I.O.: Only Handle It Once.

People in treatment for ADD usually still struggle with issues of organization, impulse control, and distractibility. But more difficult than that, 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.

However, we have seen many people in our practice, both men and women, who complain of either an inability to pay attention during sex well enough to enjoy it,

On the other hand, those who cannot pay attention often accuse themselves—or are accused by lovers—of being “frigid” or “undersexed” or involved with someone else. In fact, they may enjoy sex a great deal but simply have problems staying focused while making love, just as they have problems staying focused during any other activity.

Humor is a key to a happy life with ADD.

You don’t mean to do the things you do do, and you don’t do the things you mean to do.

These are the adults who drift off during conversations or in the midst of reading a page.

The “logical” anxiety is the anxiety that one would expect to feel if one were chronically forgetting obligations, daydreaming, speaking or acting impulsively, being late, not meeting deadlines—all the typical symptoms of ADD.

Living in such a state naturally leaves one feeling anxious: What have I forgotten? What will go wrong next? How can I keep track of all the balls I have in the air?

1. Something “startles” the brain. It may be a transition, like waking up, or going from one appointment to the next, or it may be the completion of a task, or the receiving of some piece of news. It may be, and usually is, trivial, but the “startle” requires some reorganization on the part of the brain. 2. A minipanic ensues. The mind doesn’t know where to look or what to do. It has been focused on one thing and is now being asked to change sets. This is very disorganizing. So the mind reaches out for something red-hot, something to focus on. Since worry is so “hot,” and therefore so organizing, the mind finds something to worry about. 3. Anxious rumination replaces panic. While anxious rumination is painful, it is at least organized. One can say over and over in one’s mind, thousands of times a day, “Will I get my taxes paid on time?” or “Does that look she gave me mean she is angry with me?” or “Did I pass the exam?” The panic induced by the “startle” is replaced by the focused ache of anxious rumination.

Sometimes the first symptom that brings a person with ADD to a psychiatrist is some form of mood disorder, particularly depression.

Underachieving all along, accused of being stupid or lazy or stubborn, finding the demands of everyday life extraordinarily difficult to keep up with, tuning out instead of tuning in, missing the mark time and again, living with an overflow of energy but an undersupply of self-esteem, the individual with ADD can feel that it is just not worth it to try anymore, that life is too hard, too much of a struggle, that perhaps it would be better if life were to end than go on.

It may be that ADD partakes of a common pathophysiology with biological depression (i.e., depression not caused by life events but by biology). That is to say ADD and biological depression may be physiologically, and genetically, related. Whatever goes wrong in depression, whatever the “patho” part of the physiology is, that part may also go wrong in ADD.

I don’t think I’ve ever really been happy. For as long as I can remember, there’s always been a sadness

It’s just that I’ve never felt good, about myself or about life or about the future. It’s all been an uphill battle. I guess I always thought that’s just what life was—one long series of disappointments interrupted by moments of hope.

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.”

The primary disorder—an inability to attend—can lead to the secondary problem of depression. Or the two—ADD and depression—may coexist, both arising independently from the same physiological abnormality.

When someone is alcoholic, is abusing cocaine, or is dependent upon marijuana, we often become so preoccupied with the problems the drug use creates that we fail to consider what purpose the drug must be serving for the user. ADD is one of the underlying causes of substance abuse that is particularly important to look for, because it can be treated.

So, too, for the dysphoria associated with ADD. It is a peculiar kind of feeling, the distractibility-within-self many ADD people feel. The feeling, unrecognized and untreated, often leads to substance abuse through attempts at self-medication.

Similarly, marijuana tends to quiet the noise inside, to help the individual, in the words of one of my patients, “chill out.” Unfortunately, this is also only a short-term effect, and the repeated use of marijuana as an antianxiety agent is associated with a decrease in motivation.

In order to rearrange life, in order to create, one must get comfortable with disarrangement for a while. One must be able to live with the unfamiliar without, to use Keats’s phrase, any “irritable searching after fact and reason.”

Second, one of the cardinal symptoms of ADD is impulsivity. What is creativity but impulsivity gone right? One does not plan to have a creative thought. Creative thoughts happen unscheduled. That is to say they are impulsive, the result of an impulse, not a planned course of action.

This is the ability to intensely focus or hyperfocus at times. As mentioned earlier, the term “attention deficit” is a misnomer. It is a matter of attention inconsistency. While it is true that the ADD mind wanders when not engaged, it is also the case that the ADD mind fastens on to its subject fiercely when it is engaged.

overspending. Just as lotteries have brought ease and convenience to gambling, so have credit cards made overspending insidiously easy. The overspender is often relieving some bland ennui with the excitement of a blitz through the shopping mall.

Chronic overspending

Individuals with a borderline personality disorder have a poorly defined inner sense of self.

The poorly defined inner self of the borderline can closely resemble the distracted, fragmented self of the person with ADD.

We have seen a number of cases in our practice, and have had reports from others, of patients diagnosed as borderline who in fact have ADD.

The results were dramatic. What Bonnie had perceived as depression was in retrospect “a state of aimless distractibility.” As the medication helped her focus, she began to develop goals. She enrolled in school, and is now a successful participant in a Ph.D. program in English. Her work with her therapist suddenly became productive, rather than frustratingly off target.

Family history. In your parents, grandparents, or extended family, is there any history of ADD or hyperactivity (not likely, since the diagnosis was not made frequently a generation ago, but if it was, it is highly significant)? Any history of related disorders such as depression, manic-depressive illness, alcoholism or other substance abuse, antisocial behavior, or dyslexia or other learning disabilities? If you are adopted, that itself is a significant finding, as ADD is much higher among the adopted than among the general population.

Were you slow to learn to read, to write? Did you have trouble with organization, promptness, impulsivity?

Was underachievement a pattern? Was performance inconsistent, erratic?

Interpersonal history. Have you experienced trouble staying connected, either in a conversation or

Have you had a tendency to be misunderstood interpersonally, your inattentiveness often being mistaken for indifference?