Driven to Distraction: Recognizing and Coping with Attention Deficit Disorder

by Edward M. Hallowell

The old moral model dies hard. It still lives on in the minds of certain groups and individuals. At the heart of the moral model beats the conviction that willpower controls all human emotion, learning, and behavior. Under this model, the cure for depression is to cheer up. The cure for anxiety is to suck it up. And the cure for ADD is to try harder. While trying harder helps just about everything, telling someone with ADD to try harder is no more helpful than telling someone who is nearsighted to squint harder. It missed the biological point.

The old moral model dies hard. It still lives on in the minds of certain groups and individuals. At the heart of the moral model beats the conviction that willpower controls all human emotion, learning, and behavior. Under this model, the cure for depression is to cheer up. The cure for anxiety is to suck it up. And the cure for ADD is to try harder. While trying harder helps just about everything, telling someone with ADD to try harder is no more helpful than telling someone who is nearsighted to squint harder. It missed the biological point.

ADD is more impairing than any syndrome in all mental health that is treated on an outpatient basis. More impairing than anxiety, more impairing than depression, more impairing than substance abuse. The “morbidity” of untreated ADD is profound. Twenty-five percent of the prison population has undiagnosed ADD. Most of the kids in the juvenile justice system have untreated ADD. Traffic accidents are eight times more common than in the general population. If you have ADD, you are 40 percent more likely to get divorced than if you don’t, and 30 percent more likely to be unemployed. Estimates run as high as 40 percent of the addicted population having ADD, and a significant proportion of the eating-disordered population. In other words, untreated, ADD can be a disaster.

ADD is more impairing than any syndrome in all mental health that is treated on an outpatient basis. More impairing than anxiety, more impairing than depression, more impairing than substance abuse. The “morbidity” of untreated ADD is profound. Twenty-five percent of the prison population has undiagnosed ADD. Most of the kids in the juvenile justice system have untreated ADD. Traffic accidents are eight times more common than in the general population. If you have ADD, you are 40 percent more likely to get divorced than if you don’t, and 30 percent more likely to be unemployed. Estimates run as high as 40 percent of the addicted population having ADD, and a significant proportion of the eating-disordered population. In other words, untreated, ADD can be a disaster.

Here again, the need for education is paramount; 90 percent of adults who have the condition don’t know it! If they did know it, they could transform their lives from lives of struggle, underachievement, and turmoil to lives of joy, fulfillment, and success. Regardless of whether the person is a child as young as five or an adult as old as eighty-five, the diagnosis of ADD can change a life dramaticall...

Here again, the need for education is paramount; 90 percent of adults who have the condition don’t know it! If they did know it, they could transform their lives from lives of struggle, underachievement, and turmoil to lives of joy, fulfillment, and success. Regardless of whether the person is a child as young as five or an adult as old as eighty-five, the diagnosis of ADD can change a life dramatically for the better. As impairing as ADD can be if untreated, it can be hugely gratifying to get it treated.

Due to repeated failures, misunderstandings, mislabelings, and all manner of other emotional mishaps, children with ADD usually develop problems with their self-image and self-esteem.

In many ways the most dangerous aspect of undiagnosed and untreated ADD is the assault to self-esteem that usually occurs. Whatever talents these people may have, they often never get to use them because they give up, feeling lost and stupid.

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.

For those children who do, in fact, have ADD, it is of great importance that the diagnosis be made as early as possible so as to minimize the damage to self-esteem that usually occurs when these children are misunderstood and labeled lazy or defiant or odd or bad. The life of a child, and his or her family, with undiagnosed ADD is a life full of unnecessary struggle, accusation, guilt, recrimination, underachievement, and sadness. The sooner the diagnosis can be made, the sooner this unnecessary pain can cease.

We all want our children to develop confidence, a solid sense of self-esteem that can sustain them over time. It is an invisible but decisive process, the weaving of self-esteem, drawing in threads of experience every day, threads that will last a lifetime. If those threads are made of humiliation, failure, and embarrassment, then the cloth will not be worn with much comfort. We should do everything we can to see to it that the threads are made of success, confidence, and a sense of the fairness of things.

You might describe many with ADD as having a “special something,” a hard-to-pin-down yet undeniable potential. If that potential can be tapped, the results can be spectacular.

Primary symptoms are the symptoms of the syndrome itself: distractibility, impulsivity, restlessness, and so forth. The secondary symptoms, and the ones that are most difficult to treat, are the symptoms that develop in the wake of the primary syndrome not being recognized: low self-esteem, depression, boredom and frustration with school, fear of learning new things, impaired peer relations, sometimes drug or alcohol abuse, stealing, or even violent behavior due to mounting frustration.

People with ADD often do not pick up on the subtle social cues and messages that are crucial in getting along with others. They may appear to be blasé or indifferent or self-centered or even hostile when they are simply confused or unaware of what is going on around them.

The themes of ADD run throughout: inconsistency, and inconsistency again, creativity, provocative behavior, winning personality, varying motivation, exasperating forgetfulness, disorganization and indifference, underachievement, impulsivity, and the search for excitement rather than discipline.

The often extraordinary ability to hyperfocus is also usually present, emphasizing the fact that this is a syndrome not of attention deficit but of attention inconsistency.

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.

Taking stock of oneself in terms of attention and cognitive style is not the aim of most adult introspection. We are more geared to think in terms of who likes whom, or who dislikes who else, or why did our families do this or that, or how can we deal with this fear or that. We analyze ourselves through stories and we quickly jump into the plot. We think of this person or that and we have bits of conversation and we move ourselves along in the scene, from one scene to the next, often quite painfully, but usually as part of a story with a plot. But ADD precedes the plot. It adjusts the lighting and sets the stage. If the lighting is too low or significant props are missing from the stage, the story cannot be fully comprehended. Before getting the story going, before developing the plot lines of one’s ongoing narrative of introspection, it is worthwhile to have a lighting specialist and a propman check the stage out.

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. They often feel on the brink of disaster, as if they were juggling a few more balls than they’re able to. Their inner world begs for reassurance, for signposts and guidelines.

The sense of growing panic, the feeling that gibberish is being passed off as coherent conversation, the fear that the world is engaged in meaningless discourse masquerading as meaningful exchange—these are the blurry states individuals with ADD negotiate each day.

Adults with ADD are so used to being criticized that they are often unnecessarily defensive in putting their own case forward.

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.

Avoid the pattern of mess maker and cleaner-upper. You don’t want the non-ADD partner to “enable” the ADD partner by cleaning up all the time, in the manner that the nonalcoholic spouse may “enable” the alcoholic spouse by covering up all the time. Rather, set up strategies to break this pattern.

In general, watch out for the dynamics of control, dominance, and submission that lurk in the background of most relationships, let alone relationships where ADD is involved. Try to get as clear on this as possible, so that you can work toward cooperation rather than competitive struggle.

Break the tapes of negativity. Many people who have ADD have long ago taken on a resigned attitude of “There’s no hope for me.” The same can happen to both partners in the couple. As will be mentioned in many places throughout this book, negative thinking is a most corrosive force in the treatment of ADD. What I call the “tapes of negativity” can play relentlessly, unforgivingly, endlessly in the mind of the person with ADD. It is as if they click on as the sun rises and click off only when the unconsciousness of sleep shuts them down. They play, over and over, grinding noises of “You can’t”; “You’re bad”; “You’re dumb”; “It won’t work out”; “Look how far behind you are”; “You’re just a born loser.” The tapes can be playing in the midst of a business deal, in the reverie of a car ride home, or they can take the place of making love. It is hard to be romantic when you are full of negative thoughts. The thoughts seduce you, like a satanic mistress, into “loving” them instead. These tapes are very difficult to break, but with conscious and sustained effort, they can be erased.

Use praise freely. Encouragement, too. Begin to play positive tapes. Find something positive to say about your mate or about yourself every day. Build each other up consciously, deliberately. Even if it feels hokey at firs...

Learn about mood management. Anticipation is a great way to help anyone deal with the highs and lows that come along. This is especially true in ADD. If you know in advance that when you say “Good morning, honey!” the response you get might be “Get off my back, will you!” then it is easier to deal with that response without getting a divorce. And if the other member of the couple has learned something about his or her moods, the response to “Good mor...

the job the other person does instead of you must then be adequately appreciated, noticed, and reciprocated.

Make time for each other. If the only way you can do this is by scheduling it, then schedule it. This is imperative. Many people with ADD slip away like quicksilver; now you have them, now you don’t. Clear communication, the expression of affection, the taking up of problems, playing together and having fun—all these ingredients of a good relationship cannot occur unless you spend time together.

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 immeasura...

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

The child with ADD chronically fails to meet obligations, do chores, stay up with schoolwork, keep to family schedules—get out of bed on time, arrive home on time, show up for meals on time, be ready to leave the house on time—keep his or her room tidied up, participate in family life cooperatively, and in general “get with the program” at home. This leads to chronic limit-setting by parents, with increasingly stringent penalties and increasingly tight limitations on the child. This, in turn, makes the child more defiant, less cooperative, and more alienated, which leads parents to feel more exasperated with what increasingly appears to be an attitude problem, under voluntary control, rather than the neurological problem of ADD.

As parents become more and more fed up with the child’s behavior, they become less and less sympathetic to whatever excuses or explanations the child may offer, less and less willing to believe in promises to do better, and more and more apt to apply stricter and stricter consequences in a usually futile effort to control the child’s behavior. Gradually, the child’s role in the family solidifies around being the “problem child,” and he or she becomes the designated scapegoat for all the family’s conflicts and problems. An old saying about scapegoating is that the process requires a mob and a volunteer. In the case of the Big Struggle the family forms the mob, and the ADD behavior volunteers the child. Virtually anything that goes wrong in the family gets blamed on the ADD child. Over time the child is draped with a kind of blanket of derision and scorn that smothers his development of confidence and self-esteem.

The Big Struggle may last for years. It may resemble a war, with seasonal campaigns along various fronts—the homework front or the attitude front or the chores front or the cooperation-and-responsibility front, or all of these at once—attacks and counterattacks, the use of spies and special weapons, temporary negotiated settlements, momentary surrenders, occasional desertions, betrayals, treaties, and victories and defeats for both sides a...

In the Big Struggle, parents feel they are doing their duty, that they are doing all they can to straighten their child out, that if they didn’t join in the Big Struggle the child would simply goof off interminably. And the child feels he is fighting for his independence, that he is resisting becoming an automaton. Or worse, the child doesn’t really know what is going on. He is simply reacting. Punch, counterpunch, you attack, I counterattack. The reason for the war is long forgotten as the battles go on and on, taking on a life of their own. After a while neither side quite remembers what is being fought for as resentments build, grudges encrust, and the family slugs it out one season into the next.

Unfortunately, what often happens in families is that the ADD so threatens the parents’ sense of control that one parent or the other—or both—overreacts to the threat by trying to control every last detail. This person insists on dictating how everything should be done, as well as when, where, and why. As appealing as enlightened monarchies may be in the abstract, in families torn by ADD they rarely work well. This is for several reasons. First, monarchs are usually not as enlightened as they think they are. Second, members of the family understandably resent constantly being told what to do. And third, such a controlling hand serves to raise, rather than reduce, tension and conflict within the family.

Negotiation, of course, is at times impossible. And with younger children it is often not desirable. Younger children with ADD especially need structure and limits. They want them, and they will test parents until they get them. With a younger child it makes more sense to say, “We’re going to McDonald’s,” than to say, “Which of the five fast-food restaurants in this area would you like to go to tonight?” A younger child gets caught up in the stimulation of making such a vast decision. He or she gets preoccupied with all the options and excited by all the possibilities, and could take an hour or two to decide where to have dinner. It is best in these moments to use one’s common sense and intervene decisively. “We are going to McDonald’s,” may be met with protests, but it is also met with an inner, unspoken sense of relief.

the process of negotiation is inherently difficult for someone with ADD because it entails bearing frustration. This is difficult for all people. But it is particularly difficult for the person with ADD who would rather deal with frustration by blowing it off, or by reaching closure too quickly—even if that means sabotaging his own interests—than by the excruciatingly painful ordeal of bearing with it.

“People: Separate the people from the problem.”* The idea here is to get people’s ego and pride disentangled from whatever the problem is so that the problem can be attacked without fear of attacking any person in the process. If the person is attached to the problem, the person may never change his mind, no matter how reasonable the solution, because he doesn’t want to lose face.

“Interests: Focus on interests, not positions.” This is what separates negotiation from debating. A debating team defends—or attacks—a certain position, no matter what. It is its sole interest to do that. Like an infantry, its position is its interest. Negotiation should never become debating (or trench warfare). In negotiation people have many interests, and it is the interests, not some debating position, that need to be satisfied. Indeed, one’s position may sometimes go against one’s interests and one does not want to be so identified with one’s position that one cannot change it. This is particularly true with adolescents, who can back themselves into a corner during an argument so that they end up, out of pride, defending a position they really don’t want at all.

“Options: Generate a variety of possibilities before deciding what to do.” This is particularly important in ADD families, because it is the tendency of the person with the ADD to bring premature closure to the discussion just to avoid bearing the tension of the discussion itself. Don’t feel everything has to be wrapped up in one meeting. Get the problem out and then let everybody take a few days to think about it, to come up with various options and solutions. It is muc...

“Criteria: Insist the result be based on some objective standard.” This allows the members of the negotiation to appeal to some standard other than their own will or opinion. Examples of objective standards that might be useful in family negotiations would be: What do other families in this area do about this problem? What does the school recommend? What would the open market pay for this service or item? What is the relevant medical information regarding the safety of this activity? What sort of practice schedule does t...

In principled negotiation, as described by Fisher and Ury, the idea is neither to be soft nor hard but to negotiate on the merits, on the principles and issues, always looking for ways of finding mutual gain, and where interests conflict, reconciling them on the basis of some fair standard rather than strength of will or power.

Try to change the family “reputation” of the person with ADD. Reputations within families, like reputations within towns or organizations, keep a person in one set or mold. Recasting within the family the reputation of the person with ADD can set up brighter expectations. If you are expected to screw up, you probably will; if you are expected to succeed, you just might. It may be hard to believe at first, but having ADD can be more a gift than a curse. Try to see and develop the positive aspects of the person with ADD, and try to change his family reputation to accentuate these positive aspects. Remember, this person usually brings a special something to the family—special energies, special creativity, special humor. He (or she) usually livens up any gathering he attends, and even when he is disruptive, it’s usually exciting to have him around. He punctures bombast and does not tolerate fools. He is irreverent and not afraid to speak his mind. He has a lot to give, and the family, more than any group of people, can help him reach his potential.

Make it clear that ADD is nobody’s fault. It is not Mom’s or Dad’s fault. It is not brother’s or sister’s fault. It is not Grandmother’s fault, and it is not the fault of the person who has ADD. It is nobody’s fault. It is extremely important that this be understood and believed by all members of the family. Lingering feelings that ADD is just an excuse for irresponsible behavior or that ADD is caused by laziness will sabotage treatment.

Also make it clear that ADD is a family issue. Unlike some medical problems, ADD touches upon everybody in the family in a daily, significant way. It affects early-morning behavior, it affects dinner-table behavior, it affects vacations, and it affects quiet time. Let each member of the family become a part ...

To avoid the family gridlock of the Big Struggle, or to avoid an ongoing war, it is wise to get into the habit of negotiation. This can take a lot of work, but over time negotiated settlements can usually be reached. The terms of any settlement should be made explicit; at best they should be put into writing so they can be referred to as needed. They should include concrete agreements by all parties as to what is promised, with contingency plans for meeting and not meeting the goals. Let the war end with a negotiated peace.

If you sense the Big Struggle is beginning, try to disengage from it. Try to back away. Once it has begun, it is very hard to get out of. The best way to stop it, on a day-to-day basis, is not to join it in the first place. Beware of the struggle’s becoming an irresistible force.

Try to break the negative process and turn it into a positive one. Applaud and encourage success when it happens. Try to get everyone pointed toward positive goals, rather than gloomily assuming the inevitability of negative outcomes. One of the most difficult tasks a family faces in dealing with ADD is getting onto a positive track. However, once this is done, the results can be fantastic. Use

Make it clear who has responsibility for what within the family. Everybody needs to know what is expected of him or her. Everybody needs to know what the rules are and what the consequences are.