Driven to Distraction: Recognizing and Coping with Attention Deficit Disorder

by Edward M. Hallowell

As a parent, avoid the pernicious pattern of loving the child one day and hating him the next. One day he exasperates you and you punish him and reject him. The next day he delights you and you praise him and love him. It is true of all children, but particularly true of those with ADD, that they can be little demons one day and jewels of enchantment the next. Try to keep on an even keel in response to these wide fluctuations. If you fluctuate as much as the child, the family system becomes very turbulent and unpredictable.

Make time for you and your spouse to confer with each other. Try to present a united front. The less you can be manipulated the better. Con...

Try to target problem areas. Typical problem areas include study time, morning time, bedtime, dinnertime, times of transition (leaving the house and the like), and vacations. Once the problem area has been explicitly identified, everyone can approach it more constructively. Negotiate with each other as to how to make it better. Ask each other for specific suggestions.

Have family brainstorming sessions. When a crisis is not occurring, talk to each other about how a problem area might be dealt with. Be willing to try anything once to see if it works. Approach problems as a team with a positive, can-do attitude.

Pay attention to boundaries and overcontrol within the family. People with ADD often step over boundaries without meaning to. It is important that each member of the family know and feel that he or she is an individual, and not always subject to the collective will of the family. In addition, the presence of ADD in the family can so threaten parents’ sense of control that one or another parent becomes a little tyrant, fanatically insisting on control over all things all the time. Such a hypercontrolling attitude raises the tension level within the family and makes everybody want to rebel. It also makes it difficult for family members to develop the sense of independence they need to have to function effectively outside the family.

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. However, if the family is unwilling to look differently upon its George, if the family instead sneers and snorts, “Just another one of your lame excuses! Why don’t you just shape up?” then the family can undermine whatever good treatment he may receive. Few of us ever outgrow the power of our families both to deflate us and to fill us up. Few of us ever get past the wish for love and approval from mother or father, sibling or kin. That wish can be used in our favor, to support us as the wish is granted, or it can be used in our destruction as the wish is perpetually denied.

For the family to use its considerable power to heal, it must be willing to accept the challenge of change. All groups, most especially families, feel threatened by a change in the status quo, no matter how bad the status quo may be. As the person with ADD seeks to change, he is also asking his family to change with him. This is never easy. It is not the troubled family that has a hard time with change; it is all families. But with education and information as guides, with encouragement and support as reinforcers, most families can successfully adapt. As there is less suffering in the family system, life at home can even be fun.

When we focus in on one part of the syndrome, we are at risk of overlooking another, quite different part. For example, if we focus in on inattentiveness, we can overlook the fact that most people with ADD can hyperfocus at times. Or if we focus in on hyperactivity, we can overlook the many people with ADD who are quiet and daydreamy. It is difficult to step back and see that all of these aspects are part of a greater whole.

But the evidence now shows that there are hosts of children and adults who have all the other symptoms of ADD but who are not hyperactive, or even overactive. If anything, they are motorically slow, even languid. These are the daydreamers. These are the kids—often girls—who sit in the back of the class and twirl their hair through their fingers while staring out the window and thinking long, long thoughts. These are the adults who drift off during conversations or in the midst of reading a page. These are the people, often highly imaginative, who are building stairways to heaven in the midst of conversations, or writing plays in their minds while not finishing their day’s work, or nodding agreeably and politely while not hearing what is being said at all. They steal away silently, without the noisemaking of their hyperactive brethren, but they steal away just the same.

It can be downright disabling not to be able to rely on your own mind to remember things, to prompt you to get to places on time, to keep you involved in a conversation when you want to be, or focused on a page you really do want to read, or concentrated on a project you need to complete. The meandering brook, in its desultory way, seems to be forever carrying you away from where you want to be.

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?

The person with “anxious ADD” often starts the day, or any moment of repose, by rapidly scanning his or her mental horizon in search of something to worry about. Once a subject of worry has been located, the individual locks in on it like a heat-sensing rocket and doesn’t let go. No matter how trivial the subject or how painful the worry, the individual keeps the worry alive, returning to it magnetically, obsessively.

They are actually using worry as a means of organizing their thinking. Better to have the pain of worry, they seem to feel, than to have the disquietude of chaos.

The whole point of the sequence is to avoid chaos. No one likes chaos, but most people can endure milliseconds, or even seconds, of it as they go from one task to another, one state to another, one stimulus to another. The ADD mind often cannot. Instead, it fixates on worry and gets organized—or stuck—around it.

Since childhood, the person with ADD has felt a sense of chronic frustration and failure. 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 is heartening how valiantly people with undiagnosed ADD try in the face of their despair. They don’t give up. They keep pushing. Even when they’ve been knocked down many times before, they stand up to get knocked down again. It is hard to keep them down for good. They tend not to feel sorry for themselves. Rather, they tend to get mad, to get up, to have at it again. In this sense one might say they are stubborn: they just don’t give up. But they may remain depressed.

Her sense of chronic disappointment was as much a function of her inability to perceive order or stability in her world as it was of actual failures.

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.

While the child with dyslexia or ADD may stammer, stumble, and reverse, while he may disconnect from the word or the page or the person, he may also soar. He may connect in new and unexpected ways. He may, in his stumbling, stumble onto something new and wonderful. It is therefore vital that we keep the windows of these children’s minds clean, that we keep them free of the smudge and grease of shame, criticism, defeatism, and devaluation.

The primary symptoms of ADD—erratic attention span, impulsivity, and restlessness—can make reading difficult, and therefore can mimic dyslexia. However, the two are separate disorders. The distinction is of practical significance because the treatments for the two conditions are different.

Auditory processing problems also occur frequently with ADD. As the term suggests, an auditory processing problem interferes with the brain’s ability to comprehend fully what it “hears.” The child or adult with this problem has no hearing deficiency; sound enters the brain without problems. However, once the sound gets into the brain, the cerebral cortex has trouble processing it or fully making sense of it.

Or a child may have trouble socially because he or she does not process properly what is being said. The same problems can affect an adult, both at work and socially. We do not yet appreciate how profoundly auditory processing problems interfere with learning and interacting with others. Particularly in individuals who also have ADD, auditory processing problems can greatly interfere with everyday life.

It is struggle enough to have a learning disorder, but to have that struggle compounded by a string of invidious labels—stupid, lazy, and the like—puts one’s whole self-esteem in jeopardy. The experience of moral condemnation is so frequent among the learning disordered as to be commonplace. Indeed, it is only recently that anything like an informed, compassionate view has developed. Still, one hears snide jokes all the time in reference to this population: they are “intellectually challenged,” or they are just looking for an excuse to get better grades in school or file a discrimination grievance at work. It is worth mentioning here the moral bias in our society that often prevents the diagnosis of ADD—and other learning disorders—from being made. 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. This is apparent in the field of learning disorders. In our educational system, despite reform, the operative principle is still sink or swim. School is a fair marketplace, we seem to believe. The smart will excel. If you don’t excel, well, then you are not smart. Pretty words to the contrary, most students, parents, and teachers still see...

Think for a moment of the importance of the innocent curiosity a child brings to school. Think of the little tendrils of knowledge and of self-esteem embedded in that curiosity. If nourished, those tendrils will grow, over the many years the child will spend in school, college, and beyond, into a solid store of knowledge, a feeling of confidence around learning new ideas, and a buoyant sense of self. Think of the look on the face of a three-year-old as she tries to blow bubbles, or the face of a four-year-old trying to make a house of cards, or a five-year-old balancing on his first bicycle. Think of the look of concentration on that face and think of how important it is to the child to get it right. Remember in your own life, when you were a child, the feeling of excitement and danger as you tried something new. Remember how the one thing you feared more than anything else was not failure but being made fun of, being humiliated. Think of the faces of children everywhere as they open their minds to learn. Keep those faces in mind, the little girls and boys in the early grades, all trusting the adults to show them the way, all eager and excited about life and what will come next, and then just follow those faces over time. Follow the face of a little girl who doesn’t read very well and is told to try harder; who tends to daydream and is told she better pay attention; who talks out in class when she sees something fascinating, like a butterfly on the windowpane, and is told ...

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. There is a numb period when I hear all the facts. Not much emotion, just a long narrative of what it was like to be in school. Gradually, as I empathize with what it must have been like for them, the emotion begins to emerge: the hurt, the anger, the disappointment, the fear. “You just don’t know how much I hated going to school,” Franny, a woman in her thirties, said to me. “It was all a blur. My main idea was just to get through the day without getting hurt. I always said ‘I don’t know’ rather than risk giving a wrong answer. I actually loved to read and to make up stories, but all the teachers saw was the slow reader, the late papers, the messy handwriting, the bad spelling. One teacher actually said to me, ‘Your handwriting looks like a moron’s.’ She wasn’t even a mean teacher. She just thought she was motivating me to try harder. But a ten-year-old doesn’t hear things that way. I began to think I was a kind of moron: one that liked to read and make up stories, but could never do anything with them because she couldn’t write o...

the person who has ADD with a high degree of agitation may be incorrectly diagnosed as having manic-depressive illness. This has practical significance in that the drug most commonly used to treat mania, lithium, usually does not help ADD. Indeed, it may make ADD worse. Therefore, it is important to consider ADD as a possible diagnosis in the agitated individual thought to be manic but who is nonresponsive to lithium. That person may have ADD and may get better when treated with one of the medications used for ADD.

Many people who have undiagnosed ADD feel bad and don’t know why. Some feel depressed, as we have mentioned above. Some feel agitated or anxious. Many more feel distracted and unfocused, living in a sort of disjointed limbo, waiting to come in for a landing. This feeling of unease or what psychiatrists call “dysphoria,” doesn’t have a context or even a name. It’s just life, in the minds of the people who feel it. You can live with something all your life but not be aware of it in its own right; it is simply a part of you. So it is with many of our feelings. Until we name them, they are entwined in our sense of self. Naming the feelings gives us some leverage over them. Being able to say “I am sad” can make the sadness less disabling. Once we recognize a feeling, we can attempt to control or change it. On the other hand, people who cannot say “I am sad” or “I am angry” are often directed or overpowered by these emotions in ways they are quite oblivious to.

Cocaine is in the class of drugs we call stimulants. Ritalin, one of the standard prescription medications for the treatment of ADD, is also a stimulant. Most people feel a rush of unfocused energy when they take cocaine. However, people with ADD feel focused when they use cocaine, just as they do when they take Ritalin. Rather than getting high, they suddenly feel clearheaded and able to pay attention. When those who don’t know they have ADD stumble upon cocaine, the drug seems like a cure in that it temporarily alleviates their ADD symptoms, and so they become chronic users. Interestingly enough, in the literature about cocaine, approximately 15 percent of addicts report feeling focused by the cocaine, rather than feeling high. This 15 percent probably have adult ADD and are self-medicating, albeit unwittingly, with cocaine.

By treating the ADD one reduces the likelihood that the individual will go back to abusing the original drug.

When someone with ADD receives a stimulus of some sort—an image, a sentence, an idea, a person’s face, a question—he does not immediately put it in its “proper” place. He doesn’t even know where that place is. So, for example, the water bill gets filed with concerns over a fishing trip, and the next thing you know an idea is being generated that has to do with entrepreneurial fishing expeditions. The very uncertainty with which people with ADD react to most stimuli allows for these messages to metamorphose before they solidify in the mind. This tendency to get confused or to confuse things—so often regarded as a chief bedevilment of the ADD brain—can enhance creativity most advantageously.

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. One can set up conditions that maximize the chances of a creative moment occurring, chance favoring the prepared mind, but the actual idea, or phrase, or image comes, as it were, out of nowhere. Nowhere is where many ADD people live all the time. Neither here nor there nor anywhere in particular, but rather here and there, not in any one place, but all over the place, nowhere precisely. And it is out of nowhere, on the wings of impulse, that creativity flies in.

A third element that favors creativity among people with ADD is an often-overlooked capacity they have. 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. A child with ADD may sit for hours meticulously putting together a model airplane. An adult may work with amazing concentration when faced with a deadline. Or an adult with ADD may become obsessed with a project and complete it in a tenth of the time one would have predicted. This ability to hyperfocus heats up the furnace in the brain, so to speak, and melts down rigid elements so they may easily flow and commi...

A fourth element contributing to creativity is what Russell Barkley has called the “hyperreactivity” of the ADD mind. Cousin to the traditional symptom of hyperactivity, hyperreactivity is more common among people with ADD than hyperactivity is. People with ADD are always reacting. Even when they look calm and sedate, they are usually churning inside, taking this piece of data and moving it there, pushing this thought through their emotional network, putting that idea on the fire to burn, exploding or subsiding, but always in motion. Such hyperreactivity enhances creativity because ...

The trick for the person with ADD is to harness these processes productively. Some people spend a lifetime trying. They burst with creative energy but like a live wire without a socket to plug into, they dispel their energy unchanneled. The child may dissipate his or her creativity just in making wise remarks in class, or ...

He’s always on the brink of getting fired or of being promoted.

More difficult to distinguish are those conditions that develop out of ADD, organically, like a limb. These are the personality styles that people with ADD may evolve. They can look like what psychiatry calls personality disorders. For example, consider the passive-aggressive personality. This is the person who cannot express aggression directly. Instead, he expresses it passively, through nonaction or nonresponse. Instead of telling his boss he disagrees with him, he skips his appointment with him. Instead of telling his wife he is angry with her, he buries his head behind the newspaper. Instead of competing for the job he wants, he “forgets” to send in the application on time. Traditionally, we understand the passive-aggressive style in psychodynamic terms and try to help the patient work out, through psychotherapy, whatever fears he may have of directly expressing aggressive feelings. However, forgetting, being late, finding it difficult to tune in to conversations—these are what ADD is all about. What gets labeled “passive-aggressive” may be caused by a case of ADD.

Three of the best treatments for ADD are one-to-one tutoring, high motivation, and novelty. People with ADD typically can focus in a one-to-one setting while they become distractible in a group setting such as a classroom, the workplace, or a party. Also in settings where the individual is highly motivated, the symptoms of ADD often disappear. And novel settings—unusual or new places—can stimulate the person with ADD to such a degree that their attention becomes focused.

Most people who discover they have ADD, whether children or adults, have suffered a great deal of pain. The emotional experience of ADD is filled with embarrassment, humiliation, and self-castigation. By the time the diagnosis is made, many people with ADD have lost confidence in themselves. Many have been misunderstood repeatedly. Many have consulted with numerous specialists, only to find no real help. As a result, many have lost hope. Individuals with ADD may have forgotten what is good about themselves. They may have lost any sense of the possibility of things working out. They are often locked into a kind of tenacious holding pattern, needing all their considerable resiliency and ingenuity just to keep their heads above water. And yet their capacity to hope and to dream is immense. More than most people, individuals with ADD have visionary imaginations. They think big thoughts and dream big dreams. They can take the smallest opportunity and imagine turning it into a major break. They can take a chance encounter and turn it into a grand evening out. But like most dreamers, they go limp when the dream collapses. Usually, by the time an individual seeks help, this collapse has happened often enough to leave them wary of hoping again.

Structure is central in the treatment of ADD. The word “structure” is a homely one, perhaps conjuring up dull images of blueprints or two-by-fours. However, structure can dazzle with its results. Structure makes possible the expression of talent. Without structure, no matter how much talent there may be, there is only chaos.

Whether it be the iambic pentameter of Shakespeare or the rhymed couplets of Pope or the rhythm of the long-distance runner or the timing of the short-order cook, all creative expression requires structure. Many adults with ADD have not fulfilled their considerable creative potential because they have been unable to shape and direct their creative energies.

Structure refers to essential tools like lists, reminders, notepads, appointment books, filing systems, Rolodexes, bulletin boards, schedules, receipts, IN- and OUT-boxes, answering machines, computer systems, alarm clocks, and alarm watches. Structure refers to the set of external controls that one sets up to compensate for unreliable internal controls. Most people with ADD cannot depend upon their internal controls to keep things organized and to keep themselves on task over time. For them a reliable system of external controls is essential. Setting up a system does not have to be boring; in fact, one can be quite creative in devising a workable structure. And once in place, the system will be calming and confidence-building.

Traditional psychotherapy is sometimes indicated for people with ADD because of the problems with self-esteem, anxiety, and depression that build up in the wake of ADD. While the primary problem of ADD is best treated with structure, medication, and coaching, the secondary psychological problems often require ongoing psychotherapy. It is a mistake to treat the primary problems of attention, distractibility, impulsivity, and restlessness and overlook the considerable secondary problems with self-esteem, depression, or marital or family discord.

Many people with ADD have trouble finding a place where they feel connected, a part of something larger than self. Although people with ADD tend to be outgoing and gregarious, they can also harbor strong feelings of isolation, loneliness, and disconnectedness. Their stance in life is often one of reaching out but not quite making contact, as if running alongside a speeding train, trying to grasp the hand that is being held out to them to help them on board.

The taking of medication for ADD should not be an act of faith but an act of science. Sometimes people ask, “Do you believe in medication as part of the treatment of ADD?” as if medication were a religious principle. We neither believe in it nor disbelieve in it for all people. Rather, we approach it rationally. For most people who have ADD, medication has proven to be extremely useful. For some it has proven to be ineffective. For a very few it has proven to be harmful. If the diagnosis of ADD is carefully made, the best research data we have states that a trial of medication is indicated.

Medication is not the whole treatment for ADD. It is a useful and powerful adjunct, but it should never be regarded as the complete treatment. Medication should always be monitored by a physician. One should never take medication without feeling comfortable doing so. Spend time preparing yourself to take the medication—talking about it, getting questions answered—before you start, and your chances of success will be greatly improved.

Seek encouragement. ADD adults need lots of encouragement. This is in part due to many self-doubts that have accumulated over the years. But it goes beyond that. More than most people, ADD adults wither without encouragement and thrive when given it. They will often work for another person in a way they won’t work for themselves. This is not “bad,” it just is. It should be recognized and taken advantage of.

Give up guilt over high-stimulus-seeking behavior. Understand that you are drawn to intense stimuli. Try to choose them wisely, rather than brooding over the “bad” ones.

Listen to feedback from trusted others. Adults (and children, too) with ADD are notoriously poor self-observers. They use a lot of what can appear to be denial.

Try to get rid of the negativity that may have infested your system if you have lived for years without knowing that what you had was ADD. A good psychotherapist may help in this regard.

Don’t feel chained to conventional careers or conventional ways of coping. Give yourself permission to be yourself. Give up trying to be the person you always thought you should be—the model student or the organized executive, for example—and let yourself be who you are.