Driven to Distraction: Recognizing and Coping with Attention Deficit Disorder

by Edward M. Hallowell

John himself has pioneered the emphasis on physical exercise not only as a superb treatment for ADHD, but as a brain booster in general.

ADD is a neurological syndrome whose classic defining triad of symptoms include impulsivity, distractibility, and hyperactivity or excess energy.

You don’t focus very well.

People with ADD have trouble attending to one task at a time.

The hallmark symptoms of ADD are easy distractibility, impulsivity, and sometimes, but not always, hyperactivity or excess energy.

SYNOPSIS OF TREATMENT OF ADD 1. Diagnosis: The first step in treatment is making the diagnosis. Often this carries with it considerable relief as the individual feels, “At last there’s a name for it!” The therapy begins with the diagnosis. 2. Education: The more one can learn about ADD, the more successful the therapy will be. A thorough understanding of what ADD is allows you to better understand where ADD affects your life and what to do about it. It also allows you to take the key step of explaining it to other people. 3. Structuring: Structure refers to the external limits and controls people with ADD so urgently need. Such concrete, practical tools as lists, reminders, simple filing systems, appointment books, goals, daily planning, and the like can greatly reduce the inner chaos of an ADD life and improve productivity as well as one’s sense of control. 4. Coaching and/or Psychotherapy: The person with ADD will greatly benefit from having a “coach,” someone standing on the sidelines with a whistle around his neck calling out encouragement, instructions, and reminders, and in general helping to keep things going on task. People with ADD thrive with this sort of structured encouragement, and they feel lost without it. Group therapy can provide this most excellently. Traditional psychotherapy may also be indicated if depression, problems with self-esteem, or other internal problems exist. 5. Medication: There are several medications that can help correct many of the symp...

As she began to see how many of her problems related to her being unusually distractible, we began to set up ways of restructuring her time to help her focus. She began to employ traits she knew about herself but had not used to best advantage: that she worked best in short spurts; that exercise helped her focus; that she benefited from lists, reminders, schedules, and rituals; that large, seemingly overwhelming tasks could actually get done if she broke them down into a series of small, manageable tasks; that she needed frequent feedback and encouragement; that it helped her to have someone, in this instance me, act as a kind of coach, keeping her on track.

“Danny and David started taking piano lessons about a year and a half ago. The assessment by their piano teacher is that Danny is playing at the level of a high-school student and they are both at least six years beyond where she would expect them to be. Danny and David play and listen to Bach, Beethoven, Mozart, Tchaikovsky, all the great composers. That’s who they listen to, that is what they play. They are exceptionally talented on the piano. They also take karate. They have taken it for three or four years. Last year both of them won awards in sparring. They have done exceptionally well. Karate has really taught them a lot about focusing and discipline and all the things they have needed to learn.

We are only beginning to discover how extensive ADD is—probably over 10 million American adults have it—and we are only beginning to appreciate how dramatically effective treatment for it can be.

Difficulty getting organized. A major problem for most adults with ADD. Without the structure of school, without parents around to get things organized for him or her, the adult may stagger under the organizational demands of everyday life. The supposed “little things” may mount up to create huge obstacles. For the want of a proverbial nail—a missed appointment, a lost check, a forgotten deadline—their kingdom may be lost.

Chronic procrastination or trouble getting started. Adults with ADD associate so much anxiety with beginning a task, due to their fears that they won’t do it right, that they put it off, and off, which, of course, only adds to the anxiety around the task.

Many projects going simultaneously; trouble with follow-through. A corollary of number 3. As one task is put off, another is taken up. By the end of the day, or week, or year, countless projects h...

Tendency to say what comes to mind without necessarily considering the timing or appropriateness of the remark. Like the child with ADD in the classroom, the adult with ADD gets carried away in enthusiasm. An idea comes and it m...

A frequent search for high stimulation. The adult with ADD is always on the lookout for something novel, something engaging, something in the outside world that can catc...

An intolerance of boredom. A corollary of number 6. Actually, the person with ADD seldom feels bored. This is because the millisecond he senses boredom, he swings into action ...

Easy distractibility, trouble focusing attention, tendency to tune out or drift away in the middle of a page or a conversation, often coupled...

The hallmark symptom of ADD. The “tuning out” is quite involuntary. It happens when the person isn’t looking, so to speak, and the next thing you know, he or she isn’t there. The often extraordinary ability to hyperfocus is also usually present, emphasizing the fact that th...

Often creative, intuitive, highly...

Not a symptom, but a trait deserving of mention. Adults with ADD often have unusually creative minds. In the midst of their disorganization and distractibility, they show flashes of brilliance. Capturing th...

Trouble in going through established channels, following ...

Impatient; low tolerance for frustration.

Impulsive, either verbally or in action, as in impulsive spending of money,

Mood swings, mood lability, especially when disengaged from a person or a project. The person with ADD can suddenly go into a bad mood, then into a good mood, then into a bad mood all in the space of a few hours and for no apparent reasons. These mood swings are not as pronounced as those associated with manic-depressive illness or depression.

Tendency toward addictive behavior. The addiction may be to a substance such as alcohol or cocaine, or to an activity, such as gambling, or shopping, or eating, or overwork.

Jack works as an editor for a magazine. He does well, although he has a reputation for being rude. He leaves meetings abruptly, without warning, fails to return telephone calls, insults writers without knowing that he’s doing it, makes no attempt to hide it when he’s bored, changes the subject almost in mid-sentence, and in general lacks tact. “He’s brilliant,” an associate says, “but he’s so unpredictable. You’ll be talking to him, and you’ll look away for a moment, and when you look back, he won’t be there anymore. You’ll be thinking you’re having this really interesting conversation, then poof!—he’s gone. It’s annoying, to say the least. On the other hand, he’s great to have around because he’s so full of ideas and energy.”

Peter’s study looks like—well, let him describe it. “I have my piles,” he says. “Everything I do goes into a pile. There are little piles and big piles, stacks of papers, stacks of magazines, stacks of books, stacks of bills. Some stacks are mixed. It’s like a field, little piles with white tops scattered everywhere like mushrooms. There’s no real organization to any of it. I’ll just think that pile looks a little small, I can add something to it, or this space needs a new pile, or these things I’ll move over to this other pile. Somehow or other, I survive. The piles and I must be in some kind of unconscious synchrony, I guess.”

These examples reflect the stuff adult ADD is made of. Peter’s piles are particularly emblematic. So many adults with ADD have piles, little mess-piles, big mess-piles, piles everywhere. They are like a by-product of the brain’s work. What other people somehow put away, people with ADD put into piles.

Once the diagnosis of ADD was made, she tried stimulant medication. It helped her focus quite definitely, and it had no side effects. She found that by taking medication a half hour prior to doing her writing it went much more smoothly for her. She didn’t need the medication for anything else.

It turned out that he had mild ADD, the most problematic manifestation of which was an inability to observe his own behavior and to gauge correctly the responses of other people.

This made him appear quite self-centered or indifferent. In fact, his problem was in paying attention, in noticing the subtle cues social fluency depends upon and in regulating his own responses.

Is the individual neurologically able to notice the particulars of human interaction, from voice tone to body language, to timing, to irony, and so forth? In this man’s case he needed some coaching and role-playing to learn how to tune into what he was missing. In treating his hidden ADD, his interpersonal life improved greatly.

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.

Even now I have an inordinately hard time reading, especially for someone who makes his living absorbing written documents.

very clear to me I get into panic situations if I don’t have a pretty strict routine built into my life, which involves a good deal of alone time, not necessarily quiet, but alone time.

His reading problem in school is quite typical of ADD. He may have had dyslexia as well, but his tuning out a few lines into a page is exactly what you see with ADD.

Contrary to the practice of psychoanalytic psychotherapists, 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.

The therapist might, for example, suggest that the patient buy a daily organizer, and then go over with the patient how to set it up. Or the therapist might suggest ways of finding a financial planner, and then remind the patient to do it until it gets done. This is anathema to most traditional therapy, but with people with ADD it is essential. They need direction. They need structure. The therapist should not tell the patient whom to marry, but the therapist most certainly should coach the patient on how to get organized for a date.

This structuring technique of breaking down large tasks into small ones—in my case a large course into a series of small index cards—is a valuable technique for anyone to learn to use, but it is particularly valuable for those of us who have ADD, because we can quickly feel overwhelmed by big projects or complex undertakings.

Like novelty, lots of changing interests.

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

Desk clut...

Always trying to organize things, but it doesn’t come easily. If I don’t organize them, I won’t know where they are.

Doors and drawers—never close them after myself, then come back and see them and close them.

Don’t clean up after myself well. Get overwhelmed by a large confused mess.

General problems with distractibility and disorganization.

Consider joining or starting a support group.

Make copious use of external structure: lists, reminders, files, daily rituals, and the like.

Understand mood changes and ways to manage these.

nodding agreeably and politely while not hearing what is being said at all.

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.