Driven to Distraction: Recognizing and Coping with Attention Deficit Disorder

by Edward M. Hallowell

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.

ADD comes in many shapes and sizes. In many people, particularly adults, the symptoms of ADD are masked by more obvious problems, such as depression or gambling or drinking, and the underlying ADD is never detected. In other people the symptoms take on a particular cast, congruent with the person’s personality as it evolves over time, so that the symptoms are never really noticed the way symptoms of a cold or flu might be but rather are dismissed as being part of “just the way he is,” not warranting medical or psychiatric intervention. And within the domain of properly diagnosed ADD there is also much variability. Jim’s ADD, I was discovering, was the high-energy, hyperactive type. But there is another kind of ADD that shows no hyperactivity whatsoever. Indeed, these people can be underactive. This is the child, often a girl, who sits at the back of the classroom daydreaming, or the adult who moves serenely within a cloud, never quite present anywhere. “I don’t know if there is a right job for you,” I said, coming back to Jim’s question. “For now I’d just like to hear more of your story. Have you ever really told it before?”

The hallmark symptoms of ADD are easy distractibility, impulsivity, and sometimes, but not always, hyperactivity or excess energy. These people are on the go. Type A personalities. Thrill seekers. High-energy–, action-oriented–, bottom-line–, gotta-run–type people. They have lots of projects going simultaneously. They’re always scrambling. They procrastinate a lot and they have trouble finishing things. Their moods can be quite unstable, going from high to low in the bat of an eye for no apparent reason. They can be irritable, even rageful, especially when interrupted or when making transitions. Their memories are porous. They daydream a lot. They love high-stimulus situations. They love action and novelty. Just as this kind of problem can get in the way at work, it can also interfere with close relationships. Your girlfriend can get the wrong impression if you’re constantly tuning out or going for fast action.”

to look broadly at the symptoms associated with hyperactivity and found four major traits to account for the clinical picture: (1) deficits in attention and effort, (2) impulsivity, (3) problems in regulating one’s level of arousal, and (4) the need for immediate reinforcement. In large part due to her work, in 1980 the syndrome was renamed attention deficit disorder.

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. Throughout childhood, at home and at school they are told they are defective. They are called dumb, stupid, lazy, stubborn, willful, or obnoxious. They hear terms like “spaceshot” or “daydreamer” or “out in left field” all the time.

An important, and often overlooked part of both learning disabilities and ADD is the social consequence of having them. ADD can interfere with one’s interpersonal life just as dramatically as it does with one’s academic or job performance. To make friends, you have to be able to pay attention. To get along in a group, you have to be able to follow what is being said in the group. Social cues are often subtle: the narrowing of eyes, the raising of eyebrows, a slight change in tone of voice, a tilting of the head. Often the person with ADD doesn’t pick up on these cues. This can lead to real social gaffes or a general sense of being out of it. Particularly in childhood, where social transactions happen so rapidly and the transgressor of norms is dealt with so pitilessly, a lapse in social awareness due to the distractibility or impulsivity of ADD can preclude acceptance by a group or deny understanding from a friend.

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 symptoms of ADD. The medication works like a pair of eyeglasses, helping the individual to focus. It can also reduce the sense of inner turmoil and anxiety that is so common with ADD. Th...

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. Carolyn is a wonderful example of someone who prevailed.

problem is I don’t know whether I’m smart or if I’m stupid. I’ve done well, and I’ve done poorly, and I’ve been told that I’m gifted and I’ve been told that I’m slow. I don’t know what I am.” “It is not unusual for people with ADD to have erratic, inconsistent educational histories like yours,” I said. “Were you hyperactive as a child?” I asked. “Or any kind of discipline problem?”

Problems in the development of language can occur at a number of levels and in a number of ways. One can have difficulty with input or with output. Input problems, or what are called receptive language problems, can affect both what you take in and what you are able to put out, because what you put out is dependent on what you were able to take in. Output problems, or what are called expressive language problems, can affect what you are able to write or speak as well as what you are able to conceptualize within your brain.

way that nearsightedness does: you can’t focus as well as you should, so you are not able to use the talents you have to the fullest. The first step in treatment is to get glasses, or treat the ADD, and then reassess the extent of the residual learning disability.

Problem with lateness. Even when there is plenty of time, I fill it up and then cut things too close or lose track of the time. I don’t have a sense of the passing of time.

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

We often see the following cycle in couples where one member has ADD: In order to interrupt the cycle, one needs not only to treat the ADD but also to address the feelings of anger the non-ADD spouse harbors. Those angry feelings may have built up quite a head of pressure over the years and it may take more than a few weeks or months for them to subside. If the non-ADD spouse has been running the ship for years, feeling unsupported and overlooked all the while, then that person is bound to feel angry. Simply saying “Well, I have ADD” will not make the anger go away. In fact, it may make it worse. The spouse may feel doubly angry finding out, after all these years, that there was a reason for the disorganization and distractibility, a medical condition that was going untreated. “You mean all this suffering has been unnecessary?” one spouse exclaimed. “Now I really want to kill him.”

The keys to it all, as is the case with most problems in couples, are improving communication and resolving the power struggle.

Humor is a key to a happy life with ADD.