A Condition Not Just for Kids Anymore

Alan has just spent the day doing yard work. He started mowing the lawn, but then noticed that the hedge needed trimming, so he turned off the mower and went to get the hedge clippers out of the garage.

They were under some trash, so he stuffed some of it in a plastic bag, which he left by the door. Halfway through the hedge, he came to a spot in the yard where he intended to plant a tree, which had been wilting for two weeks in a burlap bag behind the house.

So he stopped clipping, found a shovel and started digging a hole, but then he saw that the front flower bed needed weeding, so he left the tree unplanted to tackle the weeds.

Noticing that he was thirsty, Alan went inside to get a soda, expecting his wife to praise him for all the work he’d done. Instead, she took one look at the half-mown yard, with the tools lying about and a pile of trash blocking the driveway, and exploded in anger.

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Steve is a salesman for an electronics supply company. Some days, he’s able to fill out his paperwork, be on time for appointments and promptly return phone calls from his customers; other days he can’t remember their names, what they said they needed, or for that matter, where he put the car keys.

Steve is incredibly knowledgeable about his product line and can strike up an immediate rapport with customers and analyze their complicated technical problems, but some days he can’t get himself motivated enough to pick up the phone, and the office manager is ready to strangle him because his paperwork piles up for weeks.

He’s gotten two bad performance reviews, and sometimes he’s drawn so much against his commission that he doesn’t know where his next paycheck is coming from.

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Joan, a homemaker whose children are grown, recently went back to school, with much trepidation, to get the bachelor’s degree in education she put off to get married.

She enjoys the lectures and discussions in her classes and the company of her young student colleagues, and is even doing well in practice teaching, but has real trouble keeping up with long reading assignments. The only way she can finish them is if she gets up at 4 a.m. when the house is totally quiet, goes into a spare bedroom, shuts the door and pulls the shades.

She uses colored markers to highlight the points she wants to remember, but still, tests are a disaster. Her professors say her papers are full of wonderful ideas--if only she could organize them better and learn how to proofread.

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Know anyone like Alan, Steve or Joan? Chances are good you do, say psychologists, psychiatrists and family doctors.

The professionals who shared the stories of the three people above, all recent clients, on the condition they would not be identified by their real names, say Alan, Steve and Joan have something in common. Despite the differing details of their lives, the three are all exhibiting symptoms of Attention Deficit Disorder.

ADD, also known as Attention Deficit Hyperactivity Disorder, or ADHD, once was thought to be outgrown when children reach puberty.

But now researchers have found that up to two-thirds of the time the condition’s symptoms--distractibility, hyperactivity and impulsiveness--persist into adulthood, when they can wreak havoc on careers, relationships and individuals’ self-esteem.

And armed with studies showing a strong hereditary link and new theories about the physiological origins of the condition in the human brain, professionals are beginning to devise new treatments for the estimated 5% to 10% of adults who are affected.

“What people need to know about ADD is that it’s debilitating and widespread, but something can be done about it, and it can be overcome to some degree,” says Gary Millspaugh, executive director of the Allentown Rescue Mission, who found out four years ago as a 36-year-old that he had suffered from ADD his whole life.

According to professionals, adult ADD is found in men and women, although it is thought to be more common in men, and cuts across all ethnic, occupational, intellectual and educational lines.

Because many of today’s adults came of age before knowledge of the syndrome was widespread, their conditions were never diagnosed and have suffered in silence from impairments in functioning that can range from mild to severe.

Indeed, professionals say, one of the main problems with ADD in adults is that cases rarely look alike--and the condition frequently looks like something else.

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Not everyone who has ADD is as physically hyperactive as Alan. Some may have subjective feelings of restlessness, while others, many of them women, describe a constant shifting of attention, thoughts and ideas.

And, although many associate ADD with underachievement in school, as in Joan’s case, that also is not always true.

Nor is ADD just an inability to pay attention. As in Steve’s case, many ADD adults can pay attention to, and even hyperfocus on, activities they find engaging or satisfying, and they may be able to sustain effort for short periods of time, but not on a consistent basis.

“Their performance varies over time, across subject areas and tasks, and even across the same task from day to day. . . . The hallmark of these people is that their behavior is consistently inconsistent,” says George Dupaul, an education professor at Lehigh University in Pennsylvania who has studied children and adults with ADD.

Evidence is increasing that genetics plays a role in the disorder, Dupaul says. Although no one has found a specific ADD gene, he says, many find the disorder runs in families.

Research has shown that there are differences in blood flow in the brains of people found to have ADD. And others have begun research on brain chemicals that may be out of sync in ADD patients.

A new theory about the condition by top researcher Dr. Russell Barkley, professor of psychology and psychiatry at the University of Massachusetts Medical Center in Worcester, Mass., says that ADD brains are wired not to not pay attention, but to pay attention to everything.

At the same time, they don’t function quickly enough to inhibit behavior.

As a result, the behavior of those with ADD may look disorganized to others but actually has its own internal logic. The lack of inhibition can cause problems with everything from impulse spending to driving skills. Studies suggest ADD adults often have a record of having many more than the average number of automobile accidents.

So what helps adults with ADD?

For many, the first line of treatment usually is the stimulant methylphenidate, known by the trade name Ritalin, the same drug that is used for children. It is thought to stimulate the production of brain chemicals called neurotransmitters. Once brain function is normalized, concentration and impulsiveness problems improve.

Other adults use Cylert, a longer-acting drug than Ritalin, which must be taken every four hours and tends to produce a “rebound effect” in symptoms. Still others have success with anti-depressants such as Prozac and its relatives.

Professionals agree that medication is only the beginning of treatment for most ADD adults who should expect to spend some time working with a counselor or therapist on the issues and problems that arise from years of coping, both in positive and negative ways.

But which nonmedical treatments work best is still an open question.

Some ADD adults say they have found help through unconventional therapies. Millspaugh, for example, says he was aided by biofeedback. The technique is said to work by allowing people to experience and learn how to adjust their brain-wave patterns.

Still others with ADD rely on one-on-one help with people called coaches who are trained in ADD issues and problems, says Susan Sussman of Lafayette Hill, Penn., founder of the National Coaching Network.

Coaches don’t do deep analysis of a person’s psyche or family background, but they try to help clients develop time management, organizational and daily living skills, Sussman says. After an initial meeting, an ADD person typically meets weekly or daily with a coach, either in person or on the telephone.

“I call it a designed alliance. . . . Together we begin to develop strategies for dealing with specific issues and difficulties,” Sussman says.