Guides to Managing Adult ADD
The past decade has seen a substantial increase in public awareness of attention deficit disorder (ADD, sometimes referred to as ADHD, for attention-deficit/hyperactivity disorder. This article will adopt the ADD acronym). The primary focus has been on ADD in children and the use of Ritalin and other drugs to control ADD in the interest of helping children concentrate in school. In recent years there has been increasing criticism of the over-diagnosis of ADD as way of compelling children to submit to an unnatural situation, namely remaining still for hours on end in a classroom situation.
This article surveys several books and electronic materials primarily devoted to adult ADD. Regardless of one’s views on the appropriateness of enforced docility in children, it seems evident that the three main components of ADD—inattention, impulsivity, and hyperactivity—can cause serious problems for adults at work, in personal relationships, and in dealing with the world generally. Perhaps the first question for anyone troubled by these tendencies would be, do I have ADD? A set of questions designed to help assess ADD, drawn from Hallowell (1994), may be found on my website at http://oakvillepsychotherapy.com/ask.htm#Do_I_Have_ADD.
Hallowell (1994) points out the association of the primary characteristics of ADD—inattention, impulsivity, and hyperactivity—with children in general. Problems arise when these childlike characteristics persist into adulthood. The ADD symptoms of inattentiveness, forgetfulness and disorganization can play havoc in a couple relationship. Spouses of adults with ADD have frequently complained that for practical purposes, it’s just like having to deal with one more child. ADD can take multiple forms, which can confound its diagnosis and treatment. ADD frequently occurs along with other mental disorders including depression, learning disabilities, borderline personality, or obsessive-compulsive disorder, among others. Hallowell suggests a treatment plan that includes education, coaching, and appropriate medication.
Maté (1999) suggests that ADD may be best understood not as an illness but as an impairment, like nearsightedness. ADD, according to Maté, results from a “miswiring of brain circuits, in susceptible infants.” Secure attachment with the mothering figure contributes to the development of brain circuits responsible for self-regulation. Insecure attachment patterns may contribute to ADD. The interruption of the attachment process inherent in adoption may help to account for the high incidence of ADD among adopted children.
Kelly (2006) explains the chemistry of communication within the brain and helps those with ADD to understand the details of “a central nervous system that doesn’t work quite right.” The authors point out that while ADD cannot be cured, those who suffer from the disorder can learn coping skills to deal with work, marriages, social relationships and the responsibilities of day-to-day life. These coping skills rely on devising explicit concrete scripts to help negotiate the intricacies of social interactions and lists to make up for deficiencies in memory or organizational abilities. Support groups can help those with ADD to understand that they are not alone in the difficulties they encounter with life’s challenges.
Of course the very nature of ADD may make it difficult for someone wrestling with its problems to get through a book, even a well-written book. “ADD and Loving It,” a Canadian documentary written and directed by Rick Green and starring Second City veteran Patrick McKenna, offers a light-hearted but highly informative treatment of the subject. In a parody of the Post-It technique favored by many ADD coaches, McKenna covers a blackboard with giant Post-Its addressing topics related to ADD and then presents brief vignettes and interviews addressing each topic. Dr. Jill Pickett, the eminent Ontario psychologist, has produced a series of DVDs on a number of topics including two of particular interest to those concerned with ADD—one on ADHD and another specifically devoted to Ritalin.
ADD imposes a particular burden on those who, instead of enjoying the support of an equal life partner, often find themselves overstressed by having to compensate for the deficiencies of their spouses. Pera (2008) addresses itself specifically to those whose partners have ADD. The author suggests that ADD is “really not so much a disorder of attention as it is a disorder of self-regulation.” The book offers sympathetic accounts of the experiences of the non-ADD partner in dealing with the consequences of impulse buying, erratic driving, and the effects of distractibility on one’s sex life. The author points out that “the very brain deficits that cause problematic behaviors can inhibit your ADHD partner’s ability to see them.” The book offers a series of coping skills designed to keep the non-ADD partner from succumbing to hypervigilance, exhaustion and depression.
When I was in grade school, children who could not cope with the intellectual or behavioral demands of school were often described simply as “retarded.” Now the term “learning disability” encompasses a wide range of shortcomings and the educational systems of many districts have devised a wealth of technical devices and accommodations to address individual needs. Sophisticated psychological tests make it possible to isolate and treat specific deficiencies.
Recent studies on the treatment of ADD have cast the issue in the context of executive skills or executive functioning. The neo-cortex is presented as an executive center assigning tasks to lower-level agents. Dawson (2009) includes among these skills “response inhibition; working memory; emotional control; sustained attention; task initiations; planning/prioritization; organization; time management; goal-directed persistence; flexibility; and metacognition” (that is, the ability to think about the thinking process). Looking at the brain in terms of these specific areas of executive functioning, we can easily imagine the problems that ensue from the absence of any of these skills. The authors present specific suggestions for strengthening each skill in the form of exercises and organization. They encourage parents to identify not only their child’s strengths and weaknesses in executive skills but also their own.
Dawson (2010) offers detailed suggestions for identifying deficiencies in executive skills and to making environmental interventions to promote these skills. Such interventions might include “change the physical or social environment; change the nature of the task; change the way cues are provided; change the way adults interact with students.” Thoughtful and detailed control of the overall situation can help children focus on the tasks at hand and increase the probability of their success.
The concept of executive skills also provides a useful framework for dealing with adult ADD, the particular emphasis of Barkley (2010). The author identifies five problem areas: “poor self-management relative to time, planning, and goals; poor self-organization, problem solving, and working memory; poor self-discipline (inhibition); poor self-motivation; and poor self-activation, concentration, and alertness.” Few adults display all of these deficiencies. In order to formulate an effective treatment plan, one must isolate the particular areas of concern. The author offers suggestions for mastering ADD in specific areas of one’s life.
Barkley (2011) includes a self-report test containing 89 items, such as “procrastinate or put off doing things until the last minute,” or “have difficulties saying what I want to say,” or “have a low tolerance for frustrating situations.” One rates each question on a scale from 1 (meaning never or rarely) to 4 (meaning very often.) The tests are then rated using score sheets differentiated by age and gender. The resulting scores allow one to evaluate executive function in five key areas: self-management of time; self-organization and problem solving; self-restraint; self-motivation; and self-regulation of emotions. Areas in which one scores much lower than the general population--as compared with one’s own gender and age group—offer targets for specific treatment. In some cases, devising appropriate coping mechanisms may be sufficient to deal with the deficiency. In other cases, medication may be recommended along with organizational techniques aimed at a specific deficiency.
The books referenced in this article describe the frustrations that ensue from untreated adult ADD. Given the multiplicity of problems gathered under that single umbrella term, one should not be surprised at the lack of any single technique for dealing with ADD. But the possibility of isolating and identifying specific deficiencies, and recognizing the uniqueness of each individual case, offers new hope both to those suffering from ADD and from those whose lives are touched by theirs.
Barkley, Russell A. (2010). Taking Charge of Adult ADHD. New York: The Gilford Press.
Barkley, Russell A. (2011). Deficits in Executive Functioning Scale (BDEFS). New York: The Guilford Press
Dawson, Peggy and Richard Guare (2009). Smart but Scattered: The Revolutionary “Executive Skills” Approach to Helping Kids Reach Their Potential. New York: The Guilford Press.
Dawson, Peggy and Richard Guare (2010). Executive Skills in Childhood and Adolescents: A Practical Guide to Assessment and Intervention. 2nd edition. New York: The Guilford Press.
Hallowell, Edward M. and John J. Ratey (1994). Driven to Distraction: Recognizing the Coping with Attention Deficit Disorder from Childhood through Adulthood. New York: Touchstone
Kelly, Kate and Peggy Ramundo 2006). You Mean I’m Not Lazy, Stupid or Crazy?! The Classic Self-Help Book for Adults with Attention Deficit Disorder. New York: Scribner.
Maté, Gabor (1999). Scattered Minds: A New Look at the Origins and Healing of Attention Deficit Disorder. Toronto: Vintage-Canada.
Pera, Gina (2008). Is It You, Me or Adult A.D.D.? Stopping the Roller Coaster When Someone You Love Has Attention Deficit Disorder. San Francisco: 1201 Alarm Press.
ADD and Loving It (2009). Toronto: Big Brain Productions.
Pickett, Jill (2011). Dr. Jill Talks About Ritalin. www.asktheshrink.ca
Pickett, Jill (2011). Dr. Jill Talks About ADHD. www.asktheshrink.ca
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