ADD  –  It’s Not Just For Children

Lisa Grossman, M.A., M.Ed.

Over the past several years, a heightened awareness among parents, teachers, and health care professionals has helped improve the situation of  millions of children in America and here in Israel.

In fact most of us have become so familiar with examples of young ADD sufferers ( such as the hyperactive child tapping his foot and pencil, while his mind wanders from subject to subject-except for the one the teacher is discussing, or the dreamy child whose may look focused in class while his or her mind is a million miles away), that we have come to look on the subject as old news.

Despite the natural conclusion that ADD children eventually grow up and therefore outgrow their symptoms, adults with ADD has become the #1 attention-getter in newspapers, journals and books and You Tube. As early as September 2, 1997 the N.Y. Times took an in-depth look at how the disorder affects grown-ups, citing estimates that put the number of adult ADDers in the US between 5 and 10 million! The Times article documented cases of disorganized, absent-minded (yet quite often creative and intelligent) adults who shuffle through jobs and relationships, with no insight into the root of their problem or hope for their future. They are now benefiting from the professional knowledge and collective consciousness that has been raised.

 Despite the confusion regarding the definition and nature of the problem, if properly diagnosed and treated, the negative effects of ADD can be minimized. In the same way that Israeli families and educators are learning to confront the problems of ADD children, adult ADD sufferers can be helped to find ways to compensate and succeed- usually through a combination of therapies.

As with all disorders, recognition is the first critical step. There has been a growing realization that Attention Deficit Disorder persists into adulthood for many individuals. The core symptoms of ADD, inattention, impulsivity, and over activity, which are most evident during childhood, are now known to continue into adulthood for a significant percentage of (up to 70%) of ADD children.  However, in adults these symptoms of ADD are often obscured by more prominent difficulties. A number of adults who are now benefiting from diagnosis and treatment for ADD were first recognized for problems with substance abuse or other addictive behavior, such as smoking, over-eating, gambling and alcoholism. In many cases they sought or were referred to professional help for their inability to succeed in relationships, in staying organized or in holding a steady job, which often led to depression and other significant disorders. Insult to Injury

Most adults today grew up at a time when clinicians, educators, parents, and the general public knew little or nothing about ADD. As a result , adults living with  the condition are generally undiagnosed and untreated and, as noted above, usually experience a number of problems, some stemming directly from the disorder, and others resulting from associated adjustment patterns. Their presenting concerns may include several of the following items: chronic procrastination, impulsive speech and action, trouble focusing, poor short term memory, mental or physical restlessness, sleep disturbances, mood swings, depression, anxiety, and job-related problems, (e.g. interpersonal conflicts, time-management, and task-completion). In and of themselves, none of these issues seems to be debilitating. However, the unkindest cut of all may be the way society regards these people in pejorative terms- as lazy, disorganized, and undisciplined non-achievers. The painful irony behind these slings is that quite the opposite is usually true: ADDers generally score high on IQ tests and often it is their singular motivation which allows them to remain even peripherally within the mainstream. Beyond the anguish it causes, this type of insult perpetuates the low self-esteem of most ADDers,  particularly when combined with overly critical peer and parental pressures.

Diagnosing Adult ADD

The symptoms of ADD may range from mild to severe, affecting several or just a few areas of functioning. Similarly, there are many successful people who “happen” to have ADD. The most basic criteria for diagnosing adult ADD is that the symptoms noted existed before the age of 7, and are chronic and pervasive. As with children, adult ADD may or may not be accompanied by manifestations of hyperactivity. According to CHADD (Children and Adults with ADD), the number one ADD association in the U.S:

“There is no one ADD personality profile. Some people  with ADD can concentrate  if they are interested or excited, while others have difficulty concentrating under any circumstances.”

The above factors raise the importance of  compiling as detailed a history as possible when  turning to professional  help for diagnosis and treatment.

ADDers Can Be Helped

Sarah (a pseudonym), a 21 year old with a history of school failure and family problems, came to me looking for special accommodations for her matriculation exams, which she was retaking following an abbreviated and largely unsuccessful military service. Although she had an awareness of her difficulties in concentration, she had no idea that she might have a learning disorder related to specific cognitive functioning. Since there had been no glaring behavioral manifestations, she had continued to suffer silently, isolating herself from the demands of school and society, taking a path that would ultimately lead to her dropping out of both. 

The psychologists who had tested Sarah in the third grade reassured her parents that because of her high IQ, there was nothing to worry about.   Years later, when Sarah began to “drop out”, another mental health professional categorized her problem as teen depression. Had ADD been suggested, she might have received medication and been provided with practical suggestions and coping strategies that could have helped her overcome her difficulties related to concentration, planning, and focusing on the task at hand.  These elements, utilizing the combined talents of professionals, eventually helped her return to the mainstream. Earlier diagnosis might have spared her from years of failure and frustration.

Recently, Sarah has been accepted to a major university. It is interesting to note that she began a course of study in computers, a field that is often recommended for ADDers, among other reasons, because it allows the student to work at his own pace. However the story is far from any “happy ending.”  Sarah  knows that  she must fight an uphill battle against forces that constantly threaten to lead her astray. Hopefully, with continuous monitoring and proper “coaching” she will be able to enjoy a modicum of success. 

What Causes ADD

In the mid-80’s, when parents groups began forming to advocate for the needs of their children, many people realized that they shared the same characteristics seen in their children. Subsequent genetic research bore out their claims. According to Dr.  Russell Barkely, Professor of Psychiatry and Neurology at the University of Massachussetts Medical Center, approximately 40% of all youngsters with ADD have at least one parent who has the condition.

The main thrust of research has focused on finding a physiological basis for ADD.  In November 1990, the New England Journal of Medicine published the first article documenting evidence of a physiological basis for ADD based on the work conducted by  Dr. Alan Zametkin of the National Institute of Health.  Zametkin’s research suggested that the areas of the brain that control the “executive functions” –  attention , self-monitoring, emotional restraint, judgment, sequencing, planning organization and task-completion –  are  under functioning in persons with AD/HD. Subsequent research points to constant under arousal of these areas (the premotor cortex and superior prefrontal cortex) producing what may be thought of as an Environmental Dependency Syndrome, wherein the ADDer is dependent on consistent cues from the environment in order to act appropriately.

Research regarding the brain’s neurochemical system have suggested an impaired ability to use dopamine and norepinephrine, the chemicals messengers linked to self-regulation, attention, concentration and memory, being related to symptoms of distractibility, impulsivity and cognitive impairments. The medications most commonly prescribed for ADD affect the production or absorption of these neurotransmitters.


Treatment usually involves a multi-modal, or integrative approach, combining therapy, medication, and self-awareness training. It is also important to build a support system by educating and involving others close to the ADD patient in the process.

Several pharmaceutical options have proven themselves to be effective. However, as with children, there is no “quick fix” that will magically eliminate all symptoms.  Finding the right medication or combination of meds requires patience, self-observation, and careful monitoring – because each person metabolizes medication differently.  Many individuals have reported improvements in concentration, and find that they are  less distracted,  less forgetful,  and have less mental fatigue while on medication. However, because so many non-productive habit patterns need to be unlearned, solution-oriented therapy should accompany the medical approach. Adult ADDers need to develop insight into the nature of their problems and reshape lifelong adaptive behaviors  to more effectively cope with the demands of daily routines, which are anything but mundane for them. 

Because adults with ADD often experience enormous difficulty in their efforts to overcome entrenched behavior patterns, there is a growing  need for  professional  ADD coaching. ADD coaching is a supportive, practical and concrete process in which the coach and the client work together to identify the client’s goals, and chart a course towards accomplishing them. ADD coaches  provide strategies for dealing with issues such as time management, organization, and self-advocacy.  Most importantly, the coach helps the person with ADD sustain the focus and motivation necessary to follow through. Coaches act in lieu of the ADDer’s deficient cortical executive functions, not only by reminding them of the consequences of impulsivity and procrastination, but by helping them to structure their environment so they learn to form good habits, and a better outlook on life.

The ultimate goal, no matter what the treatment, is to allow people with ADD to emerge with  a new perspective, to provide opportunities for redefining and restructuring their lives, and offer hope where none was before.

Women’s Issues

While ADD is, in the words of Sari Solden (author of Women with ADD, 1995) an “equal opportunity disorder” – affecting young and old, males and females alike – it has been traditionally overlooked as a malady affecting women.  The majority of writing and research on ADD has focused on males.  Along with the recent recognition of adult ADD, as well as a greater awareness that ADD includes subtypes both with and without hyperactivity,  researchers have also begun to look seriously into the special issues confronting girls and women with ADD.  Studies looking at genetic issues, metabolic/neurological functioning, and  coexisting psychiatric disorders that often accompany ADD in females, have all confirmed that that women with ADD often suffer equally, if not more than their male counterparts from cognitive impairment, emotional and relationship problems. However, their problems may often go unnoticed, especially when their behavior is tempered, rather than marked by the outgoing, oppositional activities classically associated with boys or men with ADD.

According to Kathleen Nadeau, editor of a newsletter for women with ADD, many women with ADD “escaped” into marriage at a young age, believing that they would not be able to cope with the demands of the workplace – only to find that the requirements of running a home  –  supervising and monitoring others, doing repetitive, boring  work, and being the “emotional command center” with no clear guidelines, feedback or reward –   are a recipe for potential disaster.  At the workplace, the same cultural expectations that requires women to be in charge of   organizational issues – often prevent highly capable and creative women from reaching their professional goals.

Whether male or female, adults with ADD deserve the help and understanding that can enable them to overcome their difficulties and bring out their true potential.

The author is an educational psychologist and ADD coach working in Raanana.  For more details call:  050-248220.