4.7 % of adults have ADD. It tends to be underdiagnosed,
and is one of the more undertreated conditions in the country. ADHD
includes the "H" for hyperactivity, but most people lose the
hyperactive, fidgety portion by age 20. ADD is the most genetic of
all psychiatric conditions. We usually screen family members for
ADD. It is not uncommon for a mom to present saying "my daughter
was diagnosed with ADD and I think that I have it."
To have ADD as an adult, you must have had the condition as a child
or adolescent. If you did not, the attention problem as an adult
is not ADD, but is a combination of stress, insomnia, medication,
or other factors. It is an attentional problem, not true ADD.
The cost of untreated ADD is enormous, with a major increase in
substance abuse, auto accidents, jail time, and broken or
unfulfilled lives. Many people do compensate well for their ADD
and achieve much in their lives, but they usually do better when
they are treated.
Adults with ADD remember that they had difficulty handing in
homework, with boring projects or reading assignments, and poor
attention. They often remember working twice as much to achieve
half the amount. While people do learn to compensate for the
attentional problem, ADD still takes a great toll on quality of
life, both for the person and the family.
The features of ADD include: difficulty with boring projects,
careless mistakes, trouble starting projects or assignments,
trouble or difficulty finishing assignments, irritability,
impulsivity, and unfinished piles of materials laying about
their room or house. In addition there may be a tendency to
misplace things, being easily distracted, poor attention, and
difficulty remembering appointments.
ADD often has other comorbid psychological conditions such as
anxiety and depression. The attention problem interferes with
life’s functioning, and leads to more anxiety and depression.
ADD itself creates anxiety and stress in people’s lives.
We utilize the ASRS, Adult Self Report Scale, as a screening test
for ADD in adults. The scale is as follows:
| |
Never |
Rarely |
Sometimes |
Often |
Very Often |
- How often do you make careless
mistakes when you have to work on
a boring or difficult project?
|
0 |
1 |
2 |
3 |
4 |
- How often do you have difficulty keeping
your attention when you are doing boring
or repetitive work?
|
0 |
1 |
2 |
3 |
4 |
- How often do you have difficulty con-
centrating on what people say to you,
even when they are speaking to you
directly?
|
0 |
1 |
2 |
3 |
4 |
- How often do you have trouble wrapping
up the final details of a project, once the
challenging parts have been done?
|
0 |
1 |
2 |
3 |
4 |
- How often do you have difficulty getting
things in order when you have to do a
task that requires organization?
|
0 |
1 |
2 |
3 |
4 |
- When you have a task that requires a lot
of thought, how often do you avoid or
delay getting started?
|
0 |
1 |
2 |
3 |
4 |
- How often do you misplace or have
difficulty finding things at home or
at work?
|
0 |
1 |
2 |
3 |
4 |
- How often are you distracted by
activity or noise around you?
|
0 |
1 |
2 |
3 |
4 |
- How often do you have problems
remembering appointments or
obligations?
|
0 |
1 |
2 |
3 |
4 |
Add up your Score.
|
The scoring is:
|
0-16: Unlikely to have ADD;
17-23: Likely to have ADD;
24 or greater: highly likely to have ADD |
There are a number of good books in the bookstores on ADD.
Sometimes they are general books that encompass child and adult, and there
are books that just focus on adult ADD. The monthly magazine "ADDitude" is
also a good resource. Outside of medication, behavioral treatments and
therapies have been disappointing. Life coaches or therapists may be of
some help, particularly with coexisting anxiety or depression. The primary
mode of treatment has been medication, as the medications have been the most
successful of all of the therapies. If you feel that you may have ADD, it is
important to work with a doctor trained in dealing with patients who have ADD.
The "first-line" medications for ADD are the amphetamines (Adderall, Adderall
XR) and methylphenidates (Ritalin, Ritalin LA, Focalin, Focalin XR, Concerta).
Adderall XR is a longer-acting, once-daily form; Ritalin LA, Focalin XR, and
Concerta are also longer-acting. Side effects of these include, among others,
anxiety, faster heart rate, and insomnia. These medications do, at times,
help headaches and fatigue.
If Adderall or Ritalin-type medications are ineffective, or can’t be used,
the second-line drugs include Strattera, bupropion (Wellbutrin),
nortriptyline, or desipramine. Other antidepressants have also been used.
As usual, the idea with medication is to find an effective dose, but try and
minimize medication.
|
