A decade ago, doctors thought attention deficit disorder faded with maturity. Now drugs and coping skills can help adults with ADD comprehend much that had been misunderstood.
For most of his life, Greg Stull found listening to family, co-workers and friends torture. “After a minute or two of struggling to pay attention, I felt as if ants were crawling all over me. I’d have to change the subject or get up and move around,” says the computer software engineer, who works in Irvine.
Stull, 33, heard what people said but found even the simplest messages hard to comprehend.
“I tried to listen, but it was impossible for long,” he says. “It was like sitting in the back of a flatbed pickup truck going 100 miles an hour down a bumpy dirt road. Remembering information and drawing conclusions from facts was really difficult. I felt stupid for having to try so hard when others didn’t seem to have to.”
Stull has a condition most people associate with children rather than adults: attention deficit disorder.
He was found to have ADD as a child, and doctors predicted it would disappear as he grew. It didn’t, but Stull and those around him assumed that it had. For years, during his late teens and 20s, Stull struggled unknowingly with it. Sheer willpower and determination propelled him through college and into the computer field, but he found it hard to stay at a job.
Five years ago, in frustration, Stull decided to seek help. He confided in his family physician his fear that he might still have the disorder that had plagued him in childhood. His doctor, it turns out, was found to have ADD and knew what specialists would be best for Stull to see.Behavioral and physiological testing confirmed that Stull had not outgrown ADD. He was taught coping techniques and prescribed Ritalin, the drug most commonly used to treat ADD. The change in his life was dramatic he says: Communicating with his family, friends and co-workers was no longer a chore.
The first childhood diagnosis of this neurological and biochemical condition was made by a British pediatrician in 1902. Until just 10 years ago, doctors thought ADD faded with maturity. They’ve since found that isn’t always the case.
“In the past five years, I’ve had a gradual onslaught of adult patients afflicted with what we call residual ADD,” says psychiatrist Jean-Louis Le Renard, who has a private practice in Huntington Beach and is an assistant clinical professor at UCLA.
“When they find out what is wrong, many adults are very happy to know that there is a name for their suffering and effective treatment is available,” he says.
About one-third of children with ADD continue to experience the problem in adulthood, although it often goes undetected or is misdiagnosed as depression or another behavioral problem, according to Le Renard. Other experts put the percentage even higher.
Symptoms of ADD in adulthood are similar to those found in childhood, but they are sometimes more difficult to detect because adults become masters at hiding their problem and coping. ADD can, and usually does, affect all areas of a person’s life.
The hallmarks of the condition are extreme distractibility and sometimes destructive impulsiveness. Other symptoms include moodiness, temper flare-ups, depression, disorganization, sleep difficulties, difficulty beginning and completing tasks, fatigue and low stress tolerance.
Estimates vary on the number of people who have the disorder, but many experts concur with statistics compiled by the Ohio-based Attention Deficit Disorder Assn., which show that 5% of Americans, adults and children, have the disorder.
“I don’t think ADD has increased in frequency,” Le Renard says. “Like many medical conditions, it went unrecognized and left on the sidelines for so many years. We have become more sophisticated and knowledgeable in identifying the problem.”
Whatever the numbers, ADD has the distinction of being the fastest-growing mental disturbance diagnosis for adults. As more and more people are diagnosed, the use of Ritalin has skyrocketed. In the past four years, prescriptions for the drug have risen nearly 400%.It’s a statistic that alarms some experts in the field, such as clinical psychologist Richard Bromfield, who is a faculty member of Harvard Medical School in Boston.
“Ritalin is amphetamine related, can be addicting and is still controversial,” Bromfield says.
“Inevitably, every good medicine, from antibiotics to Valium, has been widely overprescribed and abused, so why wouldn’t that happen with Ritalin?” Bromfield asks. “While all of these drugs are miracles for some people, they can be harmful to individuals who don’t warrant them.”
Bromfield said he doesn’t question the existence of ADD but believes that it is over-diagnosed.
“I think that just 1% to 2% of the population actually has ADD,” he says.
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Psychologist Joan Andrews has worked with many ADD clients, currently at Coastline Counseling Center in Newport Beach and previously as a school district psychologist in Irvine for 12 years.
“In many cases, the person with ADD is having difficulty with an under-arousal of the brain,” she says. “The centers that are supposed to control ability and moderate impulses are not working well.”
In their search for a cause, researchers are looking at environmental factors such as toxins, fetal distress and head injuries, according to Andrews. They are also examining the role that genetics may play.
Ritalin, which would be a stimulant to the normal person, is thought to increase levels of dopamine, a neurotransmitter or chemical in the brain that people with ADD have less of than others, Andrews says.
“At the correct dosage level of Ritalin, a patient’s brain activity moves into a normal range,” she says.
When Ritalin is combined with various coping techniques, many ADD sufferers go on to live much easier lives.
Although ADD is relatively easy to detect for the trained professional, it often goes undetected, Andrews says.
“Many people with undiagnosed ADD sense they are intelligent but have difficulty processing information,” she says. “They recognize there is a glitch somewhere–that there’s a gap between where they should be functioning and where they are. But they have no idea what is wrong, and many doctors are also at a loss.”
Both men and women experience ADD, but the outward signs of it can take on different forms or be interpreted differently. Whereas a male with ADD might be seen as aggressive, a female with ADD is more likely to be seen as spacey.*
For years, Denise Medina knew there was something wrong, but doctor after doctor couldn’t find anything–or would misdiagnose her disorder.
“I had a variety of symptoms, such as depression, mood swings, memory loss, a short attention span and tardiness,” says Medina, 30, a makeup artist and stylist who works in Santa Ana. “Unfortunately, these are symptoms of other disorders as well.”
Medina was found to have a learning disability, but she knew there was something else wrong. No one pinpointed ADD until she was 28.
“When I discovered the problem, I was really mad that I had wasted all that time,” she says. “If I had found out when I was younger, I think I could have prevented certain things that happened in my life. At the same time, I was relieved to find out that I wasn’t stupid and that there was medication for my problem.”
For years, Medina had trouble at work because of her inability to concentrate and remember critical information.
“People would think that I was a ditz and kind of slow,” she says. “They didn’t understand that I was trying my hardest to pay attention, but it was very difficult to listen and retain what I had heard. I was fired for not grasping information. I’ve also been let go for excessive tardiness. When your brain isn’t functioning right, it’s hard to get up in the morning and get going.”
After receiving treatment, Medina says she felt a giant fog lift.
“Once I got help, I felt more alert, smart and capable of doing things and finishing tasks,” she says.
When undiagnosed and untreated, ADD can have devastating effects on an individual’s personal relationships as well as his or her professional life, Andrews says.
“An individual with ADD can have difficulty processing and retaining information, which can make work difficult,” she says. “Personal lives are also affected. ADD can cause a variety of moods, ranging from depression to anger. Loved ones often don’t understand why a person is upset.”
Those close to a person with ADD also find the individual’s distractibility and inability to concentrate on conversations especially nerve-racking.
“A person with ADD will listen to his or her spouse for a short period of time and then float off,” Andrews says. “This makes the other person feel that he or she isn’t interested. In reality, the person with ADD interrupts in order to stay interested. Those with ADD also have poor memories, which makes those close to them think they never pay attention and don’t care.”
*When Greg Stull was found to have ADD, many things began to make sense to his wife, Theresa, now 28.
“Before, Greg had very dramatic, extreme emotions,” she says. “He’d be on cloud nine for a while and then slide down in the dumps. When we first started dating, he couldn’t sit still for long.”
After Greg and Theresa married, problems with communicating became more apparent.
“What caused the most trouble was Greg’s not listening,” Theresa says. “I’d be in the middle of a sentence, and he’d say something totally out of the blue that didn’t correspond to the conversation at all. I sometimes felt like we were having a Ping-Pong match; things were all over the place.”
Now Theresa says that she and Greg can sit down and have a conversation over dinner. Their communication has improved dramatically, as has her understanding of his condition.
“Now that I realize Greg has a physical limitation that isn’t easily changed, I have more sympathy and patience than I did before,” she says. “In many ways, our relationship has been enriched by the experience.”
Says Greg: “I’m able to sit and concentrate on things now and get things done without struggling. I’m also much less impulsive. And I feel as if I’m better able to listen to my wife.”
