Adult ADD

Adult ADD is a nervous system disorder most easily  characterized by difficulties with “executive” functions. These include attention, a planning, concentration, managing time and tasks, maintaining focus, and making thoughtful decisions.  But it can also affect other non-executive functions like anticipation and dexterity. To qualify for the diagnosis, a person’s executive difficulties must be life-long, and there must be no other condition present to explain them.

Affected individuals have serious problems in one or more of the following areas:

* screening out distractions and keeping focused while talking, working, or playing
* starting and completing tasks
* remembering tasks, events, and plans
* organizing information and belongings
* being on time
* keeping priorities in order
* focusing on important tasks rather than low priority but interesting ones
* fulfilling their obligations on time

There are many causes of ADD, but twin and family studies suggest that the most common factor is heredity, which is responsible for 75% of cases of ADD. Throughout the world, in various cultures, ADD is a fairly consistently present in about 7% of children and about 4% of adults.

The Effects of ADD on Individuals’ Lives

People suffering from ADD often feel unfairly nagged by those around them and sometimes become defensive, even defiant, when confronted with their performance problems. Their underachievement often leads to reduced self-esteem, depression and anxiety.

ADD usually becomes evident in childhood although frequently it is not recognized as such at the time but is labeled as laziness, irresponsibility, and defiance of authority. It is often accompanied in childhood by hyperactivity and the inability to sit still in class. Many children are able to compensate for their symptoms until they are faced with greater academic challenges in high school and college that overwhelm their ability to compensate for their ADD. For some, it is not until adulthood that the demands of the workplace or of parenting lead to dysfunction that cannot be hidden.

As can be imagined, symptoms are most burdensome to individuals whose work involves a high degree of reliability, deadlines, and/or organizing and recalling complex information.

Non-ADD Causes of Executive Function Symptoms

Because other disorders that disturb executive function may resemble ADD, a thorough clinical assessment should be carried out before treatment is undertaken, particularly since an incorrect diagnosis of ADD may result in overlooking other serious disorders. Executive functions may be affected by injury to the brain, sleep apnea, fatigue, alcoholism, Alzheimer’s, and other medical and neurological disorders.

Mild or non-specific deficits of executive functions, such as planning and organizing, are common in the adult population, particularly in older people. In addition, various psychological disorders, including dementia, learning, hearing and reading disorders, thyroid problems, Aspergers syndrome, and autism, may impair executive dysfunctions. In about 15% of cases, there is no known cause.

Sometimes depression and anxiety can cause ADD-like symptoms (forgetfulness, failure to complete work, etc). The reverse is true as well: failures caused by ADD can cause depression or anxiety. In the latter case, patients may not respond to anti-depressants or anti-anxiety medications but may feel better only when their ADD symptoms improve in response to treatment.

The Treatment of ADD

While other medical or behavioral treatments may have a modest effect on some patient’s ADD, stimulant medication has been found to be effective in reducing or eliminating many symptoms of the disorder for about 70% of adults with ADD. No other treatment consistently provide the benefits of this class of medications. However, it is impossible to predict accurately which patient will respond well and which will not. Variation in response may be due to individual differences in how the medication is absorbed, metabolized, stored, and excreted, to personality factors, to variations in side effects, and to dietary and sleep habits.

Stimulant medications usually have mild side effects which often disappear over time. Very rarely they have serious adverse effects including paranoia and cardiac problems which have very rarely resulted in death, notably among individuals with a pre-existing heart problems.

Some people with ADD can benefit from behavioral coaching, couple’s therapy, and psychotherapy. Many can get help understanding their ADD and accepting themselves and their limitations by attending mutual support and ADD education groups.