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ATTENTION DEFICIT DISORDER (ADD)

Posted: December 2005  


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 lifeís functioning, and leads to more anxiety and depression. ADD itself creates anxiety and stress in peopleís 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
  1. How often do you make careless
    mistakes when you have to work on
    a boring or difficult project?
0
1
2
3
4
  1. How often do you have difficulty keeping
    your attention when you are doing boring
    or repetitive work?
0
1
2
3
4
  1. 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
  1. 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
  1. 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
  1. 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
  1. How often do you misplace or have
    difficulty finding things at home or
    at work?
0
1
2
3
4
  1. How often are you distracted by
    activity or noise around you?
0
1
2
3
4
  1. 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 canít 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.