4.7% of adults have ADD; it tends to be underdiagnosed, and is one of the more untreated conditions in the country.  ADHD includes the “H” for hyperactivity, but most people lose the hyperactive, fidgety portion by age twenty.  ADD is the most genetic of all psychiatric conditions and we usually screen family members for ADD. 

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.  Adults with true ADD remember that they had difficulty handing in homework, troubles with boring projects or reading assignments, poor attention span, and working twice as much to achieve half the amount.  The features of ADD include: trouble starting and finishing projects (especially more boring assignments), careless mistakes, irritability, impulsivity, easily distracted, tendency to misplace things, poor attention span, and difficulty remembering appointments.

The cost of untreated ADD is enormous, with a major increase in substance abuse, auto accidents, jail time, and broken or unfulfilled lives.  While many people do learn to compensate for their attentional problem and achieve much in their lives, ADD still takes a great toll on the quality of life, and patients usually do better when treated.

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, stress, and depression in people’s lives. 

The ASRS, Adult Self Report Scale, is commonly used as a screening test for ADD in adults.  The primary and most successful mode of treatment for ADD has been medication.  The “first-line” medications are the amphetamines (Adderall, Adderall XR, Vyvanse) and methyphenidates (Ritalin, Ritalin LA, Focalin, Focalin XR, Concerta).  Side effects of these meds include, among others, anxiety, faster heart rate, and insomnia.  However, 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, despiramine or other antidepressants.  As usual, the idea with medication treatment is to find an effective dose, but try and minimize medication.

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