ADD is not just a childhood condition. Millions of adult Americans suffer from it, mostly undiagnosed. Here’s how to recognize its symptoms — and keep it from running your life.
When Jennifer Koretsky was first told by a psychiatrist, at age 25, that she had a neurological condition called attention deficit disorder, or ADD, she didn’t believe it. After all, she was there to talk about her low-level depression. “I thought, oh my God, this woman is nuts. I’m not a little boy bouncing off the walls in class. I said to her, ‘No, you don’t understand. I do really well at work. My boss loves me. I’m successful.’ She said, ‘You don’t understand what ADD is.’”
The psychiatrist advised Koretsky to read up on the subject, beginning with Driven to Distraction: Recognizing and Coping with Attention Deficit Disorder from Childhood through Adulthood (Touchstone, 1995), by Edward M. Hallowell, MD, and John J. Ratey, MD — the first book to thoroughly discuss adults living with ADD.
“I put it off for a while, but when I actually started reading it, I was in tears by the third chapter,” says Koretsky. “It explained why everything was so difficult for me, and it made me feel OK, that it’s not that there’s something wrong with me; it’s that I’ve been approaching things in the wrong way.”
An estimated 15 million Americans suffer from ADD, the majority of them undiagnosed. Once considered a childhood disorder that’s outgrown by adolescence, it’s now known that 60 to 70 percent of children diagnosed with ADD continue to experience it as adults.
Characterized primarily by excessive distractibility, impulsivity and restlessness, ADD can wreak havoc in one’s personal and professional life. Too often, substance abuse, serious depression, job failure or a broken marriage are the wreckage left in the disorder’s wake.
“Traffic accidents are eight times more common among those with ADD. The prisons, divorce courts and unemployment lines are full of people with undiagnosed ADD,” says Hallowell, director of the Hallowell Center, a clinic specializing in the treatment of ADD in New York City.
“Having ADD can be a curse,” says Hallowell — who speaks from personal experience, having both been diagnosed with the disorder himself and raising two sons with ADD. But, he notes, it is not a life sentence. With the right knowledge, skills and strategies, ADD can be a unique gift that helps people thrive. “Once you learn how to live with ADD, it becomes a wonderful blessing.”
That was precisely Koretsky’s experience. Before her diagnosis, she says, “I was really struggling. It felt like I had to put in so much more work and effort just to keep things together; it was hard for me to get to work on time; there was never any food in my fridge; there was never any time to keep the apartment clean or get my laundry done. It felt like I was constantly struggling to keep up.”
Her diagnosis, she says, “explained so many of my challenges, like disorganization and poor time management, but it also validated my strengths — creativity, compassion and drive.”
Koretsky drew upon those strengths when she left the corporate world to build a business helping other adults with ADD. She’s now a Senior Certified ADHD Coach and the founder of ADD Management Group. And she’s authored a book, Odd One Out: The Maverick’s Guide to Adult ADD (Vervante, 2007). Her experience has convinced her that, with the proper tools, people with ADD can do more than just manage their symptoms; they can harness their abundant energy and creativity to improve the quality of their — and their loved ones’ — lives. They can flourish.
What is ADD?
The hectic pace of modern life, the constant techno-interruptions of email and social media, the omnipresence of speakers and video screens in public spaces — it can make anyone feel distracted. And we all misplace our keys or forget an appointment now and then. But, as Hallowell notes in another book, Delivered from Distraction: Getting the Most out of Life with Attention Deficit Disorder (Ballantine Books, 2005), occasional periods of distraction do not necessarily mean you’re suffering from ADD.
“Because its symptoms abound in modern life,” he writes, “ADD is a seductive diagnosis; it is easy to imagine that you have ADD when you do not.”
It’s the intensity and duration of symptoms that determine a diagnosis of ADD. The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) lists 18 symptoms for ADD, clustered into two areas: inattention and hyperactivity-impulsivity. To warrant an ADD diagnosis, one needs to have experienced six or more of the symptoms from one or both of the groups for at least six months. The symptoms must impair your life in some way, and they must occur in two or more areas of your life — for example, home and work. (Hallowell has established a distinct diagnosing protocol at his clinic; see the “Diagnosis: ADD” sidebar.)
Attention deficit disorder is something of a misnomer. Someone with ADD doesn’t have a deficit of attention. It’s actually an inconsistency in attention, which allows people with ADD to hyperfocus at times. And contrary to some outdated stereotypes, many people with ADD are often clever and outgoing. But that combination of sociability and hyperfocus can present its own challenges.
“If I was in the middle of something and someone approached my cube,” says Koretsky, “I had a really difficult time transitioning to talk to them.” Yet, eventually, she would transition, and then chit-chat as the clock ticked toward — and then past — her deadline.
Many people also have the misconception that ADD is limited to hyperactive boys. (The DSM-IV technically classifies the disorder as ADHD, with the “H” standing for hyperactivity. But leading experts in the field, including Hallowell and Ratey, no longer use the “H,” noting that the disorder is not always marked by hyperactivity.) While boys are diagnosed with ADD three times more often than girls, this is likely because, in girls, the disorder typically presents as the “inattentive” or “dreamy” type (staring out windows or drifting off midconversation), as opposed to the “hyperactive” type.
Gina Masullo fits the description of the dreamy type. She was nicknamed “The Wanderer” in elementary school, she says, and got a bad reputation because she couldn’t stay put in her seat. “My teachers labeled me ‘under-challenged,’ so I skipped second grade,” she recalls. The move didn’t abate her restlessness, but she coped well enough to avoid getting disastrous grades.
As an adult, Masullo job-hopped. “I’d get really excited about a new job or a new opportunity and then all of a sudden just kind of go cold on it and make another job switch,” she says. “My tolerance for job stresses was pretty low, and I would just get frustrated and give up.”
When she was diagnosed with ADD at 30, Masullo promptly put strategies in place to manage it: She exercises daily, eats a high-protein breakfast and has made behavioral adjustments like using to-do lists. She also sees an ADD coach.
And she seized upon the strengths ADD affords her — energy, creativity and drive — to start her own public relations firm. She’s now thriving professionally and accomplishing things she’d never thought possible — like running her first 5K last year, something she says she’d never had the discipline to attempt before.
Diagnosing ADD requires a thorough evaluation with a medical doctor, psychologist or psychiatrist. The evaluation could take one appointment, or it could take a few weeks. The doctor may create a brain map, which is the recording and analysis of brainwave activity through neuroimaging, and a battery of psychological tests. Blood tests can rule out underlying factors such as a thyroid problem.
The most important diagnostic tool, though, is the person’s history. Sanford J. Silverman, PhD, a psychologist at the Center for Attention Deficit and Learning Disorders in Scottsdale, Ariz., has been treating adults with ADD for two decades. Silverman advises bringing along a family member or very close friend to the evaluation. “When you get somebody else’s input — particularly someone close to you that you’re living with — they’re going to point things out that you may not be aware of,” he says.
School records may be helpful, too. Since ADD doesn’t develop in adulthood, a person would have had symptoms dating back to childhood. (Although in rare cases, ADD symptoms can develop after a head injury.)
A proper diagnosis is important, says Silverman, because “you can have ADD symptoms from another disorder. For example, if somebody has an anxiety disorder, they may look like they have some ADD components.”
Sometimes a diagnosis of adult ADD comes on the heels of a child’s diagnosis. That was the case in Melissa Orlov’s family. Her daughter was diagnosed with ADD in 1999 and her husband a few years later. That’s not uncommon, says Orlov, a marriage consultant in Boston and the author of The ADHD Effect on Marriage: Understand and Rebuild Your Relationship in Six Steps (Specialty Press, 2010). “A child is diagnosed because they’re struggling in school; then the parent starts to read up about it and says, ‘Wow, that sounds familiar.’”
For most ADD sufferers, naming what’s been going on brings relief. “When you get the ADD diagnosis, you can finally shed all those accusatory, ‘moral’ diagnoses, like lazy, weak, undisciplined, or, simply, bad,” writes Hallowell in Delivered from Distraction. After the diagnosis, he says, you can begin to “unwrap your gift” — and begin using ADD’s positive aspects to your advantage.