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ATTENTION DEFICIT DISORDER: Not Just a Children's Problem Anymore

Adult Issues Committee Children and Adults with Attention Deficit
Disorders CH.A.D.D National Board of Directors

This article may be reproduced and distributed without written
permission.

     There has been a growing realization that Attention Deficit
Disorders (ADD, ADHD) persist into adulthood for many individuals.  The
core symptoms of ADD, inattention, impulsivity, and overactivity are
most evident during childhood, but it is now known that they continue
into adulthood for a significant percentage of children with ADD.
Unfortunately, relatively few adults have been identified or treated for
ADD. ADD in adults is a "hidden disorder" in which the symptoms of ADD
are often obscured by problems with relationships, staying organized,
and holding a steady job.  A number of adults who are diagnosed ADD are
first recognized as having problems with substance abuse or impulse
control. Another factor relating to the under-diagnosis of ADD in adults
is that many mental health practitioners have received little training
in childhood disorders or were trained during the time when it was
assumed that children with ADD "grew out" of their symptoms. The growth
of CH.A.D.D. as a national organization, recognition of ADD as a
significant disability by parents and professionals, and increased media
attention to ADD have all contributed to the growing interest in adults
with ADD.  In adulthood the symptoms of ADD affect not only individuals,
but their families, friends, and others with whom they come into daily
contact.  Adults who are diagnosed with ADD can learn how it has
influenced their development and how they can cope with their symptoms
in order to live more successfully.

Characteristics of Adults with ADD

Most adults grew up at time when clinicians, educators, parents, and the
general public knew little or nothing about ADD, and even less about its
diagnosis or treatment.  As a result adults who are living with the
condition, and especially those who are undiagnosed and untreated, may
be experiencing a number of problems, some of which stem directly from
the disorder, and others which are the result of associated adjustment
patterns.  Their presenting conditions may include:

o  Distractibility o  Forgetfulness o  Chronic lateness o  Anxiety o Low
self-esteem o  Employment problems o  Substance abuse or addiction o
Disorganization o  Procrastination o  Chronic boredom o  Depression o
Mood swings o  Restlessness o  Relationship problems

The central or associated features of ADD range from mild to severe. ADD
can affect only a few areas of functioning, or it can impair nearly all.
The symptoms of ADD can be variable and situational, or constant and
unremitting. There is no one "ADD personality profile."  some persons
with ADD can concentrate if they are interested or excited, while others
have difficulty concentrating under any circumstances. Some avidly seek
stimulation, while others avoid it.  Some become oppositional, ill-
behaved and, later, antisocial; others may become ardent people-
pleasers.  Some are gregarious, and others, withdrawn.

Prevalence

     We are in the beginning stages of learning about this disorder in
adults.  Studies of children indicate that 3-5% have ADD.  Although it
is diagnosed more often in boys than in girls, this may be related to
the identification of hyperactive and/or aggressive behavior which is
more frequently demonstrated by boys. The prevalence of ADD in adults is
unknown; very few have been studied.  In the few treatment studies of
adults, there does not appear to be a significant sex difference. About
two-thirds of the children who are diagnosed in or before elementary
school with ADD continue to have behavioral symptoms in adolescence.
During this time period, associated behavioral, learning, and emotional
problems also manifest themselves.  Approximately one- third to one-half
of these adolescents continue to have symptoms of ADD during their adult
years.

What Causes ADD?

     The exact cause or causes of ADD are not conclusively known.
Scientific evidence suggests that in many cases the disorder is
genetically transmitted and is caused by an imbalance or deficiency in
certain chemicals that regulate the efficiency with which the brain
controls behavior.  An 1990 study at the National Institute of Mental
Health correlated ADD with a series of metabolic abnormalities in the
brain, providing further evidence that ADD is a neurobiological
disorder. While heredity is often indicated, problems in prenatal
development, birth complications, or later neurological damage can
contribute to ADD. There is little scientific evidence that
environmental factors, dietary factors such as food dyes or sugar,
middle ear problems or "visual motor" difficulties are the underlying
cause of ADD.

Diagnosis of ADD in Adults

     A multi-factored evaluation of an individual is important in the
diagnosis of ADD.  Diagnostic assessments of adults should be made by a
clinician or team of clinicians, who has experience and expertise in the
area of attentional dysfunction and related conditions. ADD with
hyperactivity is characterized by symptoms of inattention, impulsivity
and hyperactivity which have an onset before age seven, which persist
for at least six months, and which are not due primarily to other
psychiatric disorders or environmental circumstances such as reaction to
family stresses. The primary characteristic of ADD without hyperactivity
is significant inattentiveness.  Studies of children with this diagnosis
indicate that they show more signs of anxiety and learning problems, and
qualitatively different inattention.  Although there have been no adult
follow-up studies, it is projected that children who have ADD without
hyperactivity may have different outcomes than the hyperactive group who
show more externalizing behavior problems associated with oppositional
and conduct disorders. Various symptoms of ADD may reflect developmental
variations in some individuals, while in others, they may indicate that
other conditions, co-exist with ADD, including specific learning
disabilities, anxiety disorders, affective disorders, Tourette's
Syndrome, borderline personality disorders, and obsessive compulsive
disorder. The assessment is designed to look for the presence of
life-long patterns of behavior that indicate underlying attention and
impulse problems.  An evaluation of an adult should make use of
information from a variety of sources.  These may include:

o  A thorough medical and family history

o  A physical examination

o  Interviews or rating scales completed by others who can comment on
the person's behavior, such as a parent, friend or spouse

o  Observation of the individual

o  Psychological tests which measure cognitive abilities, social and
emotional adjustment, as well as screening for learning disabilities.

Why Identify ADD in Adults?

     Identification of adults who have ADD and appropriate management of
their educational, personal, and social development improves their
chances for a successful outcome.  Effective intervention can improve
self-esteem, work performance and skills, and educational achievement. A
proper diagnosis of ADD can help an adult put his or her difficulties
into a perspective.  These individuals have often developed low
self-esteem and negative perceptions of themselves as a result of
cumulative academic, social, and vocational failures.  Many have been
labeled as "having a bad attitude," "a slow learner," "lacking
motivation," "immature," "lazy," "spacey," or "self-centered."  Rather
than viewing their difficulties as the result of an inherited or
acquired neurobiological disorder, many have come to accept the
unsubstantiated belief that they themselves are to blame for their
problems.