Adult Attention Deficit Disorder

Adult ADD is the name given to a variety of syndromes in which psychological functions such as planning, concentration, managing time and tasks, maintaining focus, and making thoughtful decisions are impaired, and no other condition can be found to explain the impairments.  Affected individuals have serious problems in one or more of the following areas:

• screening out distractions

• starting and completing tasks

• remembering and organizing information and belongings

• being on time

• keeping priorities in order

Individuals with the disorder can get lost doing unimportant activities, heedless of more important jobs that need to be done.  At times, they may have difficulty with their short term memory.  They may not fulfill their obligations until the last moment or complete a task only when they feel an external pressure to do so.  Symptoms are particularly burdensome to those whose work involves deadlines and/or organizing and recalling complex information. 

People suffering from ADD often feel unfairly nagged by those around them and sometimes become defiant when confronted with their performance problems.  Their underachievement often leads to reduced self-esteem, depression and anxiety.  Some undertake psychotherapy to deal with interpersonal conflicts that are caused by the disorder or to gain control over their seeming negligence.  

Mild or non-specific deficits of executive functions, such as planning and organizing, are common in the general population, particularly among older people.  Executive functions may also be affected by injury to the brain, fatigue, alcoholism, Alzheimer's, and other medical disorders.  In addition, various psychological disorders, including learning disabilities, schizophrenia, depression, and anxiety, may impair executive dysfunctions.

ADD first becomes evident in childhood although frequently it is not recognized at the time.  Many people are able to compensate for their symptoms until they are faced with especially challenging tasks in high school, college, the workplace or parenting.  Since ADD has a strong hereditary component, ADD in a child is an indicator that one or both parents may suffer from ADD and vice versa.

ADD is associated with abnormalities in various parts of the brain, especially the frontal lobes.  At the present time, there is no definitive test for the disorder.  The diagnosis is based on a thorough assessment of a person's present and past functioning and, if possible, the report of a friend or relative who has observed the individual's daily behavior.  As with most psychological disorders, the severity of the symptoms and their impact on the patient's life are important factors to consider in deciding whether to make a diagnosis.  Psychological testing can sometimes be helpful in identifying learning problems that may need special attention.  They should never be used as the sole basis for making the diagnosis since some people with ADD can concentrate long enough to do well on tests or an interview but still have disabling ADD symptoms.  On the other hand, symptom questionnaires filled out by the patient or someone who knows the patient well can be useful for rapidly determining and monitoring over time the most significant areas of dysfunction.

Stimulant medication has been found to be effective for about 75% of adults with ADD in reducing or eliminating many symptoms of the disorder.   No other types of medication consistently provide the benefits of the stimulants.  Because other disorders that disturb executive function may resemble ADD, a careful assessment should be carried out by an experienced clinician before treatment is undertaken.