Does Adult ADD Really Exist?

Some people wonder whether the diagnosis of ADD makes any sense.  So many people have symptoms of ADD, like forgetfulness, procrastination, disorganization.  Maybe ADD is just a faddish diagnosis of the month.  A number of observations and facts make me think otherwise.

It may be true that everyone has some symptoms of ADD.  But it is also true that everyone has had some symptoms of pneumonia: cough, fever, and headache.  The difference between pneumonia and a cold is 1) the symptoms of pneumonia are much more severe, 2) the effects of the symptoms on people's lives is much greater, and 3) patients with pneumonia respond to treatment designed to treat pneumonia.  

To make the diagnosis of ADD, the severity of the symptoms should rise significantly above the level at which they are commonly seen in the general population.  And there should be more than just a few symptoms at that level.  Symptoms might include procrastination (all with all symptoms to follow, they should be severe and contribute to significant impairment), memory problems, distractibility, disorganization, difficulty prioritizing, difficulty focusing, difficulty maintaining concentration, difficulty following a conversation, difficulty being on time, a tendency to interrupt other when they are talking, problems completing a task, problems reading and understanding.  They must cause significant impairment in important areas of a person's life, such as their work, schooling, social life, and/or family life.  If, because of their distractibility and/or impulsivity, a person has lost friends and jobs, gotten multiple speeding tickets, or has often engaged in impulsive behavior, this too should be considered in making the diagnosis.  It strengthens the likelihood of the diagnosis if the person's symptoms started in childhood and if a blood relative exhibits ADD behaviors or was diagnosed with ADD. 

I have found that many motivated people can compensate for their ADD symptoms by working harder and longer.  But this can help just so much - when a person with ADD reaches a point in life where they advance to a point where they must function at their optimal level, they not infrequently fail or, facing failure, decide to be evaluated and treated for ADD.

The diagnosis requires that other explanations of the symptoms be excluded, such as chronic tiredness from sleep apnea, medical problems, neurological problems, hearing problems, true laziness or irresponsibility, a learning disorder, thyroid problems, etc.  Sometimes psychiatric disorders like depression or anxiety can be caused by the effects of ADD on people's lives, but sometimes the symptoms of depression and anxiety can resemble ADD.

Unfortunately there is no psychological, chemical, or X-ray test that makes the diagnosis.  It can only be made on the basis of a careful lifelong examination of a person's functioning. 

The diagnosis is made more difficult by the fact that many people with ADD can operate quite normally in many circumstances, for example, when there is a lot of pressure on them to perform, when they have just physically exercised, sometimes when they have had a lot of caffeine, when the clock is running out on a task and they must complete it very soon, when they find a task (or a game) particularly interesting.  This normalizing effect also occurs during a person's first visits to a doctor for ADD evaluation.  If the doctor doesn't take this into account, he or she may dismiss the possibility that the patient has ADD because the patient appears to be so focused and attentive.  Of course, it is true that almost everyone is more focused when there is more pressure, but the difference is much greater in patients with ADD, for whom the drop-off in focus occurs more often, lasts longer, and has much more troublesome consequences. 

In lay terms, all the situations mentioned above in which people with ADD function better are ones in which a person's adrenalin is running high, when they feel pumped up.  And when their adrenalin is low, like when they are bored or when they are sleepy, their adrenal get lower and their symptoms get worse.   

It is no coincidence that the most effective treatments of ADD are the stimulants, which in many ways mimic the effects of adrenalin.  While they can make some people who don't have ADD somewhat more alert and focused, their effects on people with ADD is much more dramatic.  Because of this adrenal effect, people sometimes feel anxious until they get used to the medication, and it sometimes raises their blood pressure.

Of course, the medication is not a panacea: only 75% of patients with ADD have an effective response, and the response can vary from mild to dramatic.  And there is no way to predict which patient will respond well and which won't.  The medications have side effects and rarely adverse effects, including death among a small number of people with coexisting heart disease.  (Be sure to discuss this with your doctor before you begin treatment with any medication.)

It is true that most adults and children who have ADD are unfortunately not diagnosed or treated for it, but it is also true that the diagnosis, or label, is often misapplied to many people, especially children, who don't have it. 

I have practiced psychiatry for over twenty five years and treated a wide variety of disorders.  None that I have treated has generally responded so well and so quickly to treatment.  And no treatment that I have used over the years has had so few side effects as the stimulants.  I have seen more than a few adults' eyes tear up as they described the remarkable effects of the medication had on their functioning, as they think about how many years and opportunities they have lost because they were not able to focus and concentrate effectively because they didn't know that ADD existed and could be treated.

ADD does exist, and its symptoms usually respond well to treatment.

If you have any questions, please click here to let me know.  (I do not make referrals so kindly do not email me asking for one.)