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National Post, 3/8/04

A WHIRRING ADULT BRAIN

by Brad Evenson

At college, as he pored over calculus and physics textbooks, Esley Jedd Crowder would sometimes jab a dart into his leg to corral his wayward mind.

Other times, he took a cigarette lighter to his arm.

"And I made my B's," says the Tennessee architectural draftsman. "I made B's in physics and calculus and that was good enough for me."

Despite his intelligence and formidable energy, Mr. Crowder was a lifelong underachiever, never able to focus his thoughts properly.

He tried many ways to cope -- bagfuls of illicit drugs, up to 18 cups of coffee a day, even God. Nothing helped much, but he always scraped by.

Then, as he and his wife prepared to adopt their second child, Mr. Crowder had a breakdown.

That is when a psychologist surprised him with a diagnosis: He had attention deficit disorder -- ADD.

With all the media focus these days, most people know the stereotypical image of a hyper kid pumped full of Ritalin, someone with serious issues.

But like Mr. Crowder, millions of adults have symptoms of a mild "shadow" of ADD, which affects their personality.

They do not seem sick, or even unusual. They are often emergency room doctors, stockbrokers and pilots -- smart people who need stimulation to make their noisy, whirring brains feel good.

Many come to see the ravenous energy and creativity this shadow ADD can confer as a gift, not a disability, unless things go awry.

"A lot of my patients come in and they're doing well," says John Ratey, a professor of psychiatry at Harvard Medical School. "They're PhDs, whatever. But then they meet a situation that they can't do and lo and behold, they've been compensating their whole lives. Either they use their social skills to get the grade or get by. But now they've reached the point where they can't."

And while such critics as Peter Kramer, author of Listening to Prozac, say ADD is overdiagnosed in children, it is too often ignored in impulsive, distracted adults.

"This isn't a problem that goes away after puberty," says Margaret Weiss, director of research for the division of child psychiatry at the University of British Columbia.

"And one of the great problems we face is that once children with ADD turn 18, they are no longer eligible for [provincial] funding for treatment and counselling. This is a time when they are going to university; when they have tremendous stresses to deal with, like scheduling, organizing themselves to study and so on. This is a vulnerable time."

As much as 6% of the population is affected by ADD. The numbers are even higher if you include people who experience it for short periods. "New parents with babies up all night," says Dr. Ratey, "most of them have attention deficit disorder because they're sleep-deprived and their frontal cortex isn't working very well. They're having a bad brain day."

People with ADD are often dubbed prisoners of the present. Planning defeats them. They forget to remember what they must do later and lack the ability to screen out incoming stimuli. Everything is a distraction. Their brains seek the immediate reward of stimulus, a short-term addiction, so activities that reward them in the future -- piano practice, golf lessons, making a schedule -- are dropped. They need the intensity of the present.

The trait appears to have a strong genetic component. Studies show a five- to six-fold increase in the frequency of ADD among first-degree relatives compared to the general population. About a quarter of children and teens with diagnosed ADD also have a reading disability.

The problems can lead to underachievement in school. It can also damage friendships and love lives and harm self-esteem.

Experts say the solution lies in focusing on people's strengths and developing their coping strategies.

For example, ADD can hinder a person's ability to pay attention to some things. But if someone with ADD is interested, he or she can often hyperfocus on a task. The condition can also confer energy and an enhanced spirit of competitiveness. Not surprisingly, a significant number of emergency room doctors and Bay Street bond traders, who leap from crisis to crisis, have ADD. But because they are "prisoners of the present," they often fail to consider the future -- to wish. Writing down long-term goals and observing milestones can be a good strategy.

"I think much of psychology and psychiatry has been focused on problems and the symptoms rather than understanding how people are effectively managing and coping and functioning very well," says Toronto psychologist Doug Saunders.

While shadow ADD is believed to affect mostly men, women are not immune. In these women, it often shows up as anxiety or depression. And it can be very difficult to recognize.

Dawn Cook, 34, had a doctorate in psychology before she was diagnosed.

Tall and attractive, Dr. Cook was exactly the kind of person others envied. She picked up sports and musical instruments with a casual ease. She went to college on a basketball scholarship, getting great marks by cramming at the last minute. But she also had a habit of letting things drop.

"As soon as something took practice or involved a lot of detail, I quit," says the Georgia psychologist.

Dr. Cook's troubles arose after she left the structured life of university. In private practice, she had to create her own structure, business model, schedules and procedures. It overwhelmed her. "I had no internal secretary, no internal traffic director and so everything was important all at once," she says. "I began to second-guess everything I was doing."

Paralyzed with anxiety, she turned to a colleague, who diagnosed her with attention deficit disorder. It shocked her.

"No one taught me really the truth," she says. "All I learned about ADD was the rough surface, the list of symptoms. And that's what most people know. They have no idea about the true experience, especially for people who have hidden ADD."

When she read a book on the topic, Driven to Distraction by Dr. Ratey and Edward Hallowell, she felt they had climbed inside her mind. "It left me in tears," she says. "Everything made sense." With the aid of an ADD coach and daily Ritalin -- a drug she believes can be a magic pill for some people -- Dr. Cook now counsels children with the disorder, helping them achieve their potential by exploiting ADD.

"I look at it as a gift, not just the challenges that are involved but also the competencies as well," she says, adding her negative symptoms are under control.

"You feel ADD and you are ADD," she says.

Jedd Crowder is a pistol. Words come out in staccato bursts, like popcorn popping. Thoughts spring loose and get trampled by new ones so fast his monologues make people dizzy -- they often take a step backward, just to stay upright. You can hear him wave his arms. On the cellphone. And he's driving.

"Do you realize that if an everyday person has a million thoughts a day, an ADD person has almost four million a day?" he says.

"That's a lot on the brain." He pauses a moment during a telephone interview to merge in traffic.

In 2001, Mr. Crowder's brain could no longer rely on the nervous energy that kept him bounding from task to task.

"I was just incredibly tired, no matter what I did," he says. His brain was struggling to pay attention to what he needed to do. Instead of burning his arm to stay focused, he was burning a candle at both ends. "Sleep for four hours a day for a few weeks and you'll know what it's like to have ADD," he says.

A psychiatrist examined his medical history and academic record and made a rapid diagnosis. Mr. Crowder is very intelligent yet he had underachieved his whole life; it was an obvious case. However, the first ADD drug he took, Ritalin, made him feel like an automaton.

Kids in his Sunday school class wondered, what happened to their bouncy, fun teacher?

A few months later he tried Adderall, a slow-releasing stimulant. So far, its effects have helped. The first day he took it, his feet, which he normally tapped so incessantly he wore out tennis shoes by the dozen, stopped. "Once, I was sitting in my office at home and realized I was thinking of nothing," he says.

That had never happened before in his uncalm mind.

His work and family life have improved immeasurably. Yet he wishes he had been diagnosed much earlier, because it would have helped his academic record and work options. And his self-esteem. "You're basically labelled as stupid and an underachiever for most of your life," he says.

Men with shadow ADD have a reputation.

They are the enemies of women's magazines everywhere: the exciting ones; slightly dangerous; the Peter Pans who never grow up; the whirlwind affairs; the men who hyperfocus on new women but soon grow bored and distant. Their loves disintegrate messily. They forget birthdays. They move on.

Dr. Ratey points out ADD males have been scolded since childhood by female voices, starting with mothers and elementary school teachers. And men who enter a relationship expecting to be disapproved of usually are. Their brains need new stimulation all the time. "The high of falling in love with a new person may be significantly more organizing, and more soothing, to the [ADD] brain than the everydayness of a 20-year marriage," he says.

Sam, a 44-year-old venture capitalist, says the main difficulty his ADD caused was his failure to listen to women.

During a group therapy session for men in Ottawa recently, he told the group, "my girlfriend says I'm not attentive and I don't care about her concerns.

"But I do care," he continued. "It's just that I get distracted in my thinking and what she says goes in one ear, out the other. So she thinks I don't give a shit."

Sam, who tried stimulant medications but no longer takes them, offers advice to men with shadow ADD. "Buy a Palm Pilot and write everything down. Organize your schedule first thing in the morning, when your brain is rested. Find a woman who understands the problem or you're finished. And get ahold of CHADD."

CHADD, short for Children and Adults with Attention Deficit Disorder, is a non-profit organization with branches around the world aimed at supporting and educating people with ADD about the condition. But one of its principal benefits may be simply showing people with ADD their experiences are shared.

"The great thing about meeting other people with ADD is seeing what high achievers many of them are," Sam says.

"Suddenly, you realize your doctor or broker, or I'm sure plenty of journalists, have this gift. And I call it a gift because once you learn to understand and manage ADD, no mountain is too high."

Copyright National Post 2004