The Manhattan Adult Attention Deficit Disorder Support Group

New York Daily News, 11/10/04

IT DOESN'T ADD UP

DO YOU HAVE ATTENTION DEFICIT DISORDER
OR ARE YOU SIMPLY OVERWORKED?

by Jordan Lite

After being frazzled in her previous corporate job, Diane DeLisa downsized her anxiety by buying a bridal shop, Reba Brides.

When Diane DeLisa first started spacing out in meetings, she laughed it off as part of growing older.

But when some of her nieces and nephews started school and had trouble focusing, DeLisa, then a corporate vice president, started to wonder. Everyone was buzzing about attention deficit/hyperactivity disorder, and DeLisa, 49, started to think there could be something more to her zoning out and procrastinating on the job than she initially believed.

"When I was growing up, there was no such thing as ADD in children or adults," DeLisa recalled, referring to the disorder by its acronym. "When they started to talk about ADD in adults I thought, you know, I do have some of these tendencies.

"Everyone fits into the mode a little bit," said DeLisa, who lives in Nutley, N.J. "Everyone can be a little disorganized."

Early this year, DeLisa turned to Frank Coppola, an executive coach in Manhattan who works with many adults with ADD.

(Hyperactivity -- the "H" in ADHD -- tends not to be as prominent in adults with the disorder as it is in children.) Coppola (www.addcoachinggroup.com) suggested that she get evaluated for the disorder.

As it turned out, DeLisa didn't have ADD, as is the case for most adults who have trouble staying organized, remembering things, managing their time and completing tasks. But barraged with E-mails, telephone calls and other distracting accouterments of 21st-century living, DeLisa had what ADD expert Dr. Ned Hallowell calls a "case of modern life," which brings out ADD-like symptoms in people who don't suffer from them when they're in calmer environments.

True ADD is often hereditary and is associated with low levels in the brain of the chemicals norepinephrine and dopamine. The disorder cuts across all aspects of an adult's life, including his work, home and social lives.

Dizzying demands

Conversely, the "modern life" problem -- Hallowell also calls it "attention deficit trait," though it's not something that can be detected with a blood test -- isn't thought to be a genetic one. Instead, it's the unintended consequence of over stimulation, and is likely to be most damaging in just one aspect of a person's life. That place is often the office.

"Our brains are now able to attend to so much that we're asking them to attend to, at times, more than they can keep up with," said Hallowell, whose latest book on ADD, "Delivered From Distraction," will be published in January.

"The multiplicity of demands that we put upon our brains these days is dizzying," he said. "For some people it's no problem at all, but for more and more people, they get overwhelmed by it and then you begin to become impulsive and distracted and a little bit frantic, and your emotional state changes from a sort of reasonable problem-solving mode to kind of a major survival mode -- and in that mode we're simply not as effective."

The nearly two decades since adult ADD was officially classified, however, have yielded a welcome bonus to those without the disorder: Coaches and therapists have found that the strategies that help ADD adults also work for people whose behavior mimics theirs.

As recognition of adult ADD has grown, more people without the disorder are reaching out for help, said Hal Meyer, co-founder of the New York City branch of Children and Adults with Attention-Deficit/Hyperactivity Disorder.

"Everybody has issues of organization, everybody has issues of procrastination, where they can't balance their checkbook, or they can't find things," Coppola said. When they seek the help of a coach, "the techniques that are used are actually exactly the same."

Some of those techniques include:

Managing your time. If you're often late, plan your activities around what time you need to leave for your next appointment, rather than what time you need to arrive there, Meyer said. "When they start thinking, ‘When do I need to leave?' they think they're late at 20 to 9, rather than at 9," Meyer said of his clients.

Limiting your schedule. If you're overbooking your children, you're overbooking yourself. "You need to reduce the amount of stimulation that you allow into your brain every day, and really select it carefully," Hallowell said.

Ending procrastination. List your responsibilities on index cards, and order them according to what needs to get done first. Write down how long each will take, then assume it will take twice as much time to complete, Meyer suggested. (Manhattan coach Bonnie Mincu has an online exercise that teaches you to better predict how long an activity will take; www.thrivewithadd.com/thrive/pdf/time_sense_exercise_tool.pdf.) Thinking of deadlines as appointments, rather than due dates, also has helped some of Meyer's clients, he said.

Getting organized. Straighten up your desk and home. Before you leave, make sure your drawers and closets are closed and that your dishes are cleaned or in the dishwasher. If you tend to forget your keys or the documents you need for meetings, put them in a basket that you leave by the door so that taking them with you becomes rote.

Planning breaks -- and then sticking to the amount of time you've allotted for them.

Exercise. Physical activity generates chemicals deficient in people with ADD, including dopamine and epinephrine, Hallowell said. These same chemicals are also used to treat depression and anxiety, he said, and provide "a wonderful, refreshing bath for your brain."

While certain drugs help the majority of adults with ADD, they're not recommended for someone who just has the trait, said Dr. Lenard Adler, director of the adult ADHD program at New York University School of Medicine.

The burgeoning coaching industry, however, has no formal accreditation system, Meyer warned. He recommends asking prospective coaches .... [missing text]

Ready, aim… CONCENTRATE!

While aspects of modern life may be more likely to bring out ADD-like tendencies in people who don't have the disorder, experts don't believe that true ADD develops in adulthood.

But more adults than in the past are consulting psychiatrists to find out whether they've had ADD all along, said Dr. Lenard Adler, director of the adult ADHD program at New York University School of Medicine. Some are concerned after hearing about the condition in the media, or after their child has been diagnosed.

Roughly 4%-6% of adults are believed to have ADHD. When a child has the disorder, there's at least a 40% chance that one of his parents does, too, Adler said. Yet an estimated 80% of adults who have ADD don't know it, according to Joseph Biederman, a psychiatry professor at Harvard University.

Adler explains how psychiatrists evaluate adults for the condition:

"Making the diagnosis of ADHD in adults is predicated on four things," Adler said:

Accident-prone

"The first thing is that you have to have not just a symptom, but a constellation of symptoms. You need to have six of nine inattentive symptoms — meaning trouble with organization, trouble with task completion, distractibility, misplacing things — and/or six of nine hyperactive/impulsive symptoms such as restlessness, difficulty waiting when you have to take turns, interrupting others, inability to relax.

"The second thing is, it's not enough just to have symptoms. You have to have impairment from the symptoms in at least two realms of your life, meaning at work or at school, at home and/or in social settings.

"The impairment can be relative," Adler said. "Adults with ADHD are often very bright [but] are likely to underperform, change jobs more frequently or be fired from their jobs. In terms of their marriages, they're more likely to be divorced or separated.

"Adults with ADHD are more likely to have more serious motor-vehicle accidents, more speeding tickets, more traffic citations, and when you put them on a driving simulator, they're more likely to have more false braking and false steering," he said. "And if untreated, adults with ADHD are more likely to abuse substances. Those impairments are all very real and affect the quality of life for adults with ADHD who are not treated.

"The third thing is, you have to have a childhood history of some of the symptoms," Adler said. "You don't have to be diagnosed in childhood, but some of the symptoms must go back to early elementary school. So if you're just having symptoms because of a life stressor, you're not going to have that childhood history.

"The fourth thing is that the symptoms have to be from ADHD and not another mental-health disorder," he said. "For example, mood disorders like depression and bipolar disorder tend to be more episodic; they tend to come and go."

A new six-question screening tool (www.med.nyu.edu/psych/assets/adhdscreener.pdf) can help you identify whether you're likely to have ADD. But only a person specializing in the condition can make a diagnosis.

Copyright 2004 Daily News, LP

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