Adventures In Fast Forward

Life, Love and Work for the Add Adult

Kathleen G. Nadeau

• Publisher: Routledge
• Year: 2013
• Print ISBN:
  9780876308004
  9781138462373
• Edition: 1
• eBook ISBN:
  9781135063245
• Topic: Psychology
• Subtopic: Inclusive Education
• Index: Psychology

Written in response to common questions posed by adults with ADD in the author's clinical practice - and for all adults with ADD, as well as those who care about them - this book is designed as a clear and practical guide for day-to-day life. The author's perspective is one of compassionate realism as she answers specific questions related to understanding and accommodating ADD whether making daily decisions or larger life choices.

1

Understanding Adult ADD

Understanding Adult ADD

WHAT IS ADULT ADD?

Our understanding of Attention Deficit Disorder keeps growing and changing. For years the disorder was known as “hyperactivity.” The professional community thought that it was strictly a childhood disorder that was outgrown sometime during adolescence. By the late 1970s, researchers in the field became interested in other symptoms such as inattention and distractibility. Some children showed the symptoms of distractibility and inattention without being hyperactive. The focus then began to shift to an emphasis upon attentional problems. In 1980 the disorder was officially renamed Attention Deficit Disorder with two subtypes: ADD with and ADD without hyperactivity. Also in 1980, a new category, Attention Deficit Disorder–Residual Type, was added because some children continued to show attentional problems as they became adults. Despite this early recognition of “residual type” adult ADD in 1980, it was not until 1990 when Dr. Alan Zametkin published the first research article on adult ADD in a medical journal,^* that a public awareness of ADD in adults really began to develop.

A photo of a PET (positron emission tomography) scan of an adult with ADD, similar to the one placed at the beginning of this chapter, was suddenly famous when it was featured in national news magazines. This PET scan demonstrated clearly for the first time that there were measurable differences in brain functioning in adults with ADD in comparison to non-ADD adults.

Throughout this book the term ADD is used to include all types of attention deficit disorders. The reader should note, however, that the “official” term used by the American Psychiatric Association is Attention Deficit/Hyperactivity Disorder (AD/HD). (Confusingly, even though the APA recognizes that some people with the disorder are not hyperactive, it continues to include the word hyperactivity even in the non-hyperactive subtype.) This chapter addresses only the official diagnostic criteria for AD/HD according to the American Psychiatric Association. Several adult ADD rating scales have been developed as well, including the “Utah Criteria” developed by Paul Wender's research group, and the Copeland Scale, developed by Edna Copeland, which address a broader range of symptoms than those listed by the American Psychiatric Association.

The official “definition” of Attention Deficit Disorder, along with the criteria for other disorders, is contained in the Diagnostic and Statistical Manual of Mental Disorders (DSM), published by the American Psychiatric Association. Periodically the DSM is revised, most recently in 1994. This latest version, the DSM-IV, presents us with changes in both the terminology and criteria for Attention Deficit Disorder. The DSM-IV refers to ADD as Attention Deficit/Hyperactivity Disorder, with three subtypes:

1. Predominantly Hyperactive-Impulsive Type

2. Predominantly Inattentive Type

3. Combined Type (meets criteria for both of the above)

The DSM-IV also allows the category in partial remission for adolescents and adults who no longer meet the full criteria for AD/HD of any subtype.

From the point of view of adults with ADD, the DSM-IV guidelines include two important changes in earlier definitions of ADD:

• There is clear recognition that Attention Deficit Disorder continues into adulthood.

• The predominantly inattentive subtype emphasizes more of the symptoms that are typically troubling for adults with ADD.

WHAT ARE THE SYMPTOMS OF ADD?

The following list of ADD symptoms follows the guidelines of the DSM-IV, but the wording has been adapted in some instances to be more descriptive of adults.

Inattention

• Distractibility

• Inattention to details (as in paperwork)

• Failure to complete tasks

• Poor planning ability

• Disorganization

• Resistance to tasks requiring an effort to concentrate

• Forgetfulness

• Tendency to lose or misplace personal items

Hyperactivity

• Feelings of restlessness

• Small-motor fidgeting—“nervous habits” such as toe tapping, drumming fingers

• Difficulty in quietly engaging in leisure activities

• Tendency to be talkative

Impulsivity

• Tendency to interrupt or intrude upon others

• Difficulty waiting one's turn in interactions with others

• Tendency to blurt out a response without waiting for the speaker to finish his or her question

The DSM-IV category Combined Type provides for categorization of individuals whose symptoms satisfy the criteria for both the inattentive and hyperactive-impulsive patterns.

AD/HD in Partial Remission

Six or more symptoms must be present for a diagnosis of ADD to be made; but if fewer symptoms are present, it is possible to make a diagnosis of AD/HD in partial remission. Many adults may tend to fall in the partial remission category.

In addition to the need for six symptoms, these are the other requirements for an AD/HD diagnosis:

• Symptoms are more frequent and severe than in others of similar age.

• Symptoms must have been present before age 7.

• Symptoms must be observed in more than one primary setting.

• Symptoms must interfere with academic, social, or occupational functioning.

• Symptoms are not the result of another disorder.

ARE THERE OTHER CHARACTERISTICS OF ADULT ADD?

The preceding section discussed only those symptoms included in the “official” symptom list of the DSM-IV. There are, however, many other problems and patterns seen in adults with ADD. Below is a brief list of some of these characteristics.

• Chronic forgetfulness

• Problems with time management

• Tendency to take on too many tasks at once

• General disorganization—late, rushed, unprepared

• Difficulty managing checkbook and finances

• Frequent moves and/or job changes

• Tendency to speak before considering consequences

• Difficulty controlling temper

• Difficulty managing paperwork

• Underachievement

• Tendency to seek “caretakers” to manage details of life

• Periodic depression (often begins in adolescence)

• Difficulty maintaining long-term relationships

• Tendency toward substance abuse

• Problems with decision making—either impulsive or obsessional

• Underactive, with a prior history of overactivity

• Low frustration tolerance

• Tendency to leave projects incomplete

• Pattern of short-lived interests

• Difficulty concentrating when reading

• Difficulty during intensive learning situations

• Thoughts tend to wander when listening to others

• Tendency to be a “night owl,” with difficulty rising on time in the morning

Not all adults with ADD share all of these characteristics. The preceding list is not meant as a diagnostic tool, but rather is intended to briefly describe some of the cognitive, emotional, and behavioral patterns often seen in adults with ADD.

WHY WASN'T ADULT ADD RECOGNIZED EARLIER?

ADD is not a new disorder; it is a newly recognized disorder. The recent awareness of ADD in adults is the result of our increased understanding of ADD. The Diagnostic and Statistical Manual of Mental Disorders—Third Edition (DSM-III) recognized for the first time in 1980 that ADD, in some instances, continues into adulthood. The diagnostic category Attention Deficit Disorder-Residual Type (ADD-RT) was added to the DSM-III.

During the 1980s, Dr. Paul Wender and others at the University of Utah developed their own set of criteria for diagnosing adults with ADD and conducted a series of research projects. During this same period several longitudinal studies were undertaken, most notably by a group headed by Gabrielle Weiss and Lillian Hechtman, who described their work in the book Hyperactive Children Grown Up. Both groups, however, studied individuals whose characteristics conformed to the hyperactive subtype of ADD, ignoring perhaps the largest groups of adults with ADD, who fall into the predominantly inattentive category.

Despite this ongoing research, widespread awareness of ADD in adults did not exist. In the mid-1980s, active parents’ groups began to form to advocate for the needs of children with ADD. At their meetings, many parents quickly realized that they shared many of the same characteristics seen in their ADD children. These adults began to refer to themselves as ADD adults. In this way, recognition of adult ADD, particularly including the nonhyperactive variant, piggybacked on the wave of concern for children with ADD.

In November 1990, an article was published in the New England Journal of Medicine that described a study of adults whose histories suggested AD/HD in childhood; it was conducted by Dr. Alan Zametkin of the National Institute of Mental Health. Zametkin's study suggested a physiological basis for AD/HD. Ironically, adults were studied not from a specific interest in adult issues, but because the low level of radiation emitted by the PET scans (positron emission tomography) used in the study was considered too risky for children. Adults eager for recognition of their disorder, and for help, embraced Zametkin's study, the first research that seemed to offer real “proof of adult ADD. During that same month, at the national meeting of CH.A.D.D. (Children with Attention Deficit Disorder), a panel was organized to discuss ADD in adults.

In the few years since the first panel on adult issues was organized at a CH.A.D.D. annual meeting, the recognition of adult ADD has come a long way. CH.A.D.D., the largest national organization concerned with ADD, has officially changed its name to include “adults” in its title. ADDA, another large national group, focuses exclusively on t...

Table of contents

• Front Cover
• Half Title
• Title Page
• Copyright
• Contents
• Foreword
• Acknowledgments
• Introduction
• CHAPTER 1 Understanding Adult ADD
• CHAPTER 2 Diagnosing Adult ADD
• CHAPTER 3 Treating Adult ADD: Medication and Psychotherapy
• CHAPTER 4 Learning Life-Management Skills
• CHAPTER 5 Building a Strong Marriage
• CHAPTER 6 Family Life: Stresses and Strategies
• CHAPTER 7 Improving Social Skills
• CHAPTER 8 ADD in the Workplace
• CHAPTER 9 Continuing Your Education
• CHAPTER 10 Women and ADD
• CHAPTER 11 Self-Advocacy for Adults with ADD: Evaluating and Creating Resources
• CHAPTER 12 Success Stories: From College Years to Senior Years
• Resource List
• References
• Index