Wednesday, December 29, 2004

Abby's Position Statement on ADD and ADHD

Yet another Tribe friend contacted me this morning to say that he thought he might have ADD. I know that for each person who begins to have these thoughts, it's a brand new world of consideration, but for me, whether or not someone has ADD or ADHD is kind of a regular part of my week, both personally and professionally.

Let me cut you off right now if you think you're going to find a nice person to debate the very existence of this disorder with me. You see, I'm not interested. I know a lot more about this than you do, and I'm not interested in bringing you over to my side about it. That's your question to consider, not one I ever wish to debate ever again. I've put in my time on that one. Been there. Done that.

If you ask me whether I think ADD or ADHD exists, I will say that, without question, it does. Is it overdiagnosed? Absolutely. Do I believe in medication? For those who need it, absolutely yes. For 4 year old kids? Almost never. At that age, being hyper and inattentive is developmentally appropriate. Wait until your kid is 7 and then get back to me. Is stimulant medication overprescribed? Oh my god, YES!

The next thing I want to do is to answer a question you may be about to ask. That question is: What's the difference between ADD and ADHD? Well, the H was added not that long ago, and it stands for Hyperactivity. It was added because some people have a lot of hyperactivity (as in wiggly-ness) and some people don't. When it comes down to it, I just don't think the distinction is all that important. In my mind, the only salient point here is that if you don't have the H, there is a much better chance that your issues with concentration, attention, and impulsivity will be much less likely to be noticed. I tend to call it all ADD. When I was first diagnosed and medicated (in 1979), they were calling it Minimal Brain Dysfunction. Seriously!

A few important points:
  • There are many look-alike issues that are misdiagnosed as ADD. Examples are anxiety, learning disability (No, not low IQ. LD is when your IQ is normal or above, but you're struggling in one particular area.), Autism, childhood depression (especially in boys).
  • It is possible to have ADD and another diagnosis at the same time. I've noticed lots of kids with ADD and Anxiety, ADD and Depression, and I've worked with many kids with Austism or Asperger'w who are also medicated with stimulants.
  • If you weren't having any issues before age 7, or if you spontaneously started having problems when you got to college, it probably isn't ADD. It doesn't just start mid-life. On the other hand, you may have been smart enough to get along fine until greater organization and longer readings came into play, and then WHAMMO! If that's the case, then maybe it's ADD.
  • If you or your kids ends up on meds, try keeping a journal of the effects, including appetite, sleep patterns, and when concentration is good and bad. Getting the dosage amount and timing right requires close med monitoring. It's rare that the first prescription will work perfectly. It almost always needs tweaking, and over time, the effects can morph, so keep in close touch with your or your child's psychiatrist.
  • ADD relates to inconsistent attention, not poor attention at all times. Kids with ADD who are having trouble with homework might work harder if you can find a way to link their work to their interests. If a kid likes baseball, then he will write more if it's about baseball. True for all kids, but MORE true for kids with ADD. And true for adults with ADD, too.
  • They used to say we grew out of it. WRONG! So not the case. We get less wiggly, but that's it. Trust me on this one.
  • People diagnosed with ADD as adults often report that they were smart enough to finish college or follow through on adult responsibilities, but for some reason they didn't. That's a story I hear a lot more often than you'd think. I'm just saying.
  • Do I think you shouldn't take stimulants when you aren't at work or school? NO! Take them every day. It's affecting your social skills and your basic tasks of life more than you know.
  • ADD and Sex. Can ADD affect your sex life? YES! This is one that isn't written about a lot, but I learned a lot about this from a shrink who works with my dad. She said that most adults with ADD are either chronic masturbators/sex addicts OR they are extremely sensitive to touch and have almost a forcefield around them. Interesting. I wish someone would write more about this.
  • A wise shrink once said that adults with ADD are very sensitive, but they lack insight. So, they take it very personally when someone tells them to chill, but they don't have a clue what they were doing that led someone to tell them that in the first place. They are not great judges of their own behavior. I have found this to be true.
Internet Junkies and ADD

OK, so lots of people who hear that I'm a psychologist-type and that I have ADD approach me on Tribe wondering if they have ADD. Here's my thought about that. I gravitate to people who are speedy and fast thinkers because that's how I am. Everyone else are what my friend Adam calls "the slows!" I think that Tribe and Internet Junkies are more likely to have ADD than the average man on the street. Hell, sometimes I think that the ability to keep up with me might constitute a diagnostic criteria! But I don't want to be the one to start diagnosing my friends. I can't do that ethically. It just ain't right.

The Advice

If you are an adult, read Driven to Distraction. If you're a woman, and you're not hyperactive, I also recommend reading Women With Attention Deficit Disorder: Embracing Disorganization at Home and in the Workplace. (Women are often not diagnosed because they lack the hyperactivity. I was lucky because I was SO HYPER!). See if the books rings true for you. If it does, then call up a local psychiatrist and set up a session to check it out.

If you have a child you suspect has ADD, DO NOT (I repeat) DO NOT go to a pediatrician to get an ADD diagnosis for your child. I really recommend getting a real thorough eval from a child psychologist first (Clinical or School Psychologist - the public school system will do it, but it will be less thorough and will take time), and HAVE THEM DO A CLASSROOM OBSERVATION IF POSSIBLE! Then, if they think it's ADD, have them refer you to a psychiatrist for the med monitoring. Give the psychiatrist a copy of the psychological report. That will help them a lot.

If this advice has been helpful, please click here and help me get a free iPod! :P