ADD

Overview

Attention Deficit [and sometimes Hyperactivity] Disorder (ADD/ADHD) is a frequently spoken of but little understood mental disorder. Right now you might be questioning whether it even exists. For a variety of reasons this is unfortunately common. I’m not going to try and persuade you with logical arguments1At least not in this article here and now. regarding the validity of ADD as a legitimate form of mental illness other than to note that as I have experienced significant relief in other areas (OCD, depression, and insomnia) it is the ADD which remains my greatest adversary and I often feel on the brink of tears due to the frustrations and failures it brings into my life. For me, this is serious and I hope it is or will be for you as well.

ADD/ADHD was once considered a childhood disorder, something that one grew out of as one entered into adulthood. More recent studies show that 4-5% of Americans still struggle with the disorder in adulthood.2Russell Barkley, Taking Charge, pg. 2. The misunderstanding regarding the nature of ADD arises in part from the way symptoms change as age progresses. In particular, the prevalence of hyperactivity decreases significantly among adults.3Russell Barkley, Taking Charge, pg. 6. This misunderstanding means that those who were treated for AD(H)D as children oftentimes continue to struggle with the disorder as adults but without appropriate treatment. It also means that many adults who were never properly diagnosed with ADD as children also are not receiving necessary treatment.

But what exactly is ADHD? ADHD is a genetically heritable disorder4Barkley, Taking Charge, pp. 23, 46. that causes sub-par performance in specific areas of mental activity (and this can then results in sub-optimal behaviors). The areas of the brain most affected by ADHD are those relating to executive functioning – e.g., the parts of our brain responsible for concentration, organization, impulse control, etc.

Medication is the most effective treatment for ADHD and a number of alternative treatments which can be effective will have minimal efficacy until medication is being taken for the ADD. 5Russell Barkley, Taking Charge, pg. 15.

Symptoms of ADHD/ADD

How does one know if one has ADD? Or how can one recognize ADD in another? While we need to rely upon medical professionals to help us arrive at an appropriate diagnosis6One of the reasons this is important is because there is overlap in the symptoms of different mental disorders. One could see symptoms that appear to indicate ADD but are in fact indicative of Depression or Anxiety or vice versa. the following list of symptoms7I am heavily indebted to helpguide.org’s ADD/ADHD page for this list. can be helpful in assessing whether someone is struggling with ADD.

I’ve placed an asterisk after symptoms I’ve experienced in the past or experience currently.

  • Focus Issues:
    • Trouble concentrating.*
    • Trouble staying focused.*
    • Short attention span.*
    • Lack of persistence in tasks.*
    • Zoning Out.*8While reading I oftentimes find myself needing to reread a section b/c my mind has begun thinking about something else entirely. I tend to read aloud as this requires more intentional effort and helps me remain focused, but I am still quite capable of losing focus even while reading aloud..
    • Difficulty completing (even simple) tasks.*9I oftentimes find mundane tasks like brushing my teeth and shaving painful. I am quite capable at some very complicated tasks and work with complex systems for a living, but the little things can be almost paralyzing.
    • Lack of attention to details.*10I avoid all skills which require the ability to do detail work – e.g. almost any form of art.
    • Poor listening skills.*11I have significant difficulty in recalling other’s names even when I make an intentional effort to remember them. Several years as a pastor significantly improved my skills in this area but I am still below the capacity of what many others are able to recall effortlessly.
    • Fail to remember/follow directions.
  • Hyperfocus.*12If you set me to programming I can become hyperfocused on this task for hours on end. Similarly with certain research topics – e.g. theology, history, psychology.
  • Disorganization:
    • Forgetful.*13I live by my smartphone. It tells me what I need to do and when. If it isn’t in the smartphone, I won’t remember.
    • Difficulty determining relevancy of information.*14I get overwhelmed by the vast amount of info. available on any topic – and have a hard time sorting out what I need to consider immediately and when I should stop researching and take action.
    • Prioritizing tasks.15I hate trying to decide what to do next, and even when I can I oftentimes feel great resistance to performing said task.
    • Tracking tasks/responsibilities.
    • Time management.*
    • Procrastination.*
    • Late to appointments.*
    • Misplacing things (e.g. keys, wallet, cell phone, glasses).*16This is constant. Oftentimes I will put something down and literally look for it two seconds later and be unable to remember where I put it…occasionally these items are glasses perched on my forehead, keys in my pocket, etc.
    • Inability to adequately estimate time required for specific projects/tasks.*
  • Impulse Control:17”Impaired ability to control impulses and delay gratification.” (Russell Barkley, Taking Charge, pg. 29)
    • Interrupt or talk over others.
    • Poor self-control.*
    • Speak before thinking.
    • Addictive tendencies.*
      • Compulsive eating.*
      • Substance abuse.
    • Act without regard for consequences.
    • Inability to follow social etiquette (e.g. sitting for extended periods).*
  • Emotional:
    • Feel one is not achieving one’s potential.*
    • Easily frustrated.*
    • Easily stressed.*
    • Irritable.
    • Mood swings.
    • Lack of consistent motivation.*
    • Hypersensitive to criticism.
    • Short (and sometimes explosive) temper.
    • Low self-esteem.
  • Hyperactivity / Restlessness:
    • Internal feelings of restlessness.*
    • Increased willingness to take risks.*
    • Easily bored.*
    • Racing thoughts.*
    • Fidgeting.*
    • Adrenaline Junkie.*
    • Constantly talking.
    • Hyper-Multitasking.*18I am always working on 70+ books simultaneously. It takes me forever to complete a book, but I read constantly.

Dr. Barkley’s book provides fascinating statistical evidence of these differences. For example, when polling an ADHD population versus a regular community population these sorts of differences appear:

  • “Fails to give close attention to details”, ADD: 74%, Regular Community: 3%.
  • “Difficulty sustaining attentuion”, ADD: 97%, Regular Community: 3%.

A much fuller description of differences is found in Dr. Russell Barkey’s book Taking Charge of Adult ADHD, pp. 32-34 as well as in the Appendixes on pp. 269-275.

Comorbidity – What is that?

ADHD is often comorbid with other disorders – this means that if one has ADD there is a significant likelihood that one also has another mental disorder and for a significant minority there will be yet a third.19Russell Barkley. Taking Charge of Adult ADHD, pg. 15. In my case the trifecta seems to be Obsessive Compulsive Disorder (OCD), ADD, and Depression.

In many cases one disorder will mask the others. For me it was my OCD. It wasn’t until significant progress had been made on treating my OCD that the ADD became apparent.

I know this may be disheartening news – but I assure you that it is better to find out and take advantage of the various methods available for treating the problem than to simply ignore it. All we do when we refuse to see the problem is allow it to fester below the surface and it oftentimes bursts out at the most inopportune times and in ways that are greatly detrimental to those we care most about.

Treatment

ADD is very responsive to medication and there is a significant likelihood that you can experience a substantial decrease in your symptoms simply by taking medication. Dr. Barkley notes, importantly, that while other treatments are important they oftentimes won’t be effective until one is already taking medication.20Taking Charge of Adult ADHD, pg. 16: “A lot of other treatments and coping methods have little effect unless the person with ADHD is also taking medication.”[/]ref]

You can learn more about treatments for ADD on my ADD Treatments page as well as specific regarding medications used to treat ADD on my ADD Medications page.

Barkley’s Five Areas of Difficulty in Managing Daily Activities

Dr. Barkley provides a list of five areas in which individuals with ADD oftentimes struggle on a daily basis. These are:

  1. “Poor Self-Management relative to Time, Planning, and Goals”21Russell Barkley, Taking Charge, pg. 48.
  2. “Poor Self-Organization, Problem Solving, and Working Memory”22Russell Barkley, Taking Charge, pg. 50.
  3. “Poor Self-Discipline (Inhibition)”23Russell Barkley, Taking Charge, pg. 51.
  4. “Poor Self-Motivation”24Russell Barkley, Taking Charge, pg. 53.
  5. “Poor Self-Activation, Concentration, and Alertness.”25Russell Barkley, Taking Charge. pg. 54.

The Executive Functions

Executive Functions are one of the areas where individuals with ADHD experience significant impairment. There is not complete consensus on the number or naming of these executive functions. Dr. Barkley’s list26See Taking Charge, pg. 69. includes the following:

  1. Inhibition
  2. Nonverbal Working Memory – “allows you to hold in your head pictures, sounds, tastes, touches, and scents.”27Taking Charge, pg. 72. This includes the ability to process spans of time and Barkley notes, “We can see further and further ahead…by adulthood (ages 20-30), behavior is typically being organized to deal with events 8-12 weeks ahead.” (pg. 73) Yikes! That isn’t me at all!
  3. Verbal Working Memory
  4. Emotions Regulation
  5. Planning/Problem Solving

Dr. Barkley suggests that knowing which areas of executive functioning for us helps us know which areas we should focus on treatment on.28Taking Charge, pg. 69.

Struggling with Time

  • Externalize Information – Instead of trying to remember things in one’s mind, use smartphones, computers, calendars, notepads, etc. to act as a reliable form of memory.29Russell Barkley, Taking Charge of Adult ADHD, pg. 91.
  • Make Time Physical – Use external means to make yourself notice the passage of time – for example use an alarm clock, timer, or smartphone to remind yourself at intervals how much time has passed.30Russell Barkley, Taking Charge of Adult ADHD, pg. 92.
  • Use External Incentives – That is, use incentives outside of oneself to incentivize what one needs to accomplish.31Russell Barkley, Taking Charge of Adult ADHD, pg. 92.
  • Normalize Neurology – There is no known permanent cure for the brain issues that cause ADD, but medications can be quite effective in helping the brain functional normally as long as they are in one’s system.32Russell Barkley, Taking Charge of Adult ADHD, pp. 92-93.
  • Externalize Rules – Make lists, physical, written lists.33Russell Barkley, Taking Charge of Adult ADHD, pg. 93.
  • Break Larger Tasks Into Smaller Components – Try to make these time quantifiable.[ref]Russell Barkley, Taking Charge of Adult ADHD, pg. 93.

 

Other Insightful Quotes:

  • “In our research, the average number of major life activities in which adults with ADHD said they were often impaired was 6 or 7 out of 10. ADHD causes serious impairment across all the domains of adult life, from education to work to family.” – Dr. Russell A. Barkley, Taking Charge of Adult ADHD, pg. 9.
  • “The fact is that adults (and children) with ADHD often report doing better on certain tasks than outside observation and objective measurements reveal. Driving is a particularly common example.” – Dr. Russell A. Barkley, Taking Charge of Adult ADHD, pg. 23.
  • “What distinguishes adults with ADHD from others is the considerably greater frequency with which they display these characteristics. Distractibility, inability to concentrate, and other problems reach a point of being developmentally inappropriate (rate) for their age group.” – Dr. Russell A. Barkley, pg. 32.
  • “ADHD IN ADULTS IS NOT MERELY A TRIVIAL DISORDER OF PAYING ATTENTION! Instead it’s a problem with the ability to organize behavior over time to prepare for the future. The five problem areas in ADHD add up to an exceptional nearsightedness about the future.” – Dr. Russell A. Barkley, Taking Charge of Adult ADHD, pg. 56.
  • “Poor inhibition is a problem that develops very early in life in most cases and remains a problem for adults with ADHD across their entire life. Parents, friends, and coworkers have probably been baffled by your inability to block out distracting sights, sounds, and movements for as long as you can remember. They can zero in on the task at hand; why can’t you? Do you perceive peripheral noises and sights better than other people? Are you more sensitive to everything that’s going on around you? No. People without ADHD can stop themselves from responding to distractions; they do it so automatically that they’re not even aware of having made an effort to do so….The same underlying problem that makes it hard for you to sit still and concentrate or to think before acting can, believe it or not, also make it difficult to stop what you’re doing….If what they are doing is particularly fun, rewarding, or interesting, many adults with ADHD may als find it hard to stop even when they’re not making mistakes but need to get on with another task that needs to be done soon but is far less interesting. We call this problem perseveration. Perseveration often looks like procrastination. But as you might know, it’s not that the person has decided to put off something that isn’t fun. It’s that he or she decided to keep going on something that is fun.” – Dr. Russell A. Barkley, Taking Charge of Adult ADHD, pg. 59, 61, 62.
  • “Lacking self-control robs you of free-will. This is one of the most tragic consequences of ADHD. You might think you’re doing what you desire. Yet if you can’t inhibit your behavior, you miss out on the delay between an event and your response. That delay is essential: It gives you the chance to think. Even more critically, that delay empowers you to choose freely.” – Dr. Barkley, Taking Charge of Adult ADHD, pg. 63.

Recommended Reading

  • Dr. Russell Barkley. Taking Charge of Adult ADHD.
  • Additude Editors. Daily Tips: Surviving the Holidays. – This collection focuses on surviving the holidays when one is the parent of an ADD children, but also covers a few tips for individuals with ADD…and some tips for children are applicable to adults as well.

Footnotes   [ + ]

1. At least not in this article here and now.
2. Russell Barkley, Taking Charge, pg. 2.
3. Russell Barkley, Taking Charge, pg. 6.
4. Barkley, Taking Charge, pp. 23, 46.
5. Russell Barkley, Taking Charge, pg. 15.
6. One of the reasons this is important is because there is overlap in the symptoms of different mental disorders. One could see symptoms that appear to indicate ADD but are in fact indicative of Depression or Anxiety or vice versa.
7. I am heavily indebted to helpguide.org’s ADD/ADHD page for this list.
8. While reading I oftentimes find myself needing to reread a section b/c my mind has begun thinking about something else entirely. I tend to read aloud as this requires more intentional effort and helps me remain focused, but I am still quite capable of losing focus even while reading aloud..
9. I oftentimes find mundane tasks like brushing my teeth and shaving painful. I am quite capable at some very complicated tasks and work with complex systems for a living, but the little things can be almost paralyzing.
10. I avoid all skills which require the ability to do detail work – e.g. almost any form of art.
11. I have significant difficulty in recalling other’s names even when I make an intentional effort to remember them. Several years as a pastor significantly improved my skills in this area but I am still below the capacity of what many others are able to recall effortlessly.
12. If you set me to programming I can become hyperfocused on this task for hours on end. Similarly with certain research topics – e.g. theology, history, psychology.
13. I live by my smartphone. It tells me what I need to do and when. If it isn’t in the smartphone, I won’t remember.
14. I get overwhelmed by the vast amount of info. available on any topic – and have a hard time sorting out what I need to consider immediately and when I should stop researching and take action.
15. I hate trying to decide what to do next, and even when I can I oftentimes feel great resistance to performing said task.
16. This is constant. Oftentimes I will put something down and literally look for it two seconds later and be unable to remember where I put it…occasionally these items are glasses perched on my forehead, keys in my pocket, etc.
17. ”Impaired ability to control impulses and delay gratification.” (Russell Barkley, Taking Charge, pg. 29)
18. I am always working on 70+ books simultaneously. It takes me forever to complete a book, but I read constantly.
19. Russell Barkley. Taking Charge of Adult ADHD, pg. 15.
20. Taking Charge of Adult ADHD, pg. 16: “A lot of other treatments and coping methods have little effect unless the person with ADHD is also taking medication.”[/]ref]

You can learn more about treatments for ADD on my ADD Treatments page as well as specific regarding medications used to treat ADD on my ADD Medications page.

Barkley’s Five Areas of Difficulty in Managing Daily Activities

Dr. Barkley provides a list of five areas in which individuals with ADD oftentimes struggle on a daily basis. These are:

  1. “Poor Self-Management relative to Time, Planning, and Goals”[ref]Russell Barkley, Taking Charge, pg. 48.
21. Russell Barkley, Taking Charge, pg. 48.
  • “Poor Self-Organization, Problem Solving, and Working Memory”[ref]Russell Barkley, Taking Charge, pg. 50.
  • 22. Russell Barkley, Taking Charge, pg. 50.
  • “Poor Self-Discipline (Inhibition)”[ref]Russell Barkley, Taking Charge, pg. 51.
  • 23. Russell Barkley, Taking Charge, pg. 51.
  • “Poor Self-Motivation”[ref]Russell Barkley, Taking Charge, pg. 53.
  • 24. Russell Barkley, Taking Charge, pg. 53.
  • “Poor Self-Activation, Concentration, and Alertness.”[ref]Russell Barkley, Taking Charge. pg. 54.
  • 25. Russell Barkley, Taking Charge. pg. 54.

    The Executive Functions

    Executive Functions are one of the areas where individuals with ADHD experience significant impairment. There is not complete consensus on the number or naming of these executive functions. Dr. Barkley’s list[ref]See Taking Charge, pg. 69.

    26. See Taking Charge, pg. 69. includes the following:

    1. Inhibition
    2. Nonverbal Working Memory – “allows you to hold in your head pictures, sounds, tastes, touches, and scents.”[ref]Taking Charge, pg. 72. This includes the ability to process spans of time and Barkley notes, “We can see further and further ahead…by adulthood (ages 20-30), behavior is typically being organized to deal with events 8-12 weeks ahead.” (pg. 73) Yikes! That isn’t me at all!
    27. Taking Charge, pg. 72. This includes the ability to process spans of time and Barkley notes, “We can see further and further ahead…by adulthood (ages 20-30), behavior is typically being organized to deal with events 8-12 weeks ahead.” (pg. 73) Yikes! That isn’t me at all!
  • Verbal Working Memory
  • Emotions Regulation
  • Planning/Problem Solving
  • Dr. Barkley suggests that knowing which areas of executive functioning for us helps us know which areas we should focus on treatment on.[ref]Taking Charge, pg. 69.

    28. Taking Charge, pg. 69.

    Struggling with Time

    • Externalize Information – Instead of trying to remember things in one’s mind, use smartphones, computers, calendars, notepads, etc. to act as a reliable form of memory.[ref]Russell Barkley, Taking Charge of Adult ADHD, pg. 91.
    29. Russell Barkley, Taking Charge of Adult ADHD, pg. 91.
  • Make Time Physical – Use external means to make yourself notice the passage of time – for example use an alarm clock, timer, or smartphone to remind yourself at intervals how much time has passed.[ref]Russell Barkley, Taking Charge of Adult ADHD, pg. 92.
  • 30. Russell Barkley, Taking Charge of Adult ADHD, pg. 92.
  • Use External Incentives – That is, use incentives outside of oneself to incentivize what one needs to accomplish.[ref]Russell Barkley, Taking Charge of Adult ADHD, pg. 92.
  • 31. Russell Barkley, Taking Charge of Adult ADHD, pg. 92.
  • Normalize Neurology – There is no known permanent cure for the brain issues that cause ADD, but medications can be quite effective in helping the brain functional normally as long as they are in one’s system.[ref]Russell Barkley, Taking Charge of Adult ADHD, pp. 92-93.
  • 32. Russell Barkley, Taking Charge of Adult ADHD, pp. 92-93.
  • Externalize Rules – Make lists, physical, written lists.[ref]Russell Barkley, Taking Charge of Adult ADHD, pg. 93.
  • 33. Russell Barkley, Taking Charge of Adult ADHD, pg. 93.
  • Break Larger Tasks Into Smaller Components – Try to make these time quantifiable.[ref]Russell Barkley, Taking Charge of Adult ADHD, pg. 93.
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