adult ADHD

In the past two years, both of my sons have been diagnosed with Attention Deficit Hyperactivity Disorder. The older one, a career class clown, tipped his hand when, in eighth grade, he addressed his math teacher as "sweet cheeks," landing himself in the dean's office for the third time in a week. My younger, age seven, was an easier call: He ran laps around the table during dinner, fidgeted with such vigor that he fell off his chair, and was so distracted when we walked down the street that he routinely failed to notice pedestrians, even oncoming cars. Their ADHD, I soon learned, is probably hereditary, as are 80 percent of cases. (The other 20 percent is largely accounted for by brain injury and other cognitive insults, like lead poisoning and fetal alchohol syndrome.) Factor in two different dads—each of my sons' fathers is calm, measured, and highly competent—and it becomes pretty clear whose DNA is at work. Still, I'd never even remotely considered that I might have ADHD. How could I have missed the acronym on the wall?

For one thing, it's long been considered a uniquely childhood condition. Adult ADHD (or ADD—the terms are used interchangeably) only began to get public recognition in the mid-1990s when the book Driven to Distraction, by psychiatrists Edward Hallowell and John Ratey, became a best-seller. Scientific papers dating to the 1960s had suggested that hyperactive children were likely to have parents with the same symptoms, implying that the disorder did not necessarily disappear in adolescence. Back then it was known as "minimal brain dysfunction," and though experts were looking at its attributes through a medical rather than a moral lens—for centuries, ADHD sufferers have been labeled as stupid, lazy, even touched by the devil—the name suggested dire abnormality.

For another, I always thought ADHD revolved around two traits—distraction and hyperactivity—and neither seemed to apply to me. I was a seven-year-old who arranged her stuffed animals by height and in rows, as though posing them for a class picture. I was a 10-year-old whose hospital corners made it nearly impossible to squeeze between the sheets. I was a boarding school teen whose Pledge-drenched room was a stop on every admissions tour. And I am a mother who must admit to once color-coding an erasable calendar in an effort to streamline family schedules. My obsessiveness has, at times, made me quite useful—I've been flown cross-country on several occasions to help exorcise friends' closets. But during periods of stress and depression—in the early months of separating from my first husband, for example—it's also felt like a curse, one that bewitches me into passing hours just plumping pillows and straightening chairs. Me? ADHD? I don't think so. And yet, while standing in my basement one day staring at shelf after shelf of painstakingly boxed and labeled stuff, I finally got it. I realized that I had learned early and well to quiet my buzzing brain. Chaos—that supposed wellspring of creativity—leaves me feeling overwhelmed and under siege. If I can't put away, I pull away. I organize, therefore I am.

So I made an appointment with Hallowell, whom I sought out not only because he's one of the most respected ADHD clinicians around, but also because his book had been my most meaningful guide as I researched my sons' condition. He speaks from more than 25 years of experience treating both children and adults, but his interest is more personal than that. In 1981, while in a medical fellowship, he attended a lecture about ADHD and became convinced that he himself had the disorder.

"It's very powerful to understand that your brain is simply wired a certain way," he says as I sit across from him in his Manhattan clinic (the flagship office is in Sudbury, Massachusetts). "To realize that it's not about some moral failing. Most adults who discover they have ADHD have lived their whole lives thinking that something was wrong with them. It's a huge burden. And it's not about feeling some of the symptoms some of the time. It's about the intensity, duration, and lasting impact of those symptoms as they relate to an entire life."

Adult ADHD is both complex and relatively common, affecting an estimated 11 million Americans, or 5 percent of the population. (To plug that number into the national switchboard of adult afflictions, roughly 7 percent suffer from asthma and 7 percent from depression.) The condition, classified as a mental disorder in the Diagnostic and Statistical Manual of Mental Disorders, is divided into subtypes. You might be an "ADHD combined subtype" and display distractibility, impulsivity, and restlessness—referred to as the "triad of symptoms" by Russell Barkley, research professor in the department of psychiatry at the SUNY Upstate Medical University in Syracuse, New York, and one of the most well-regarded ADHD researchers. Then again, you could be an "ADHD inattentive subtype," appearing dreamy and distant; or an "ADHD hyperactive subtype," which is to say, fidgety and impulsive. In school, you could very well have been the archetypal bubblehead, absentminded nerd, class cutup, or Tasmanian devil. But you all shared one defining ADHD trait: You could not, for the life of you, pay attention.

Flash forward, say, 10 years after your high school graduation. You're officially an adult, but there are still a bunch of basic things you're not very good at. According to Barkley's data, there are nine key symptoms of adult ADHD, any six of which, when they recur frequently, can determine a sound diagnosis: You are easily distractible; make decisions impulsively; have difficulty stopping activities when you should; start a project without reading or listening to directions; show poor follow-through on promises or commitments; have trouble doing things in their proper order; drive faster than others or, if a nondriver, have difficulty doing fun things quietly; have difficulty sustaining attention; and are challenged by organizing tasks and activities. Barkley's list might sound laughably universal except for the fact that, during his extensive studies on adult ADHD, he tested for just one symptom—distractibility—and ruled out 98 percent of the "normal adult" control group.

Given the broad, if vivid, strokes used to paint an ADHD diagnosis, it's not surprising that Barkley's researchers found little significant evidence that men experience the condition differently from women. But many clinicians disagree, having discovered that female sufferers are more prone than men to anxiety, depression, and low self-esteem, in part, they theorize, because the disorder inhibits their ability to succeed both in the workplace and at home. This often reflects a lifelong sense of total incompetence in spheres modern society considers to be of equal importance. They feel forgetful, disorganized, and oversensitive while on the job; then they feel the same way when it comes to managing a relationship, parenting, and a household. "Having it all" feels more like "failing at it all."





Though diagnosing ADHD is hardly an exact process—as Hallowell says, "It's not like there's a blood test we can run"—neuroscience has pinpointed several physiological differences in the brains of people with ADHD. Almost two decades ago, a study published in The New England Journal of Medicine showed differences in glucose metabolism in adult ADHD brains compared with their normal counterparts. Then, through magnetic resonance imaging, it was revealed that certain areas of the ADHD brain were smaller than in normal brains. More recently, the National Institute of Mental Health and McGill University weighed in with a study showing that, in childhood, people with ADHD experience a three-year delay in brain development. Psychiatric researchers compared brain scans taken over a decade from two groups of children—one with ADHD, the other without. In kids with "normal" brains, the cerebral cortex—the outer wrapping of the brain that contains the neural circuitry responsible for conscious thought—began to thin out around age seven, thereby allowing other parts of the brain to mature. But in the children with ADHD brains, the cerebral cortex didn't change until they'd reached 10, and a marked delay in brain maturation was found in precisely the areas associated with attention and motor control. According to the press—the story made it onto the front page of The New York Times—what this study proved was that ADHD was a "delay" and not a "deficit." However, reading it as the mother of two ADHD kids—one of them exactly seven—I wasn't sure how important this shift in terms really was. After all, a three-year learning gap can be devastating to a child of 10 if nothing has been done to help him or her learn differently. No matter what the research says, a delay becomes a deficit when no one picks up on the problem.

Then again, there is cause for optimism: Hallowell's own success certainly points to the possibility that many negative aspects of the disease can be overcome. And he's seen remarkable positive characteristics in his ADHD patients. Whether as entrepreneurs or poets, many of the those he's treated for ADHD are highly creative and original thinkers. They look at life in an unusual way, resulting in a wacky sense of humor or the ability to take an innovative and unpredictable approach to pretty much anything. They're resilient and persistent to the point of stubbornness. They are warm-hearted, generous, and highly empathic. And most mysterious of all, they possess keen intuition and a knack for seeing straight through to the heart of the matter.

In Hallowell's glass-half-full view, everyone from Robert Frost (a daydreamer who dropped out of college) to Thomas Edison (an Energizer Bunny capable of working round the clock for days on end) to Leonardo da Vinci (so famously lacking in follow-through that he finished only a known 17 paintings in 67 years) could well have been suffering from ADHD. Bonnie Cramond, director of the Torrance Center for Creati-vity and Talent Development at the University of Georgia, wrote a paper in 1995 arguing that many of the thousands of children diagnosed may just be highly creative. A simple reframing of terms sums up her main point. Distractible? Try dreamy or imaginative. Impulsive? Try bold or willing to take risks. Restless? Try energetic or full of ideas.

Of course, as far as Barkley is concerned, this is self-deception of the worst kind. All pocket protectors and pessimism, he writes that the "claim that adults with ADHD are more intelligent, more creative, more `lateral' in their thinking, more optimistic, more entrepreneurial, and better able to handle crises than those without the disorder" has no scientific support. Furthermore, it's largely refuted by the studies he's done.

How hopeless, exactly, should I feel? Hallowell offers some succor. "Some of the foremost ADHD researchers would say that I deal in false hope," says the man I might be tempted to dismiss as a Pollyanna were I not so persuaded by the the audacity of his optimism. "I'd say that they deal in false despair. If you tell an adult they have a mental illness, you instill dejection. Why do that when you can use a responsible diagnosis of ADHD as a means of discovery, one that can alleviate a lifetime of poor self-esteem, shame, and depression?"

The most hopeful finding in Barkley's recent studies is his conclusion that 14 to 35 percent of people with ADHD are likely to outgrow their disorder by the time they reach adulthood. The estimated percentage depends on who's being consulted (the patient or someone close to them) and on the fact that everyone has a subjective idea as to what "recovered" means. Also, paradoxically, adults who discover their ADHD later in life and seek treatment tend to be better educated and suffer fewer "achievement difficulties" than those diagnosed and treated in childhood, perhaps because they've developed compensatory skills—or simply because those motivated enough to get help may possess keen survi-val instincts. This may in part explain why not a single person I've ever known would say that I have ADHD. And yet in less than 25 minutes, Hallowell had me pegged as "a high-functioning woman with a history of childhood and adult ADHD" (though a full diagnostic workup takes much longer). The statement hit me hard, like pushing over a single domino and then watching the rest—a long, curving ribbon stretching back into my past—all fall into place.

Clearly, without even being aware of it, I have implemented countless coping techniques to deal with a disorder I never knew I had. I work alone and on an extremely erratic schedule filled with stops and starts. I force an often obsessive vigilance on myself when it comes to controlling my surroundings. I have even been prescribed a small dose of Ritalin—one of several stimulants that, if carefully monitored and taken with some form of therapy, can be highly effective in managing ADHD. Because Ritalin takes effect immediately and then leaves the system, I can use it when I need it, when I know that I can't afford to lose a moment to distraction.

Perhaps more importantly, though, I have decided to accept my myriad weaknesses—all of which make sense to me now in a way they never did before. I know that I will forget names, dates, and numbers almost as soon as I have heard them; that I will lose my temper dramatically and often; that I will change plans on a dime; that I may not always be able to get something done when I want to; that, while remaining rock-solid in a crisis, I will crumple in the face of obstacles others hardly notice; and that I will occasionally go on near evangelical talking jags that would exhaust even the most patient parishioner—or, in my case, husband, parent, friend, teenage son, or shrink.

For me, acquiring a reasonable understanding of ADHD—first my sons', then my own—has changed my life. To some degree, it has given me patience, a quality I am famous for not possessing. It has shown me who I am and how, for better or worse, I got this way. It has illuminated my past. And it has enabled me to take advantage of the multitude of aids that exist—including drugs—to help me manage myself more effectively. I don't think I've outgrown my ADHD; I've just unknowingly integrated it into a life that seems to work, more or less, for me. Had I known way back when what I know now, I'd likely be a very different person. More successful and mature, less volatile and insecure. Still, I'm glad I see it now. I've got half a lifetime to go, if I'm lucky. Why not plunge forward with eyes wide open?

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