Destructive Distraction: Recognizing AD/HD in Adults by Gina Shaw Manhattan executive John Hughes (not his real name) received a work evaluation that would trouble anyone trying to succeed in business. ìThe clients like you, but they feel youíre not listening when youíre meeting with them,î it said. Hughes tended to drift off and appear not to be paying attention during important discussions, the evaluation went on. Although his work, when completed, was excellent, everything always seemed to be a crisis that was left to the last minuteófor no apparent reason. One year later, Hughes was evaluated again. ìI donít know what you did,î his supervisor wrote, ìbut you addressed everything that was a problem.î The change was remarkableóclients were happy, bosses were happy and Hughes was happy. What changed? Hughes discovered that he had adult attention deficit/hyperactivity disorder (AD/HD) and sought treatment. Like many people, he had assumed that AD/HD was a condition that only affected children, but in fact, some 8 million adults in the United States are estimated to have AD/HD. And according to Hughesís doctor, Dr. Lenard Adler, director of the AD/HD Program at the New York University School of Medicine, p robably 80 percent of those people donít realize they have the condition. Up until 1987, the diagnostic manuals that psychiatrists use didnít even address AD/HD in adults. But since then, professionals have come to realize that as many as 65 percent of people diagnosed with AD/HD as children will continue to experience the inattention, hyperactivity and impulsivity that are hallmarks of the disorder as they move into adulthood. As anyone with a busy professional and family life will admit, we all get distracted from time to time. Who hasnít zoned out in a dull meeting or been unable to keep track of the weekís school and practice schedules? That alone doesnít mean you have AD/HD. ìHow do you tell AD/HD from what I call a severe case of modern life?î asked psychiatrist Dr. Ned Hallowell, a nationally known expert on AD/HD and founder of the Hallowell Center for Cognitive and Emotional Health in Sudbury, Mass. ìIf you take someone with a severe case of modern life and put them on a farm in Vermont, theyíll relax. The person with AD/HD will turn the farm into an amusement park.î The hallmark of AD/HD is distractibility, explained Hallowell, who with co-author Dr. John Ratey has written three books on AD/HD: ìDriven to Distraction,î ìAnswers to Distractionî and ìDelivered from Distraction.î ìOf course, everyone can be distractedóthe difference is how often it happens and how much it gets in your way. If it happens a lot and keeps you from reading a report youíre supposed to read, or participating in a meeting youíre supposed to have, or taking care of someone you need to take care of, then thatís a problem,î he said. NYUís Adler agrees. ìPeople with AD/HD are easily distracted, drift off in conversation, and have trouble planning, trouble waiting and trouble with time management,î he said. But these symptoms alone donít mean you have AD/HD: The key question is whether they cause you problems. ìTo make the diagnosis of AD/HD, the symptoms have to impair two of the three primary realms of life: work or school, home and social settings,î Adler explained. When that happens, the results can be severe. Adults with AD/HD are more likely to be divorced or separated, to change jobs, to be underemployed, and when their condition is untreated, more likely to ìself-medicateî through substance use and abuse. One way to find out if you might have AD/HD is to take an assessment test, like the one developed by the World Health Organization and available online at the NYU Web site: www.med.nyu.edu/psych/assets/adhdscreener.pdf. But donít ìself-diagnoseî using this tool. If the screening questions indicate you may have AD/HD, consult a specialist to find out more. Children and Adults with Attention Deficit-Hyperactivity Disorder (CHADD) (www.chadd.org, (800) 233-4050) can provide referrals to professionals in your area. So what if youíre told you do have adult AD/HD? ìThis is actually a ëgood newsí diagnosis,î said Hallowell. ìUnderstanding that you have AD/HD can only change your life for the better. AD/HD isnít something you can see on an x-ray; itís a collection of symptoms. I think of it as a trait, and depending on how you manage it, it can be useful or not. Both prisons and the halls of the powerful are full of people with AD/HD.î One of those people is Hallowell himself. ìI have AD/HD, and itís not treated in any way. I married the right person, and I play to my strengths, not what Iím bad at. Iím good at writing and Iím bad at balancing my checkbook, so thatís what I do,î he said. Of course, not everyone can organize their career and marriage around their AD/HD, although Hallowell said that finding the right job and marrying the right person are two of the best ways to ìtreatî the disorder. Medication has also proved very successfulófor someone like Adlerís patient, John Hughes, it can literally be a life-changing experience. ìLarge-scale studies in children have shown that medications do play a primary role in treating AD/HD,î said Adler. Both stimulant and non-stimulant medications are used to treat adult AD/HD. The two medications currently approved by the FDA for adults with the condition are Strattera (a non-stimulant) and Adderall XR (a stimulant). Some 70 percent of people with adult AD/HD will find their condition improving with the first medication they take, said Adler. Only about 10 percent donít respond to medication at all. Many people, like Hughes, combine medication with lifestyle interventions such as cognitive behavioral therapy. ìMedication provides the tool to allow an individual to make change, and cognitive behavioral therapy helps them to implement change,î Adler said. Intervention has radically changed lives for the better. ìI can think of a number of individuals whose marriages were on the brink before they sought treatment, or whose jobs were at risk,î Adler said. ìWith treatment, improvement of time management, and coaching to try to learn how to plan, marriages and jobs were saved.î That, said Hallowell, is the main reason to find out if you have AD/HD and seek treatment. ìIf you know in your heart you could be doing betteróprofessionally and in relationshipsóand all your attempts to do so have failed, thatís the best reason,î he said. ìIf you are not where you could or should be professionally and personally, thatís the time to seek help.î Gina Shaw is the medical writer for The Washington Diplomat.