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Research creates new controversy, questions about ADD

Grosse Pointe News, August 17, 1995 pg. 1B

by Phyllis Fries

"It's like trying to build a house of cards in a windstorm, or having 10 televisions on inside your head simultaneously."

This is how the symptoms of Attention Deficit Disorder (ADD), one of the fastest growing diagnostic categories for adults has been described.

ADD became the focus of new controversy when research revealed there are actually two similar but distinctive disorders with overlapping symptoms. As a result, adults who had been diagnosed in childhood found themselves once again having problems. Some, never diagnosed when children, recognized their own symptoms after their child was diagnosed.

At a lecture earlier this year, Dr. Walter Guevara, head of psychiatry at Cottage Hospital, told the audience that in the last few years, researchers began to realize that many adults were suffering from ADD. "The question is, where were they before?" he asked.

It was once thought that ADD affected only children and that symptoms diminished or disappeared with maturity, but it is now believed to be genetically transmitted and that 70 percent of the children will carry the disorder into adulthood.

According to an article by Thomas Brown, PhD., at Yale University, ADD/WO (without hyperactivity) became a valid diagnostic category in 1991 when research confirmed, "ADD is found in two independent dimensions: one consisting of motor hyperactivity and impulsive behavior, and the other consisting of inattention, disorganization and difficulty completing tasks," and concluded, "It no longer seems doubtful that ADD/WO exists and that ADD/WO differs from ADD/W (with hyperactivity) in important clinical ways."

Dr. Barbara Fisher, who with her husband founded the United Psychological Services Attention Deficit Disorder Clinic in Macomb County and Ann Arbor says, "ADD/WO is true sustained attention deficit, more common and less severe. This may be one of the reasons ADHD, (Attention Deficit Hyperactive Disorder, or ADD/W) is still the focus of most research because of the severity of behavioral and conduct problems associated with it."

Drs. John J. Ratey and Edward M. Hallowell who both have ADD and wrote the book, "Driven to Distraction," claim that ADD/WO, "can be a severely debilitating disorder in which even very bright and talented people are unable to activate and sustain their effort for productive work. In ADD, time collapses and it feels like everything is happening all at once, creating a sense of inner turmoil or even panic."

Because they are so easily distracted, some ADD individuals can't go into a shopping mall, attend a social gathering or focus on facial expressions when talking with someone without being overwhelmed by the extraneous stimuli.

As one might suspect with this type of disorder, most ADD adults performed poorly in school and even those who managed to get by on native intelligence were still considered to be lazy, unmotivated or were labeled stupid.

Once believed to be a psychological disorder, ADD is now known to be a biochemical imbalance and the new theory is that it is a thinking disorder. This means the brain cannot work to its fullest potential. Most ADD individuals will tell you they spend a lifetime hearing the message: "You could do better if you would only try."

Ratey and Hallowell say, "The most dangerous part, if left untreated, is the assault to the self-esteem."

Common not only with self-destructive risk takers and type A Personalities, it is also highly associated with creative, intuitive, high-energy and highly productive people.

Usually above average in intelligence, these individuals have been able to problem-solve their way through a multitude of challenging situations. Difficulties begin to increase later with the complexities of life, jobs, marriage and family as well as the aging process.

One woman persuaded her husband to go with her for counseling in an effort to learn communication skills when it appeared he didn't listen and never remembered what she said. "Most of the time he would either stare into space or interrupt me to interject something unrelated," she said.

When the husband failed repeatedly to accurately feed back dialog, the counselor lectured on the importance of developing good listening skills. Totally frustrated, he confessed during their second session that he was trying and really wanted to listen, but had never been able to focus for more than a few seconds. The astute counselor suspected ADD and suggested he be evaluated.

Most ADD individuals experience immediate and profound relief as well as new hope once they have been diagnosed. They are elated to finally understand the underlying source of the chaos, problems, frustrations and devastating feelings of inadequacy they've endured throughout life.

One 52-year-old man said after being diagnosed, "I wish my parents were still alive so they would know I was really trying, I was always trying my best."

Like others, Guevara believes the best method of diagnosis is to look at the childhood history of behavior and consider observations of current family members.

Fisher, while agreeing that background information is important, has compiled a battery of psychological, personality an other tests which she finds helpful not only in confirming and diagnosing ADD but in differentiating between the two disorders.

"Diagnosis is critical in the treatment of both disorders, not only in prescribing the best medication but in teaching behavior modification and coping skills," she said.

Some doctors remain skeptical and are reluctant to diagnose and prescribe medication because ADD symptoms seem to apply to almost everyone.

Ratey and Hollowell say that's because our American lifestyles are ADD-ogenic: "American society tends to create ADD-like symptoms in all of us." The key, they say is when you have nine or 10 of the symptoms and they have been pervasive in your life as long as you can remember.

Curiously, Ritalin, the most commonly prescribed medication, is a stimulant, but reacts in an opposite manner on ADD individuals and can produce spectacular and dramatic results when it works. It helps them to focus and reduces anxiety.

A 6-year-old child probably best described both the symptoms of ADD and the effects of the medication in a story which appeared in Time (July 18, 1994): "I know how it works," he announced after trying the Ritalin. "You do?" asked his doctor. "Yes," the child replied, "it cleaned out my ears, now I can hear the teacher".

One adult said, "It's like driving when it's hazy, then you blink your eyes and suddenly everything is in perfect focus."

The woman who took her husband to the counselor said he took his first Ritalin before they attended a Christmas candlelight service. "Instead of fidgeting all through the service as he had in past years, he sat quietly, his hands folded in his lap. He was totally mesmerized. After the service, tears streamed down his face and he told me it was the first time he had ever been able to focus, to hear and see everything. He really enjoyed it," she said in amazement.

For some, the windstorm has subsided, the house of cards is stable and all the TVs are quiet, except for the one that is tuned in perfectly.

"ADD does not need to be a deterrent to maximizing one's potential and it is not a closed door," Fisher said. "More is being learned about it every day and there is a pathway of success for everybody.

"Categories of ADD with hyperactivity and without hyperactivity are not fast and rigid. The idea is simply to identify the problems and begin to work with them."

Checklist of ADD symptoms
* Continuing sense of underachievement, regardless of accomplishments.
* Difficulty getting organized.
* Continually procrastinating.
* Many simultaneous projects; difficulty finishing anything.
* Speaking the mind, often inappropriately.
* Thrill-seeking.
* Intolerance of boredom.
* Easily distracted; can't focus attention; drifts off in the middle of
* Often creative, intuitive, intelligent.
* Trouble following established rules.
* Easily frustrated.
* Impulsive.
* Excessive worry.
* Insecurity.
* Extreme mood swings.
* Restlessness.
* Tendency toward addictive personality.
* Low self-esteem.
* Poor judge of own achievements.
* One or more family members has ADD.

ADD Page