Stereotypes, Ignorance, and Britney Spears

I have not posted in ages, and I promise to write a substantive post soon. But for now, I just wanted to comment on something that I found ridiculous, offensive, and factually incorrect.

Last week's US Weekly, which granted is not the authoritative source on anything other than photographs of and gossip about celebrities, wrote (emphasis mine):

Days after a judge ruled that Britney Spears could only spend three days a week with her children, she reacted by leaving her two kids in a parked car with a court-appointed monitor (whose job description does not include babysitting) as she shopped for $18,200 worth of chandeliers at the Crystal Place design shop near L.A. November 4.

Why does Spears, 25 — even after having physical custody of her kids taken away — keep exhibiting such questionable parenting skills?

Sources say the troubled pop star does not seem to grasp the gravity of her custody case, and they blame her bizarre public behavior (swapping clothes with a stranger, among her recent moves) on psychological issues, not drugs.

“It’s not substance abuse — it’s mental!” a confidante tells Us."Pals suspect adult-onset ADD or depression, with one friend saying, “Postpartum has always been a problem” after giving birth to Sean Preston, 2, and Jayden James, 1."

This is problematic for a number of reasons.

First, it might be true that Spears is dealing with mental illness, but it is unlikely that all of her bad judgment, or even most of it can be attributed to mental illness. The article implies that people with mental illness, people with ADD or depression would be unable to take care of children, or that an imbalance of serotonin or norepinephirine would cause someone to think it was O.K. to trade Halloween costumes with the bartender. I am not a doctor -- and it should be noted that Spears' friends and US Weekly sources are not doctors either--but I am pretty sure that that's pretty unlikely.

Secondly, and this is what caught my eye in the first place, there isn't really such a thing as "adult-onset ADD".

According to the DSM It is essential that "some hyperactive-impulsive or inattentive symptoms that caused impairment were present before age 7 years. As Doctors Glenn Brynes Carol Watkins, of Northern County Psychiatric Associates in Baltimore wrote, "By definition, AD/HD is a condition that has its onset in childhood."

It's great that Spears' friends -- or so called friends since they are dishing to magazines instead of getting her help--are concerned, but US Weekly perpetuates all sorts of falsehoods and stereotypes by printing these guesses. All that would have been needed to fix it was one line from a doctor explaining what was and what was not possible. Maybe this week's cover story on Spears' childhood will reveal a long-time struggle with ADD. Maybe. I am not holding my breath.

I am all for celebrities with ADD or any other disorder talking about it to raise awareness and to educate people. But spreading ignorance and perpetuating stereotypes? It doesn't make dealing and living with ADD any easier for those who have it. Even US Weekly should do better than that. Or for a magazine as widely read as US, maybe I should say especially US Weekly.

News For Thought

This New York Times Magazine article, "Self Non-Medication," is one of the best examples of science journalism I have seen in quite some time. It is a personal story of a man trying to go off of depression medicine, which I should note is not at all necessarily reflective of ADD medicine. What is great is the mix of personal and science. It is an interesting look at the quesiton of taking medicine, though admittedly for a different disorder.

It's a bit long but well worth the read.

Enjoy.

A Preliminary, Personal Decision

Part 1 in a series on medicine and the thought processes that go into deciding to take it.

It's been a while since I wrote a post here and even longer since I wrote a post of substance. So here goes. A lot of the books I have been using are sitting in a box in my parents' house, so I am going to try my best to write about medicine without the books and will write an updated or new post when I unpack that box. Because it seems I have a lot to say, this post will just be about deciding whether or not to take medication and later posts will cover the options. I'm trying out this bolding key sentences style as a way of breaking up huge blocks of text.

First off, there is a lot of bad information on the Internet. By bad I mean either patently false or very biased. There are people who don't believe in taking medication ever, there are those who don't believe that Attention Deficit Disorder is in fact a disorder and therefore don't believe in treating it, and there are people who are paid by drug companies to promote specific drugs. Know that and do not self medicate. It's not worth the risks, and even with the medicine that says there are "no side effects" there can still be side effects because each person reacts to medication differently (I had horrible side effects with a med I tried, even after being assured by a top doctor that side effects with that medicine were extremely rare) and there are ALWAYS risks if you are self-medicating.

I firmly believe that the decision about taking medication for ADD is an extremely personal decision, one that should be made with your doctor and whoever else you choose to consult. No one else, not even if you are still on your parents' health insurance, should be allowed to weigh in without your consent. (Keep in mind, this is a blog directed at adults with ADD, it might be different when the person in question is a small child, but I am not commenting at all here about medicating children. That's a whole different discussion that does not have a place on this blog). For that reason, I will not write here anything about whether or not I am currently taking medicine or which ones, if any, I am taking.

When I first considered whether or not to take medicine, my primary concern was that my personality would change. I didn't want to lose the speed at which I talk, the sharpness of my sarcasm, my ability to be interested in multiple conversations and topics at once, or my creativity. That's not to say that there is any medicine for ADD or ADHD out there that does that, but there were things I was worried about. I had heard descriptions of high-schoolers complaining that their friends were so much more fun -- funny, loud, all around goofy and more active--when they didn't take their medication. And I didn't want that to be me, even though I had been told by more than one doctor that those effects were common in people who have the hyperactive subset and in children, neither of which I was, I was still nervous. But this quote of a mother describing her child on medication : "She's still my dreamer, but now it's on purpose that she dreams" (Hallowell, 40). In short, the medication didn't stop her ability to dream, only let her choose when to do it.

When I considered taking medication, I decided that I would tell a few very close friends, friends who knew me very well and would see me in varying situations. These would be the only people I would tell at first--three or four people total--and I would let them know that I expected them to be honest with me. Did I seem less distracted? Was the change noticeable? Was the change positive? Were there personality differences? Were there things that were missing, and if so were those things that they were glad to see go (like, walking into the middle of the street with out looking, temper bursts, too much anxiety) or quirks that were part of who I am?

Pay attention to things that irk other people. Are those things that you want to change about yourself? Are those things that medicine could help you change?

One more thing to think about: You should be able to tell if the medicine is having an effect, so with people with more mild forms of ADD or ADHD, you might want to take your environment into account. About to leave school and start a job? Switching from one job to another? About to go on vacation? Do you want the extra boost (and I mean this in an entirely positive, way. Taking ADD medicine is not cheating or giving you an unfair leg up. It's leveling the playing field) as you start a new job, or are the demands on your attention so different that you need to be able to see what lack of attention feels like before you can decide if it needs to be remedied? In other words, are you going to be able to tell what changes are caused by medicine and what are caused by a new environment? Is that something that you are concerned about?

This post is full of questions, many of which people might want to bring to the doctor who is prescribing the medicine, but they are also questions to ask yourself, because as I said before and will say again, taking medicine should be an informed, safe, and intensely personal decision.

NEXT: On the different medicines. What is out there? What are the differences?

Comic Relief

Today's theme--and hopefully I can keep them on my site this time--is missing deadlines. In some careers, missing a deadline can be a death sentence, but it happens to the best of us every once and a while, and apparently to the smartest of us. At least according to this recent column in the Washington Post.

"A local organization is eager to give out some scholarship money, but its members dozed on the deadline to be included in the publicity done by the national group. Having missed the cutoff, they were afraid no one would know about the $3,000 that's burning a hole in their pocket.
The group that missed the deadline: Mensa.
That's the organization for geniuses."

A word of warning: I am not, I repeat NOT including this to say that people who are geniuses have ADD or vice versa, or even that all people with ADD miss deadlines, just that the column made me laugh. Take a look at the headline: "Even Geniuses Miss Deadlines . . . And Frolic Nude" and tell me you're not smiling. I will pontificate on giftedness and ADD in a bit. But for now, a comic strip from Bill Amend, the writer of Foxtrot when he was nearing retirement from his daily strip:

Some Personal Thoughts

This blog was designed to provide information but I think it's also important to provide personal reactions so that when other people read it it might resonate with people who are dealing with ADD, testing, or diagnosis. So here are some personal thoughts. They are from a longer essay, edited for legnth and identifying features. That's why it sounds disjointed.

I am part of a growing number of students and adults who are diagnosed post-childhood because, growing up, they were the academic super-stars, popular, and more or less well behaved. Their symptoms were overlooked when they were children because they seemed to fare well without medication or therapy.

The first time I remember having a panic attack was in fourth grade. I didn’t call it that. I didn’t call it that until I was a junior in college. But when I was nine, I had the test the next day on the digestive system, and I didn’t feel prepared so I burst into tears, the big back-shaking kind, with liquid coming from everywhere, eyes, nose, mouth. I don’t remember what my mom said. I do remember that she came into my room later that night and took the diagrams of the stomach and intestines and the flashlight from under my blankets. I got an 103 on the test. No one worried, because when the tears dried I was an overachiever....

On the molecular level, Speed—the blanket name given to a group of drugs that produce the stimulant effect—and Adderall are the same drug. Both are Amphetamines—the title that is given collectively to an assortment of drugs with similar molecular structures including Meth, which can be made illegally in secret laboratories. Amphetamines, legal or illegal can be taken orally, or through injection, smoking, or snorting and create the same rush.

When I nervously asked a psychiatrist counseling center what the difference was between Speed and Adderall, he said, “nothing. Molecularly, they are the same. The difference is how you take them. Adderall is prescribed in small, controlled doses.” The illegal counterparts of the drug clearly are not.

It’s of little surprise then, that Adderall is easy to get on college campuses. Students, some joking some not, beg for it when they are faced with pulling an all-nighter. Other students use it as a party drug.

“I snort it sometimes when I'm going out for fun, because it hits you faster if you snort it,” an NYU student identified only as Mary told The Washington Square News.

When I told a friend via an instant message chat that I wasn’t sure if I was going to get a prescription for Adderall, he wrote “WHAT!?!??!...but like, it's speed.”

Which is exactly why I didn’t want to take it. Edward Hallowell, a physiatrist who has ADD himself, treats it and has written multiple books about the subject, listed “[t]endency towards addictive behavior,” as a symptom of adult ADD in his book Driven to Distraction. Later in the book, Hallowell, describing high stimulation ADD, a specific subset of Adult ADD, “he—and it is usually a he—may seek high stimulation through relatively safe avenues [such as] creating tight deadlines to work under.”

I don’t know if I have high-stimulation ADD. I don’t fit all of the descriptors and I am not a risk taker in the most widely accepted form it takes. I am afraid of roller coasters and skiing. But I am addicted to deadlines. Ask the person who sits next to me in the library. I hate the exhaustion that comes with writing on tight deadlines. But I love the rush that comes with them.

I have a tendency to addiction—my dependency of coffee indicates that much. So I am afraid of prescription medication.

News For Thought

Hopefully a reoccurring post with interesting newspaper articles.

I do not have ADD linked with any other disorder. But, because I would like this to be a resource for other people, and because ADD is often linked with anxiety and depression, and because of the recent events at Virginia Tech, I wanted to provide links to two articles that I thought were interesting approaches to mental health.

First from the New York Times, a story about the woman who started the mental health awareness group, Active Minds, after her brother committed suicide while on leave from college.

And, from the Washington Post an Op-Ed that I link to because of the questions of stigma that it brings up, about the panel being formed in the wake of Virginia Tech.

"A Man Walks Down the Street, He Says, Why Am I Short Of Attention? Got A Short Little Span of Attention" - Music and ADD

A while back, the New York Times ran an article about the dangers of multi-tasking. I thought it was ridiculous at the time and I still think it is silly. It contains "news" such as "The findings, according to neuroscientists, psychologists and management professors, suggest that many people would be wise to curb their multitasking behavior when working in an office, studying or driving a car."

I can't imagine that even people without ADD actually think their attention is equally shared among things like talking on the phone and paying attention to the road. It didn't strike me as something scientists needed to study.

But I have been thinking a lot about this line in the article: "Listening to soothing background music while studying may improve concentration. But other distractions — most songs with lyrics, instant messaging, television shows — hamper performance."

I listen to music with lyrics while studying and writing papers. I have been trying to writing papers in a quiet library recently, and it has been a disaster. One of the things about ADD is that people with ADD are more likely to seek out distractions or get distracted by things that are available and interesting but is not the task at hand (O.K. that's essentially a working definition of ADD). For me, that manifests itself as a lot of time on the Internet. (Case and point this blog). But when I am listening to music with lyrics,--I try to choose songs whose lyrics I already know so I won't spend time trying to figure out the lyrics--I am less likely to get distracted by all out time wasters like Internet or random walks. I type more quickly and am more focused. It's choosing the lesser evil and I think it works.

Lyrics in the Title from Paul Simon's "You Can Call Me Al" click play below to hear the song (with a weird video).

Paul Simon - You Can Call Me Al
Uploaded by manon42

Jealousy

The worst part about knowing this is fixable is knowing that there are people who can do their work without getting distracted.

Comic Relief

An occasional post of comic strips that make you say "Haha. I do that," or make you realize it could be worse.

UPDATE 06/27: The comic got take down from its host site, so bear with me while I figure out what to do. Sorry.

UPDATE: 08/19: I found it but now the other comic is down. I think I will have to give up on posting comics for a while.

ADD Books: Part I: Finding The Symptoms That Make You Say "Aha!"

I didn't forget about the promised science posts. It turns out they are a lot more complicated than I thought. I will get to them when I understand more about the science of the medicines. But for now, I want to write about some of the more anecdotal things. I have been doing a lot of reading both online and in books. One book that I plowed through today (skimming the parts that seemed less relevant to me, but reading most of the first 100 pages) is Driven to Distraction by Edward M. Hallowell and John J. Ratey, both doctors with ADD. (They chose to use ADD instead of ADHD because it is more inclusive since hyperactivity is not assumed). It is an easy read full of anecdotes but not skimpy on the real science. There is some of the laughing at ADD that I find annoying (like questions such as "did you have trouble reaching the end of this questionnaire), and some repetitive language that I suppose is helpful for people who read the book in more than two sittings, but mostly it is very well done.

I've found reading about ADD frustrating because often I don't fit the symptoms, and I find myself questioning the diagnosis and saying "this is not me". I have always done well in school. I am good at evaluating myself, and I am not really impulsive, for example. But Hallowell (the book is mostly in his voice) describes enough different cases that I have found symptoms close enough to mine, even though he suggests that someone with ADD would meet 15 of his 20 symptoms where I barely meet 12 of them.

There was one patient he wrote about, Sarah (pages 94-101) an adult with ADD, whose symptoms made me understand more about me and about some of the people in my life. I am just going to block quote here:

"Oh," she answered, "that is about a cough drop someone left on the dashboard of our car. The other day I saw the cough drop and thought, I'll have to throw that away. When I arrived at my first stop, I forgot to take the cough drop to a trash can. When I got back into the car, I saw it and thought, I'll throw it away at the gas station. The gas station came and went and I hadn't thrown the cough drop away. Well, the whole day went like that, the cough drop still sitting on the dashboard. When I got home, I thought, I'll take it inside with me and throw it out. In the time it tool for me to open the car door, I forgot about the cough drop. It was there to greet me when I got in the car the next morning. Jeff [her husband] was with me. I looked at the cough drop and bust into tears. Jeff asked me why I was crying , and I told him it was because of the cough drop. He thought I was losing my mind. 'But you don't understand,' I said, my whole life is like that. I see something that I mean to do, and then I don't do it. It's not only trivial things like the cough drop; it's big things too.' That's why I cried. "
It was such a classic ADD story that I've come to call it the cough-drop sign (Page 95).

This anecdote reminded me of myself in a lot of ways. Though I can't think of any specific incidents, it was familiar. But more importantly, it reminded me of someone I know, who is in her 50's (like Sarah in the story) and on occasion worries that she is developing Alzheimer's disease--like after she read a New York Times Magazine Lives column about Alzheimer's disease, or after she watched an episode of the West Wing where the White House Press Secretary C.J. Cregg spends time with her father who has Alzheimer's. But the symptoms she most worried about were most similar to the cough-drop symptom. Maybe it's not as scary as Alzheimer's. I bet it's ADD.

Sarah provided Hallowell with a whole list of things she thought were relevant that bothered her. Some of them did not apply to me at all. Other ones made my mouth drop in recognition. Those are below. I list them here, in a blog that is supposed to be more informational than personal, because I would never have associated them with ADD, but Hallowell did--calling Sarah's list something that "could serve as a pamphlet on adult ADD" (page 98)--and so I think others would be equally surprised at the links between the symptoms and between the symptoms and ADD.

I am going to list all the ones in Sarah's list that apply to me. Some are more surprising than others. I don't want to give the impression that I am a totally atypical person with ADD I have put stars and notes next to the ones I found jaw-dropping.

CAUTIONARY NOTE: This list makes me seem like a total space cadet. Most, if not all of these things DO NOT CONTROL MY LIFE. I have figured out how to work around them or to use them to my advantage. I am very successful and trustworthy. Also, I am NOT BLAMING ADD. Some of these are things that I am going to work out, ADD or not. It's just cool to see that they might be connected to one another. (There's my fear about someone figuring out who is writing this and using it against me).

With that out of the way, the list:

• "Daydreamed a lot in class as a child."
• "Have lots of ideas but have a hard time structuring things so they actually happen."
• "Desk cluttered."
• "Forgetful."
• "Difficult to walk in a straight line--tend to veer into things or people." *** (My friends used to make fun of me for this. I have one--very close--friend who used to see if he could edge me to the curb to see if I would walk into a telephone pole. It almost always worked. I had NO IDEA this could be ADD related).
  
• "Unless I am involved, usually get very sleepy during lectures.
• "Handwriting: sometimes I wrote things I don't mean to; skip letters or form them wrong." *(I have used this to my advantage in creative writing to come up with unique turns of phrase).
• "Lose what's in my head very easily."
• "Organize my life around projects"
• "Problems with lateness. Even when there is plenty of time, I fill it up and then cut things too close or lose track of time. I don't have a sense of passing time." * (I sometimes have a very acute sense of passing time. But sometimes I have no sense at all. I thought that I just loved working on tight deadlines, but this gave me a different perspective).
  
• "There is something inside that needs to change."* (This was something I just noticed this year as I started talking about ADD).
  
• "Doors and drawers--never close them after myself, then come back and see them and close them."* (I always got yelled at for this. It's cool to see how much of this might be related.
  
• "Get overwhelmed by a large confused mess."
• General problems with distractibility and disorganization."
  

That's a ton of descriptors that I thought matched my life. It was the first time I have actually felt the relief that everyone keeps saying comes with a diagnosis. It was the first time that I actually seriously considered taking meds. I will post soon on meds and fears about them, but I want to do that when I am more informed.

ADD Science: Part I

I am an English major. The class that I did the worst in during college was biology. But I got an A+ in high school in biology so, armed with the need to know, I dove into David Freides' Developmental Disorders: A Neuropsychological Approach to try to figure out what is going on in my brain. I've found the book surprisingly easy to understand and interesting. I am not going to quote from it here. Instead, I am going to try to give some paragraphs about my initial findings. As best as I can, I will give page numbers to Freides. He quotes a huge number of studies that I will try to outline separately in a different post.

Inattention has been described in two ways: 1. A failure to remain alert due to a failure of outside attention-grabbers to grab attention. This is called the underarousal hypothesis, and it has been widely questioned. 2. A failure to sort through attention grabbers to react to the ones that demand focus, or "an impaired ability to modulate arousal or alertness to meet situational demands." (Douglas, 1984 as quoted on page 175).

Right now, I do not fully understand the science of the former. It has something to do with the fact that people react to all attention-grabbers but learn to screen certain ones out over time. The first theory says that people with ADHD do not react at the same level to anything that might demand attention, and compares the hyperactive subtype to someone trying to keep himself awake. The hyperactive person with ADHD is trying to keep himself stimulated.

The latter one seems to be more rooted in actual places in the brain. To that end, I included two diagrams of the brain lifted off the Internet and some definitions:

This one show the lobes of the outer layer of grey mass: the cerebral cortex. The frontal lobe is in blue. That is the one that comes into play here, but just for reference, the other lobes are Temporal (green) Occipital (pink) and Parietal (yellow).

The frontal lobes, according to wikipedia, "have been found to play a part in impulse control, judgment, language production, working memory, motor function, problem solving, sexual behavior, socialization and spontaneity."

Also, at play here are the Basal ganglia, which are a group of transit points for electrical signals in the brain. They join all the lobes. The second diagram here indicates where they are.



O.K. Now that we got all of that down, we can look at this hypothesis of what is actually going on in the brain.

A study of hyperactive children in 1989 showed that subjects with ADD had increased blood flow to the sensory parts of the brain (that's all the lobes except for the frontal, with the most emphasis on the Parietal) and insufficient blood flow to the basal ganglia where inhibition and regulation of behavior and control comes from (page 175).

Now, to quote directly from Freides, "the more activity, the more blood is required" (175). So, in other words, there was not enough activity in the place that controls action and too much in the place that processes sensory input (all of those attention grabbers). Again to quote directly, "When there is inadequate Basal ganglia activity, the subjects sensory system is overactive, responding to every input" (175).

In English, with not enough activity in the part of the brain that transmits signals telling the rest of the of the brain what to notice and what to ignore, the brain pays attention to everything.

This is the biology of the theory that someone with ADD pays attention to TOO MUCH (i.e. everything) not too little (i.e. has no attention at all).

Stimulant drugs like Ritalin and Adderall were found to even out the activity in the two areas, giving the person with ADD a boost in sorting through life's sensory material.

It is really late at night (or I guess early in the morning) so I am going to call it quits here for now. But soon I am going to post on the next section of the book which focuses primarily on adult ADD and lack of executive function, which is more specifically my problems (i.e. organization, tidiness, time-management).

I Have ADHD. Now What?

The three days after I got a diagnosis were some of the hardest days for me emotionally. I was a mess. At first I was relieved and then I just cried. I was angry, hurt, and confused. Nothing had changed about me. I had felt that the diagnosis was waste of time because it told me nothing new. I now had options, but other than that it was the same as before the test. I was therefore surprised that I was so upset.

I had been afraid of stigma, but all of my friends seemed to shrug off the idea of ADHD the way that I just did above: nothing was changing about me, so why did it matter? But it DID matter. For the first time in my life, I felt REALLY distracted. I couldn't study for my midterm. I couldn't participate in discussions. I couldn't listen to lectures. All I could do was doodle the letters ADD. And, when I was alone or with my counselor, I cried.

There are a lot of reasons that I do not like this Web site. For starters I don't think it's funny to keep saying "Look at me! I can't pay attention! I can't finish building a Web site! Because of my ADD you have to look at horrific backgrounds!" Also, I find the Web site a confusing mess and am uncomfortable with talk of an ADD community or "ADD circles". But, it has a lot of information a page that validated a lot of what I had felt. If you don't feel like clicking on it, I have quoted from it below:

"The days and weeks immediately following diagnosis are a real emotional roller-coaster for the ADDer. There is the very real feeling of relief which comes from just being able to put a name on the "disorder" that has been so much a part of your life. Many of the ADD books refer to this as the "Aha" moment, and this is a common term in ADD circles. There is a strong feeling of companionship which can only be truly appreciated by those of have felt like they never fit in to any group. All of this is very positive and very healthy.

However, as the full implications of the diagnosis begin to sink in, the ADDer (and/or his parents) may experience extreme emotional turmoil. For many, one of the first emotions to hit after the "Aha" wears off is one of real grief.

We all grew up with the image of the perfect baby in our minds. We all grew up thinking that WE were the embodiment of the Gerber Baby, right there off the label, in living blue and grey.

Now, imagine hitting The Wall and realizing that YOU are not the Gerber baby."
-http://www.bobseay.com/littlecorner/newurl/treat.html

That feeling is horrible and draining. But it's normal. And it wears off, especially if you have supportive friends and family. Seek out the people who understand that it's hard for you and will let you talk about it on your own terms.

What Does It Mean To Be Tested?

I was frustrated by the lack of Web sites out there that actually told you what the test for ADHD is. In my experience, the test was simply an extend psychiatric evaluation (a lot of questions that you answer) and then we looked at the list below. (Note that I was not being tested for any learning disabilities, where a test is probably longer and more varied in type). The list is from The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. In order to be diagnosed with ADHD, one must show at least six symptoms from a single category (I think. It may be that you need six from each subtype). Symptoms must have been displayed in at least two settings (school, home, work, etc.) and have been present before the age of 7.

I have only the first subtype--inattention. That's what most people call ADD, but it's really just a subtype of ADHD. The other choice is combined inattentive and hyperactive.

This is not meant to be a self-diagnosis reference. When I described these symptoms to my friends, a lot of them said that the 'symptoms' were things they saw in themselves and in others as parts of personalities.

Generally, an ADHD diagnosis means that the presence of these symptoms has been detrimental to everyday life. However, many adults who have lived with it have adapted much of the effects of ADHD into their normal life. For me, that means laughing off the disorganization, making friends who are sharp-tongued and fast paced, attraction to a varied work environment, and listening to music while writing papers. For me, that also means that I have not decided whether or not I am going to take medication.

SYMPTOMS OF INATTENTION
a. often ignores details; makes careless mistakes
b. often has trouble sustaining attention in work or play
c. often does not seem to listen when directly addressed
d. often does not follow through on instructions; fails to finish
e. often has difficulty organizing tasks and activities
f. often avoids activities that require a sustained mental effort
g. often loses things he needs
h. often gets distracted by extraneous noise
i. is often forgetful in daily activities

SYMPTOMS OF HYPERACTIVITY-IMPULSIVITY
a. often fidgets or squirms
b. often has to get up from seat
c. often runs or climbs when he shouldn't
(in adults, feelings of physical restlessness)
d. often has difficulty with quiet leisure activities
e. often "on the go", as if driven by a motor
f. often talks excessively
g. often blurts out answers before questions have been completed
h. often has difficulty waiting his turn
i. often interrupts or intrudes on others