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