Harvard psychiatrist Tim Wilens uses the tornado metaphor to describe the problem of diagnosing ADD in an adult. When you look back over the life of an ADD person you see the evidence that a tornado went through. There is underachievement and attempts at compensation. The ADD adult may have been the day dreamer, space cadet, or the class clown. Teachers often say, "does not perform to ability". There is inconsistency in school work. There are frequent relationship problems. To get a diagnosis, we usually have to rely on a history of childhood from an ADD person who tends to be overly in the moment, a "prisoner of the present". We usually don’t have documented symptoms or proof, but we can see the results. I recently spoke in the Los Angeles area with psychiatrists, neurologists and pediatricians about how to improve the recognition and treatment of ADD in all age groups. There is concern that it is too easy for adults to say that they have symptoms and get a prescription for stimulants. There are parents that are afraid to give their child any medication that affects their mind. Is medication the answer? And if so which medication should we start with? How do we find the right dose? How closely do patients need to be monitored? These questions will be discussed in depth in an article later this week. Last Monday (August 22nd) one of the leading stories in the news was a report from the annual meeting of the American Psychological Association about the consequences of being ADD. Psychologists Barkley and Fischer presented the results of a 13 year study of ADD children compared to non ADD children and how they were doing in their early 20’s. To specialists in the field the outcome was not surprising, but to many of the skeptics "there’s no such thing as a chemical imbalance". The statistics are hard to dismiss.
There were over 200 kids involved in the study. Some of the results of the study include the following:
• Graduated from high school – all non ADD kids but only 2/3’s of the ADD kids • Attending college – 78% of non ADD kids, but only 21% of ADD kids • Sexual activity – 1 in 25 non ADD kids had unplanned pregnancies, but ADD kids became sexually active 1 year earlier, had an average of 14 sexual partners (versus 5 for non ADD), were less likely to use birth control and 1 out of 3 had unplanned pregnancies • Job history – ADD kids were twice as likely to have been fired from a job
When you add in results from other studies showing 4 x the risk of serious driving accidents for ADD kids there should not be any question about the seriousness of the problem.
There are medications that are safe and effective. Stimulants have helped many people with ADD change their life from feeling helpless in the middle of a storm to being motivated and in control. Stimulants help an ADD person go from "underachiever, or absent minded professor" to being creative, productive and successful. In order to have success with stimulants they need to be the right medicine at the right dose. Unfortunately not every ADD patient has a totally positive response but the overall "batting average" in the long term is higher than any other medication we currently have. ADD kids bounce around the classroom. ADD adults bounce around life. ADD kids usually grow up to be ADD adults. Being ADD has definite advantages but definite risks. Medication is not always needed. Some people with ADD are able to just persevere or do things they have a high interest in. But most of us have to do a lot of things that either are not very stimulating or not particularly interesting but need to be done. We don’t have to live like we’re in the middle of a tornado. We don’t have to be at the mercy of our environment or our impulses. We can be motivated and in control.
