It’s not surprising that people are often puzzled about ADHD (Attention Deficit/Hyperactivity Disorder) or ADD (Attention Deficit Disorder without hyperactivity).
How can someone so organized at work be disorganized at home, despite their best efforts? Why does a student do well in English and biology, but repeatedly struggle with math? Why do some individuals, despite being highly motivated, find it nearly impossible to get started on some tasks while easily able to start others? How can someone be very empathic in some situations but oddly un-empathic in others?
COMMON ADHD DIFFICULTIES
People with ADD or ADHD may experience some of the following:
* Difficulty with tasks – difficulty organizing, beginning and/or completing some tasks (procrastination); problems managing finances, time or plans
* Distractibility – difficulty maintaining focus on lectures or conversations; being easily distracted by things going on around you or by thoughts in your own mind; difficulty sticking with a plan
* Memory problems – absentmindedness; difficulty remembering what you wanted to say; difficulty holding something in mind while finishing another task
* Intense emotion – feeling depressed, moody, irritable, impatient, frustrated or overwhelmed for little reason
* Difficulty regulating alertness and sleep – you feel low energy or sleepy during the day despite good sleep, or so energized that it’s hard to fall asleep. You may wonder why you’re attracted to high-stimulation (and high-risk) activities
* Relationships problems –impatience and irritability with others; difficulty contacting friends and loved ones even though you want to or chronic lateness and procrastination
ASSETS OR STRENGTHS ASSOCIATED WITH ADHD
However, people with ADD or ADHD are just as likely to benefit from strengths associated with ADHD, including:
*Creativity
* Charisma – We see this liveliness and effervescence in some politicians, teachers, actors/actresses, musicians and other performance artists.
* Enhanced problem-solving, thinking outside the box, love of and skill solving puzzles
* Comfort with – or even attraction to – novelty, easy adaptability to change
* Intuition
*Empathy - warm-heartedness; concern about fairness and justice
* Ability to hyper-focus in some situations, pursuing interests deeply; persistence; resilience
* Affinity with nature
A NEW LOOK AT ADHD
“A package deal” – ADHD used to be thought of as all deficit, difficulty and downside. While there are undeniably difficulties associated with ADHD, there are also robust strengths and assets. ADHD is a “package deal”. (See Hallowell & Ratey, 2005)
Not restricted to childhood – ADHD can appear in childhood, or not until an individual runs into the particular demands and settings of adolescence or adulthood. ADHD can diminish with maturation or persist throughout a person’s lifespan.
Situational Variability - A person may be able to concentrate on their work in one setting, but not others, or be funny in one kind of setting but not others. (See Thomas Brown, 2013.)
One Size does not fit all. - ADHD can look very different in different people. This has contributed to both under-diagnosis and over-diagnosis. Assessment and treatment for ADHD should focus on an individual’s particular difficulties and strengths.
ASSESSMENT FOR POSSIBLE ADHD
I have worked with individuals with attentional difficulties for over 20 years. People are referred to me by colleges or universities, friends, co-workers, family members, centers for treating ADHD, clinicians and insurance companies.
The bottom line: It’s never too late. No matter what your age, life can be a lot better if ADHD is recognized and treated.
Adolescents and adults who wonder if they have ADHD have several evaluation options. Some individuals can be evaluated at school, college or university. Others can request an assessment from a mental health clinician. It is important that these professionals are knowledgeable about, and have experience, evaluating for ADHD.
ADHD is a complex disorder. There is no single psychological test, imaging technique or blood test that can definitively identify ADHD.
Expert clinicians and researchers believe that ADHD can best be evaluated and diagnosed using clinical interviews to assess patterns of functioning over time and across domains. Many people will have some signs of ADHD, but that doesn’t warrant an ADHD diagnosis. Only when a sufficient number of ADHD-related problems interfere with a person’s life in two or more contexts would a diagnosis of ADHD be made.
Neuropsychological testing is useful in assessing an individual’s cognitive “profile” -- their relative strengths and weaknesses – and any learning disabilities. It is required by most colleges and universities for academic accommodations. However, neuropsychological testing is not necessary to establish the diagnosis.
A comprehensive evaluation for possible ADHD can usually be accomplished in a few focused sessions. Complicated clinical situations take a little more time.
I use clinical interviewing to gather information about patterns through time and across several domains and contexts in an individual’s life. We work collaboratively to get a true, comprehensive picture of how they function and feel over time.
I might ask someone to complete a paper-and-pencil ADHD screener and read some short material on ADHD. Then we discuss these. I might request neuropsychological testing (especially if academic accommodations are indicated) and will provide referrals to skilled neuropsychologists who are knowledgeable about ADHD.
I provide feedback from the evaluation, in detail and in person, with recommendations and options. Typically, two or three sessions are needed to give us time for questions and dialogue. I am available for any questions at a later time. If ADHD is identified, I usually recommend short-term treatment focused specifically on ADHD.
INTEGRATIVE TREATMENT FOR ADHD and ADD
Some individuals may only want an expert’s judgment on whether or not they have ADHD. Or they may ask for a report to be sent to an academic institution, for example, to support their need for accommodations. In those cases, the evaluation marks the end of our contact, although I remain available for any questions in the future. Others – for example, those already working with another therapist – may want to have a few sessions with me, specifically focused on ADHD, that they can integrate into their on-going therapy. I am always willing to discuss my findings with other therapists if clients ask me to do so. Others may want to pursue treatment with me.
Because ADHD is complex and “one size does not fit all,” I design an integrative treatment for each individual, tailored to their particular needs and strengths. It may be short term or comprehensive. The treatment I provide is designed to reduce ADHD’s negative impact on the individual’s life and increase their reliable access to areas of strength.
Treatment for ADD/ADHD generally involves two – and sometimes three – major components. These are: understanding what ADHD is and how it affects that individual (as well as where it does not); strategies to address difficulties and utilize strengths; and, in some cases, a medication trial.
Treatment includes learning about where and how their particular ADHD interferes in their lives, a practical process that narrows the focus to only their relevant difficulties and strengths, which is the best use of time and effort. Many people experience relief as they learn about ADHD. It changes how they understand and feel about themselves, and they are more able to utilize current strengths.
Specific strategies can be designed to address areas of continuing difficulty. Strategies are developed collaboratively; they’re practiced during the treatment so we can assess which ones work, which need to be tweaked, and which just aren’t useful.
Many clients have had a number of painful experiences in the past because of untreated ADHD; if these continue to negatively affect them, we might discuss the use of EMDR (Eye Movement Desensitization and Reprocessing) to digest and process these old experiences. This usually resolves such experiences quite rapidly. (See EMDR.)
We may discuss the possibility of a medication trial. Some individuals chose to not pursue this; others want to know whether stimulant medication can help them. If so, I refer to providers knowledgeable about ADHD medication trials. Over the next few weeks, the client and I discuss what they are noticing about any medication effects.
Treatment for ADHD is designed to reduce particular ADHD problems an individual experiences and increase his or her ability to reliably access their areas of strength.
Brown, T.E. (2013). A New Understanding of ADHD in Children and Adults. New York: Routledge.
Hallowell, E.M. & Ratey, J.J. (2005). Delivered from Distraction. New York: Ballantine Books.