When Jennifer Koretsky was first told by a psychiatrist, at age 25, that she had a neurological condition called attention deficit disorder, or ADD, she didn’t believe it. After all, she was there to talk about her low-level depression. “I thought, oh my God, this woman is nuts. I’m not a little boy bouncing off the walls in class. I said to her, ‘No, you don’t understand. I do really well at work. My boss loves me. I’m successful.’ She said, ‘You don’t understand what ADD is.’”
The psychiatrist advised Koretsky to read up on the subject, beginning with Driven to Distraction: Recognizing and Coping with Attention Deficit Disorder from Childhood through Adulthood (Touchstone, 1995), by Edward M. Hallowell, MD, and John J. Ratey, MD — the first book to thoroughly discuss adults living with ADD.
“I put it off for a while, but when I actually started reading it, I was in tears by the third chapter,” says Koretsky. “It explained why everything was so difficult for me, and it made me feel OK, that it’s not that there’s something wrong with me; it’s that I’ve been approaching things in the wrong way.”
An estimated 15 million Americans suffer from ADD, the majority of them undiagnosed. Once considered a childhood disorder that’s outgrown by adolescence, it’s now known that 60 to 70 percent of children diagnosed with ADD continue to experience it as adults.
Characterized primarily by excessive distractibility, impulsivity and restlessness, ADD can wreak havoc in one’s personal and professional life. Too often, substance abuse, serious depression, job failure or a broken marriage are the wreckage left in the disorder’s wake.
“Traffic accidents are eight times more common among those with ADD. The prisons, divorce courts and unemployment lines are full of people with undiagnosed ADD,” says Hallowell, director of the Hallowell Center, a clinic specializing in the treatment of ADD in New York City.
“Having ADD can be a curse,” says Hallowell — who speaks from personal experience, having both been diagnosed with the disorder himself and raising two sons with ADD. But, he notes, it is not a life sentence. With the right knowledge, skills and strategies, ADD can be a unique gift that helps people thrive. “Once you learn how to live with ADD, it becomes a wonderful blessing.”
That was precisely Koretsky’s experience. Before her diagnosis, she says, “I was really struggling. It felt like I had to put in so much more work and effort just to keep things together; it was hard for me to get to work on time; there was never any food in my fridge; there was never any time to keep the apartment clean or get my laundry done. It felt like I was constantly struggling to keep up.”
Her diagnosis, she says, “explained so many of my challenges, like disorganization and poor time management, but it also validated my strengths — creativity, compassion and drive.”
Koretsky drew upon those strengths when she left the corporate world to build a business helping other adults with ADD. She’s now a Senior Certified ADHD Coach and the founder of ADD Management Group. And she’s authored a book, Odd One Out: The Maverick’s Guide to Adult ADD (Vervante, 2007). Her experience has convinced her that, with the proper tools, people with ADD can do more than just manage their symptoms; they can harness their abundant energy and creativity to improve the quality of their — and their loved ones’ — lives. They can flourish.
What is ADD?
The hectic pace of modern life, the constant techno-interruptions of email and social media, the omnipresence of speakers and video screens in public spaces — it can make anyone feel distracted. And we all misplace our keys or forget an appointment now and then. But, as Hallowell notes in another book, Delivered from Distraction: Getting the Most out of Life with Attention Deficit Disorder (Ballantine Books, 2005), occasional periods of distraction do not necessarily mean you’re suffering from ADD.
“Because its symptoms abound in modern life,” he writes, “ADD is a seductive diagnosis; it is easy to imagine that you have ADD when you do not.”
It’s the intensity and duration of symptoms that determine a diagnosis of ADD. The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) lists 18 symptoms for ADD, clustered into two areas: inattention and hyperactivity-impulsivity. To warrant an ADD diagnosis, one needs to have experienced six or more of the symptoms from one or both of the groups for at least six months. The symptoms must impair your life in some way, and they must occur in two or more areas of your life — for example, home and work. (Hallowell has established a distinct diagnosing protocol at his clinic; see the “Diagnosis: ADD” sidebar.)
Attention deficit disorder is something of a misnomer. Someone with ADD doesn’t have a deficit of attention. It’s actually an inconsistency in attention, which allows people with ADD to hyperfocus at times. And contrary to some outdated stereotypes, many people with ADD are often clever and outgoing. But that combination of sociability and hyperfocus can present its own challenges.
“If I was in the middle of something and someone approached my cube,” says Koretsky, “I had a really difficult time transitioning to talk to them.” Yet, eventually, she would transition, and then chit-chat as the clock ticked toward — and then past — her deadline.
Many people also have the misconception that ADD is limited to hyperactive boys. (The DSM-IV technically classifies the disorder as ADHD, with the “H” standing for hyperactivity. But leading experts in the field, including Hallowell and Ratey, no longer use the “H,” noting that the disorder is not always marked by hyperactivity.) While boys are diagnosed with ADD three times more often than girls, this is likely because, in girls, the disorder typically presents as the “inattentive” or “dreamy” type (staring out windows or drifting off midconversation), as opposed to the “hyperactive” type.
Gina Masullo fits the description of the dreamy type. She was nicknamed “The Wanderer” in elementary school, she says, and got a bad reputation because she couldn’t stay put in her seat. “My teachers labeled me ‘under-challenged,’ so I skipped second grade,” she recalls. The move didn’t abate her restlessness, but she coped well enough to avoid getting disastrous grades.
As an adult, Masullo job-hopped. “I’d get really excited about a new job or a new opportunity and then all of a sudden just kind of go cold on it and make another job switch,” she says. “My tolerance for job stresses was pretty low, and I would just get frustrated and give up.”
When she was diagnosed with ADD at 30, Masullo promptly put strategies in place to manage it: She exercises daily, eats a high-protein breakfast and has made behavioral adjustments like using to-do lists. She also sees an ADD coach.
And she seized upon the strengths ADD affords her — energy, creativity and drive — to start her own public relations firm. She’s now thriving professionally and accomplishing things she’d never thought possible — like running her first 5K last year, something she says she’d never had the discipline to attempt before.
Diagnosing ADD requires a thorough evaluation with a medical doctor, psychologist or psychiatrist. The evaluation could take one appointment, or it could take a few weeks. The doctor may create a brain map, which is the recording and analysis of brainwave activity through neuroimaging, and a battery of psychological tests. Blood tests can rule out underlying factors such as a thyroid problem.
The most important diagnostic tool, though, is the person’s history. Sanford J. Silverman, PhD, a psychologist at the Center for Attention Deficit and Learning Disorders in Scottsdale, Ariz., has been treating adults with ADD for two decades. Silverman advises bringing along a family member or very close friend to the evaluation. “When you get somebody else’s input — particularly someone close to you that you’re living with — they’re going to point things out that you may not be aware of,” he says.
School records may be helpful, too. Since ADD doesn’t develop in adulthood, a person would have had symptoms dating back to childhood. (Although in rare cases, ADD symptoms can develop after a head injury.)
A proper diagnosis is important, says Silverman, because “you can have ADD symptoms from another disorder. For example, if somebody has an anxiety disorder, they may look like they have some ADD components.”
Sometimes a diagnosis of adult ADD comes on the heels of a child’s diagnosis. That was the case in Melissa Orlov’s family. Her daughter was diagnosed with ADD in 1999 and her husband a few years later. That’s not uncommon, says Orlov, a marriage consultant in Boston and the author of The ADHD Effect on Marriage: Understand and Rebuild Your Relationship in Six Steps (Specialty Press, 2010). “A child is diagnosed because they’re struggling in school; then the parent starts to read up about it and says, ‘Wow, that sounds familiar.’”
For most ADD sufferers, naming what’s been going on brings relief. “When you get the ADD diagnosis, you can finally shed all those accusatory, ‘moral’ diagnoses, like lazy, weak, undisciplined, or, simply, bad,” writes Hallowell in Delivered from Distraction. After the diagnosis, he says, you can begin to “unwrap your gift” — and begin using ADD’s positive aspects to your advantage.
The following characteristics are commonly associated with attention deficit disorder, according to Edward Hallowell, MD, director of the Hallowell Center in New York City, which specializes in diagnosing and treating ADD and other cognitive and emotional conditions.
“If you have exhibited at least 12 of the following behaviors since childhood, and if these symptoms are not associated with any other medical or psychiatric condition, you should consider being evaluated by a professional,” says Hallowell.
A sense of underachievement, of not meeting one’s goals (regardless of how much one has actually accomplished)
- Difficulty getting organized
- Chronic procrastination or trouble getting started
- Many projects going simultaneously; trouble with follow-through
- A tendency to say whatever comes to mind without necessarily considering the timing or appropriateness of the remark
- A frequent search for high stimulation
- An intolerance of boredom
- Easy distractibility; trouble focusing attention, tendency to tune out or drift away in the middle of a page or conversation
- Often creative, intuitive, highly intelligent
- Trouble going through established channels and following “proper” procedures
- Impatient; low tolerance of frustration
- Impulsive, either verbally or in action (e.g., impulsive spending of money)
- Changing plans, enacting new schemes or career plans and the like; hot-tempered
- A tendency to worry needlessly, endlessly; a tendency to scan the horizon looking for something to worry about, alternating with attention to or disregard for actual dangers
- A sense of insecurity
- Mood swings, especially when disengaged from a person or a project
- Physical or cognitive restlessness
- A tendency toward addictive behavior
- Chronic problems with self-esteem
- Inaccurate self-observation
- Family history of ADD/ADHD or manic-depressive illness, or depression, substance abuse, or other disorders of impulse control or mood
Ways to Thrive With ADD
“The diagnosis becomes therapeutic through education,” writes Driven to Distraction author Edward Hallowell. “The more you know about the kind of mind you have — whether or not you call it ADD — the better able you will be to improve your life.”
Hallowell’s books are good places to begin learning more about ADD. You can also ask the healthcare professional who gives you a diagnosis to recommend books or support groups. Numerous Web sites, including the site for the Attention Deficit Disorder Association at www.add.org, offer support, resources and information.
It may also be helpful for your partner and family members to become familiar with some of the fundamental patterns, challenges and gifts associated with ADD. Hallowell notes that having an informed, compassionate partner tends to be a huge advantage for many adults with ADD.
Create systems to remind you.
“You want to create external reminders,” says Hallowell. For example, put a basket by the front door for your keys. Hang hooks by your front door for coats, scarves, umbrellas or whatever you carry with you. Utilize the built-in reminder systems in your computer or phone to alert you when it’s time to do a new task. “These are all necessary and helpful structural changes.”
At the Hallowell Center, coaches encourage to-do lists. Gina Masullo now carries a notebook with her at all times. “That way, when something pops into my head, I no longer have to act on it immediately,” she says. “I don’t get distracted and then not remember what I was doing before. It sounds so simple, but for me, keeping to-do lists has been life changing.” She even installed a white board in her shower. “It’s where a lot of ideas come to me, so I figured, why not?”
Coaching, counseling or other support is important, says psychologist Sanford Silverman, because ADD often occurs in tandem with another disorder, like depression, anxiety, OCD, substance abuse or bipolar disorder — and those things need to be addressed as well.
“I want to help people capitalize on their strengths,” says Silverman, who uses a combination of therapies, including neurofeedback and traditional talk-therapy, to help people manage their ADD and other disorders. “I work with them on all kinds of issues: family issues, relationships, social skills training — basically, how they can maximize their performance in all aspects of their lives.”
Those whose marriages are being stressed by ADD dynamics may also benefit from specialized counseling and support strategies.
Recognize and build on your strengths.
Work with a coach or ADD-experienced counselor to identify your strengths and then devise strategies to use and build on them.
“One of the hallmarks of ADD is impulsivity. But, often, that’s very good for creativity,” says marriage consultant Melissa Orlov. “The ADD brain doesn’t filter much — which is part of the reason they’re so distracted — but that might enable that person to solve a problem in a completely new way.”
For example, at work, someone with ADD might be better suited to brainstorm or initiate a new project rather than complete it, or to step into a project midway and help solve problems that have cropped up.
Helen Driscoll, a former screenwriter based in Los Angeles who was diagnosed with ADD 20 years ago, knew her strength was brainstorming. “I’m good at the ideas, and my friend was always really good at working within the scene,” she says of their successful writing partnership.“Our system worked well for us.”
Eat protein and healthy fats.
Low blood sugar can be especially troublesome for individuals with ADD, as it can radically disrupt their brain function and mood.
“Having some protein in your breakfast is a good idea because it keeps your blood sugar from yo-yoing,” says Hallowell. “If all you have are carbohydrates, your blood sugar goes way up, but then it goes way down and you start feeling sleepy or distracted.” For this reason, a steady supply of protein is important throughout the entire day. “Whenever you have food, try to balance protein with carbohydrates. Try to stay away from straight carbohydrates.”
Omega-3 fats are good for everyone, but they can be especially beneficial for people with ADD. Hallowell advises people with ADD to take up to 5,000 milligrams a day. Good whole-food sources of omega-3s include wild, fatty fish like salmon; walnuts; flaxseeds; and dark leafy greens.
“Exercise generates all kinds of chemicals in your brain that your body loves,” Hallowell says. “It’s better than medication. It’s remarkably helpful.”
Masullo credits her exercise regimen with helping her feel more focused and calm. “Before I started excising I would experience a lot of ups and downs,” she says. “If I skip the gym even one day I feel a difference.”
If you have trouble sticking with your exercise routine, join a class or a group fitness program. Paying class fees and being accountable to fellow students is great motivation. Scheduling time for workouts on your calendar or hiring a trainer or coach can also help.
“Unfortunately, with ADD, sleep problems are common — whether it’s getting to sleep or staying asleep,” says Silverman. Disrupted sleep can hinder already precarious energy levels.
“It’s all energy regulation,” says Jennifer Koretsky, which is why even though she considers herself a night owl, she tries not to stay up late anymore.
To get more and better-quality sleep, start by establishing a set bedtime — and stick to it. Half an hour or so before your set bedtime, switch into “wind-down” mode by doing something relaxing like reading, stretching or taking a bath. The ritual will help prime your body for sleep. Minimize the amount of light coming into your bedroom with thick curtains and by keeping electronics out of the room. Removing electronics also reinforces that the bedroom isn’t the living room or family room; it’s where you sleep, not where you work or play video games. (For more sleep-enhancing strategies, search on “Getting to Sleep.”)
Understand how others perceive you.
“People with ADD are often labeled lazy, though that’s very far from the truth,” says Orlov. “But people say, ‘Well, gee, you weren’t able to complete this task, so that must mean that you’re lazy.’ Another thing you sometimes hear is ‘self-centered.’ And that’s because a person with ADD can be very self-contained — they’re doing their own thing and are perfectly happy not interacting as much.” They may also not notice (or remember) that someone near them is waiting or expecting them to complete a task. And many spouses of ADD partners wind up carrying more than their share of household responsibilities as a result.
If you’re not conscious of these dynamics, it can bring additional stress to your relationships.
If you feel comfortable, wait until a neutral time (not the middle of a fight or when your relationship is tense) and ask friends or family members for insights on your behaviors. If that feels too scary, imagine a group of your friends or family and what they might say. You can also consult with a therapist or coach about how people might perceive you. That self-knowledge and awareness can help you reframe your behaviors and better manage your energy.
Be OK with being “organized enough.”
Speaking from his own ADD experience, Hallowell writes in Delivered from Distraction: “We have trouble organizing things. We have trouble organizing time. We have trouble organizing thoughts. We have trouble organizing data.” Trying to become super-organized is “not only out of our reach, but it is also unnecessary.” You can still reach your goals without having a house or office that looks like it should be photographed for Better Homes and Gardens. So take the focus off trying to be perfect and use that energy to focus on what’s attainable instead.