Frazzled No More
I suspected my lack of focus was a symptom of ADHD and I finally got a diagnosis… better late than not at all.
Recently, I had to cut short a telephone call to handle some urgent business. The distraction lasted only a few minutes, but by the time it was over, I’d forgotten about the call. By chance, something jogged my memory, and I called my friend back – but not until the following day.
Unfortunately, that kind of disconnect is not unusual for me. Walking around my house in the morning, I find myself narrating reminders: “Turn off the iron,” or, with a slap to my forehead as I’m heading out the door, “Keys.” Shortly after arriving at the office, I often have to return home to retrieve a notebook or a file.
For years, friends, family members, and colleagues kindly chalked up these lapses to my being a little spacey. I have, they would tell me, plenty of charming qualities to compensate. But lately it seemed my absentmindedness had gotten out of control.
More and more people were getting insulted by those neglected phone calls. My tendency to procrastinate was reaching pathological proportions. And in the office, where I edit documents, my “eye” was becoming remarkably inconsistent. Even my boss had noticed. Eventually, at wit’s end, I sought the advice of a psychologist.
My doctor’s hypothesis
After a lengthy conversation about my personal history, he offered a surprising hypothesis: Perhaps I had attention deficit hyperactivity disorder (ADHD).
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But aren’t people with ADD hyperactive? I asked. The official name of the condition is, after all, attention-deficit/hyperactivity disorder, and as anyone who knows me will attest, I operate in anything but high gear. Even when the brain is working fast and furious, this body barely budges. That was even more true of me during childhood, when ADD is generally diagnosed.
It seems, however, that there are three distinct types of ADHD: the more familiar one, called predominantly hyperactive, and one that’s gaining recognition, predominantly inattentive. People with the latter variety are notably absentminded, the daydreamy types who quietly tune out at meetings or in class. Often they go undiagnosed because their symptoms are so subtle. The majority are female.
Perhaps, the psychologist suggested, I was suffering from ADD number two.
Over the next few weeks, as I talked to people I knew about ADD, I heard skepticism and even contempt. “You can focus,” one colleague told me. “People who have ADD can’t focus.” (She was wrong. People with ADD can focus – just not consistently.)
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“You’ve simply got too much on your plate,” a friend said. (She had a point. I was working on many projects at once. Was I merely overextended?)
“Oh, ADD,” moaned someone else. “Isn’t that the disorder du jour?”
It seems that it is. Since 1990, diagnoses of ADD have more than doubled, and the curve seems to be getting steeper. Books on the topic are selling briskly. At conferences with themes like “Living the ADDventure,” vendors hawk ADD-pride paraphernalia, special ADD date books, and coaching services for the terminally scattered. Most high schoolers, and many college students, who have ADD can get extra time on standardized tests because of their disability.
The boom, in part, reflects a rise in diagnoses among children. But a portion of the newly diagnosed are adults. In 1990 Alan Zametkin, a psychiatrist at the National Institutes of Health, published evidence from positron-emission tomography scans that showed ADD to be associated with at least one physical marker in the brain: lower levels of activity in the prefrontal cortex, from which planning and self-control proceed. Other researchers have suggested the condition tends to run in families.
A raging debate
The findings haven’t settled a raging debate about how common adult ADD really is. Some critics claim that psychologists are too quick to diagnose it without the proper testing. But even skeptics agree that at least some of the newly identified have the personality type described by my psychologist and could benefit from treatment.
So I decided to go for the more rigorous evaluation. During the three-hour session, I took numerous tests of comprehension, memory, and problem-solving skills. The capper was a particularly frustrating one called the TOVA (Test of Variability of Attention), which consists of watching an orange square appear and disappear on a computer screen. When the square appears below the screen’s center, you do nothing. When it appears above, you hit a button. Simple, right? Wrong. Despite humming, and even biting my lip to stay focused, I ended up making an incredible number of errors.
It turns out, my childhood was riddled with signs of the disorder. I recalled that, when I asked my mother a question, she’d often want to know precisely how long she had to answer. She knew that at some point I would get that glazed look – distracted by other concerns, impatient to move on. At school I was a classic underachiever; lost in my thoughts, I had a great deal of difficulty concentrating on the subject at hand.
Looking at the overwhelming evidence, both the doctor and I ended up convinced that mine was a classic case of attention-deficit/hyperactivity disorder, inattentive type. My reaction when she told me her opinion further convinced me: I cried, both fearful of the implications of the diagnosis and relieved to find an explanation for the problems that have plagued me all these years.
And what next? There are any number of behavioral approaches to treating ADHD in adults, such as workbooks and coaching programs designed to help people focus. But for the underlying attention problem, particularly for someone who does detail-oriented work, doctors usually favor a low dose of the stimulant medication Ritalin.
Though I can’t begin to address the controversy surrounding this drug, particularly its use on children, I can testify that a minimal dose works wonders for me. It keeps my editorial eye focused for three to four hours at a stretch. I feel less scattered, and I’ve noticed a definite improvement in my moment-to-moment memory. (And all these benefits come to me without side effects.) When I went back to take the TOVA on medication, I got a perfect score.
Still, even though my behavior has improved, I worry. If people, particularly coworkers, knew about my diagnosis, might they consider me one of the shirkers, someone who just wants an excuse for flaky behavior? That fear is why I’ve used a pseudonym for this story.
And I can’t say ADD isn’t a fad diagnosis. But to tell you the truth, in my case the treatment was so liberating that I don’t really care.
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©1998 Health magazine. Reprinted with permission.