A recent article in the Journal of child Psychology and Psychiatry examined the long term course of ADHD and co-morbid diagnoses among boys and girls as they transitioned from childhood into adolescence. The vast majority of research on ADHD has been done with boys, mostly due to the sex difference in the rates of ADHD. The few studies that have included girls have shown significant differences between boys and girls in a number of domains, including the physiological correlates of the condition, cognitive function, and co-morbidities. Yet, we know little of the longitudinal progression of ADHD in girls. Specifically, it is unknown whether the course of ADHD is similar in boys and girls or whether they have similar co-morbid conditions throughout childhood and adolescence.

The authors of the Journal of Child Psychology and Psychiatry study examined participants from two independent longitudinal studies of ADHD. The first study started in the 1980s and included 140 6-to-17 year-old boys with ADHD, 206 siblings, 280 parents, and 120 non-ADHD peers. These kids were assessed for up to 10 years after the initiation of the study. The second study started in 1993 and included 140 6-to-17 year-old girls, 183 siblings, 274 parents, and 122 non-ADHD peers. These girls were followed for up to 5 years. The final sample for the study included 143 ADHD girls and 147 ADHD boys. Both groups were on average approximately 11 years old at the time of the first assessment. However boys were significantly older (mean age 19) at the time of the last followup compared to the girls (mean age 16).

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What are the symptoms of ADHD on Adults? Additionally to the common symptoms found in children, many adults present a logical outgrow of those symptoms. The following suggested diagnostic criteria is from the book “Driven to Distraction”, a very well written and informational resource by Edward M Hallowell, M.D. and John J. Ratey, M.D.
Note of the Authors: “Consider a criterion met only if the behavior is considerably more frequent than that of most people of the same mental age.”

ADHD is a chronic disturbance in which at least fifteen of the following are present:

1. A sense of underachievement, of not meeting one’s goals (regardless of how much one has actually accomplished).

We put this symptom first because it its the most common reason an adult seeks help. “I just can’t get my act together” is the frequent refrain. The person might be highly accomplished by objective standards, or may be floundering, stuck with a sense of being lost in a maze, unable to capitalize on innate potential.

2. Difficulty getting organized.

A major problem for most adults with ADHD. Without the structure of school, without parents around to get things organized for him or her, the adult may stagger under the organizational demands of everyday life. The supposed “little things” may mount up to create huge obstacles. For the want of proverbial nail – a missed appointment, a lost check, a forgot deadline- their kingdom may be lost.

3. Chronic procrastination or trouble getting started.

Adults with ADHD associate so much anxiety with beginning a task, due to their fears that they won’t do it right, that they put it off, and off, which, of course, only adds to the anxiety around the task.

4. Many projects going simultaneously; trouble with follow-through.

A corollary of number 3. As one task is put off, countless projects have been undertaken, while few have found completion.

5. Tendency to say what comes to mind without necessarily considering the timing or appropriateness of the remark.

Like the child with ADHD in the classroom, the adult with ADHD gets carried away in enthusiasm. And idea comes and it must be spoken – tact or guile yielding to childlike exuberance.

6. A frequent search for high stimulation.

The adult with ADHD is always on the lookout for something novel, something engaging, somehting in the outside world that can catch up the whirlwind that’s is rushing inside.

7. An intolerance for boredom.

A corollary of number 6. Actually the person with ADHD seldom feels bored. This is because the millisecond he sense boredom, he swings into action and finds something new; he changes the channel.

8. Easy distractibility, trouble focusing attention, tendency to tune out of drift ways in the middle of a page or a conversation, often coupled with the ability to hyperfocus at times.

The hallmark symptom of ADHD. The “tuning out” is quite involuntary. It happens when the person isn’t looking, so to speak, and the next thing you know, he or she isn’t there. The often extraordinary ability to hyperfocus is also usually present, emphasizing the fact that this is a syndrome not of attention deficit but of attention inconsistency.

9. Often creative, intuitive, highly intelligent.

Not a symptom, but a trait deserving of mention. Adults with ADHD have unusually creative minds. In the midst of their disorganization and distractibility, they show flashes of brilliance. Capturing this “special something” is one of the goals of treatment.

10. Trouble in going through established channels, following “proper” procedure.

Contrary to one might think, this is not due to some unresolved problem with authority figures. Rather, it is a manifestation of boredom and frustration: boredom with routine ways of doing things and excitement around novel approaches, and frustration with being unable to do things the way they’re “supposed” to be done.

11. Impatient; low tolerance for frustration.

Frustration of any sort reminds the adult with ADHD of all the failures in the past. “Oh, no.” he thinks,”here we go again.” So he gets angry or withdraws. The impatience drives from the need for constant stimulation and can lead others to think of the individual as immature or insatiable.

12. Impulsive, either verbally or in action, as in impulsve spending of money, changing plans, enacting new schemes or career plans, and the like.

This is one of the more dangerous of the adult symptoms, or depending on the impulse, one of the more advantageous.

13. Tendency to worry needlessly, endlessly; tendency to scan the horizon looking for something to worry about, alternating with the inattention to or disregard for actual dangers.

Worry becomes what attention turns into when it isn’t focused on some task.

14. Sense of insecurity.

Many adults with ADHD feel chronically insecure, no matter how stable their life situation may be. They often feel as if their world could collapse around them.

15. Mood swings, mood lability, specially when disengaged from a person or project. The person with ADHD can suddently go into a bad mood, then into a good mood, then into a bad mood all in the space of a few hours and for no apparent reasons. These mood swings are not as pronounced as those associated with manic-depressive illness or depression.

Adults with ADHD, more than children, are given to unstable moods. Much of this is due to their experience of frustration and/or failure, while some of it is due to the biology of the disorder.

16. Restlessness.

One usually does not see, in an adult, the full-blown hyperactivity one may see in a child. Instead, one sees what looks like “nervous energy”: pacing, drumming of fingers, shifting position while sitting, leaving a table or room frequently, feeling edgy while at rest.

17. Tendency toward addictive behavior.

The addiction may be to a substance such as alcohol or cocaine, or to an activity, such gambling, or shopping, or eating or overwork.

18. Chronic problems with self-steem.

These problems are the direct and unhappy result of years of frustration, failure or of just not getting it right. Even the person with ADHD who has achieved a great deal usually feels in some way defective. What is impressive is how resilient most adults are, despite all the setbacks.

19. Inaccurate self-observation.

People with ADHD are poor self-observers. They do not accurately gauge the impact they have on other people. They usually see themselves as less effective of powerful that other people do.

20. Family history of ADHD or manic-depressive illness or depression or substance abuse or other disorders of impulsive control or mood.

Since ADHD is probably genetically transmitted and related to the other conditions mentioned, it is not uncommon (but not necessary) to find such family history.

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Evelyn Solis, M.A.
Eve can be reached at Counseling for Modern Life, (408) 246-3874 extension 12

Living with ADHD is no picnic—not if you are the parent of a child with ADHD, not if you have lived with it yourself, and also not if you are the non-ADHD partner of an ADHD-er. Anyone with this disorder has the traumatic experience of having been pinned with negative labels ranging from annoying and hard-to-live-with, lazy and unmotivated, brash and intrusive, unreliable and forgetful, stubborn and difficult, too intense and scatterbrained. Over time, you may have internalized these invalidating labels to the point where you see yourself in these ways—leaving you feeling ever more hopeless and defeated as you struggle endlessly to access the enormous potential you sense within you.

ADHD-ers have difficulties in school, in their jobs, in their interpersonal relationships even though their “high energy” style may initially attract people. However, the excitement soon wears thin, giving way to disillusionment and avoidance because of “low follow-through” tendencies. The result often is a series of relationships that are frequently superficial and ultimately dissatisfying. ADHD-ers, both children and adults, often have many acquaintances, yet few close, long-time friends and confidants because their weak memory skills, chronic disorganization, and distractibility quickly undermine the goodwill of prospective friends and partners.

Does that mean that receiving a diagnosis of ADHD at any age is an economic and social “death sentence”? That ADHD-ers are ultimately unable to learn consistent, appropriate life and work skills? That they will always struggle and not ever lead contented, stimulating, and successful lives? No, absolutely not! Having ADHD is not an excuse for anyone to claim life-long disability, use it as a defense for unethical/illegal behavior, to expect others to compensate for one’s irresponsible behavior, or to simply float through life in a haphazard manner. Individuals with ADHD need to work much harder at learning good organizational and interpersonal skills—just as a blind person needs to learn Braille and other crucial living skills to lead a successful life.

At the same time, many of the prominent characteristics of ADHD, which tend to be viewed as weaknesses by society at large, can also be perceived as personal strengths. Following are a few examples of how traits that may drive partners and parents of ADHD-ers up the wall at times are also qualities we all wish we possessed and could nurture with the help of well-meaning, positive and consistent feedback and support from the people in our lives.

Distractibility/Inattentiveness or Creativity?

The daydreaming, distractibility, and inattentiveness which are key features in ADHD are all closely related to the individual’s creativity. These periods of “absentmindedness” are not simply mental black-outs, but rather filled with a myriad of external and internal stimuli: sounds, sensations, thoughts, smells, sights, or memories. The ADHD-ers mind happily hopscotches back and forth between internal and external sensory data to create intricate webs of unusual, exciting, novel connections. Maybe innovative, new engineering designs or strange eco-solutions to save the planet, imaginary trips to far-off lands, and extravagant plans to conquer the world or terminal diseases are all products of an active ADHD brain. Many ADHD-ers can conceive of and juggle multiple tasks as long as they have a good support network to carry out the delegated tasks. Might such artists as Salvador Dali and Picasso, Da Vinci or Van Gogh, Beethoven or Einstein, Jules Verne or Louis Pasteur be diagnosed with ADHD today? What about Bill Gates, Steve Wozniak and Steve Jobs who hire thousands of employees to make their crazy, imaginative dreams become reality?

Failure to pay attention to details/Making Careless Mistakes or Divergent Thinking?

Many ADHD-ers experience significant difficulties with multiple-choice test taking and retrieving rote memorization information. Yet, many do well with open-ended test questions, free recall and brainstorming tasks as well as creative writing projects (with some editing help, of course). This type of mental processing is called “divergent thinking” which allows the individual to generate multiple, creative problem-solving solutions that non-ADHD people may fail to consider. These individuals may not do well as accountants, yet shine in activities and careers that emphasize unconventional problem-solving and innovation such as software programmers or designers. The career possibilities are endless.

Hyperactivity or high energy, tirelessness, and zest for life?

Many individuals with ADHD are outgoing, friendly, gregarious and exhibit an infectious enthusiasm that can provide the spark and spirit for a party or family gathering, a crucial company project, or to gather support and funding for important research. With guidance and support to provide structure and harness the intensity, hyperactivity can be the dynamo driving the successful athlete, scientist, business executive, etc. One might wonder if superb athletes like Carl Lewis or Magic Johnson and manic comedians like Julia Dreyfus, Robin Williams, or Jim Carrey could possibly show some ADHD traits?

Impulsivity, undiplomatic, bluntness = spontaneity and sincerity/honesty/ frankness

Yes, ADHD-ers often “leap before looking and don’t stop before it’s done”—and often too late to undo the damage they inadvertently and unintentionally inflicted. Their direct, heart-felt bluntness can sting those of us who prefer indirect, politically and socially correct manners and communication styles. AND, they also can be valuable catalysts for action to those of us who complacently or timidly wait for someone else to get their hands dirty. Their openness, sarcasm and biting satire can often hold a mirror to our apathy, smugness or jadedness. Would John Lennon, Winston Churchill or George Burns, Mike Wallace, Joan Rivers or Whoopi Goldberg be interested in taking an informal ADHD screening?

Excessive talking, blurting out answers, disruptive or expressiveness, enthusiasm, challenging?

Without trying to minimize the frustration we feel when there is always one member of an audience or team who footnotes every comment by others, insists on speaking out of turn, or doesn’t know when to stop the monologue—there is a positive side to such behavior! Many ADHD-ers have brilliant brains and often are three steps ahead of anyone else in their thinking process. If they were to submit to social convention and not interrupt others when their ingenuity erupts they would forget the brilliant idea and thus deprive the world of potentially life-saving truths or simply enjoyable chatter. Furthermore, recent research on the concept of “eminence” showed that geniuses and highly intelligent people rarely have congenial, jovial, or humble personalities! Let’s ponder Jay Leno, Napoleon, Jack Nicholson, Nostradamus, Rosie O’Donnell, Tom Smothers, or Socrates for possible ADHD candidates, shall we?

Stubborn, headstrong, brash or courage, determination and persistence?

Those of us who live with ADHD or with someone who has ADHD know very well that sometimes, it almost takes a set of “jaws of life” to pry an ADHD-er away from a stimulating video game, the constant visual/ auditory onslaught of a TV, their latest obsession with a hobby or project. Without such wholehearted, singular ability to focus and tune out the rest of the world many historical, medical, and scientific breakthroughs would have never happened! Think of Alexander Graham Bell, Thomas Edison, Louis Pasteur or Paul Ehrlich (who discovered the first compound to arrest syphilis), Einstein, Marie Curie, and Margaret Thatcher.

Melodramatic, emotional, extravagant or sensitivity and generosity?

Would gifted actors and entertainers be as fascinating and mesmerizing if they didn’t possess a highly developed degree of sensitivity that allows them to probe the breadth of their emotional scale to give us unforgettable moments with their artistry? Why do we enjoy Shaw’s “Pygmalion” if not for it’s emotional drama and extravagant, fairy tale type of story? Would Jack Nicholson, Judy Dench or Anthony Hopkins be as enigmatic and brilliant without their intense ability for melodrama? What would Cher’s extravagance be without the playfulness and spontaneity so typical of ADHD-ers?

Irresponsibility or tolerance and forgiveness

Living with an ADHD-er confronts us daily with their frustrating tendency not to follow through on tasks or commitments, to forget important deadlines and anniversaries, to lose the mail or paycheck, letting the dog eat the homework, and so on. On the bright side, many of them are probably acutely aware of human foibles—very likely because they get more negative labels pinned on their lapels that most other people! Their struggle to maintain some sense of self-esteem and self-efficacy may well sensitize them to other people’s weaknesses because it is in recognizing one’s own struggle in the other human being that we learn forgiveness and tolerance! When we walk a mile in someone else’s shoes we become compassionate fellow travelers in life’s journey!

Fussy, picky or choosing carefully, discriminating?

No, ADHD-ers are NOT fussy eaters, overly sensitive wool-haters and picky window-shoppers! They have exquisite, self-defined style, a discriminating palate, delicate skin that picks up on minute sensory stimuli. And, they choose merchandise carefully and agonize over choices because, after all, quality is important! After all, they have heard it demanded by others about themselves forever! They might as well begin the process of quality improvement in the things that really matter to them: their food, their unique, dramatic and creative style of mixing and matching their clothes or decorating.

Lack of self-confidence or humility?

Our culture places great value and emphasis on building self-esteem and self-confidence and often perceives humility and authentic self-restraint as negative attributes. Clearly, feelings of shame and inadequacy need to be remedied with the help of encouragement and learning good interpersonal and time management skills to prevent further emotional pain. However, healthy self-esteem involves not only a strong I-can attitude, feeling good about one’s person as well as feeling loved and cared for by others. It entails recognizing one’s strengths and potential AS WELL AS one’s challenges and limitations. Not all of us will be brain surgeons or rocket scientists, and a realistic appraisal of our abilities is not evidence of low self-esteem, but rather an authentic, kind affirmation that we are unique, special, and capable of living up to our innate potential with the talents we have.

So, to all the ADHD-ers and those living with them: Work hard and play hard—lighten up. It takes everyone’s talents and foibles to make life an excellent, stimulating adventure!

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