Life in Overdrive
Life in Overdrive
Doctors say huge numbers of kids and adults have attention
deficit disorder. Is it for real?
By Claudia Wallis
Dusty Nash, an angelic-looking blond child of seven, awoke at
5 one recent morning in his Chicago home and proceeded to throw
a fit. He wailed. He kicked. Every muscle in his 50-lb. body flew
in furious motion. Finally, after about 30 minutes, Dusty pulled
himself together sufficiently to head downstairs for breakfast.
While his mother bustled about the kitchen, the hyperkinetic child
pulled a box of Kix cereal from the cupboard and sat on a chair.
But sitting still was not in the cards this morning. After grabbing
some cereal with his hands, he began kicking the box, scattering
little round corn puffs across the room. Next he turned his attention
to the TV set, or rather, the table supporting it. The table was
covered with a checkerboard Con-Tact paper, and Dusty began peeling
it off. Then he became intrigued with the spilled cereal and started
stomping it to bits. At this point his mother interceded. In a
firm but calm voice she told her son to get the stand-up dust
pan and broom and clean up the mess. Dusty got out the dust pan
but forgot the rest of the order. Within seconds he was dismantling
the plastic dust pan, piece by piece. His next project: grabbing
three rolls of toilet paper from the bathroom and unraveling them
around the house.
It was only 7:30, and his mother Kyle Nash, who teaches a medical-school
course on death and dying, was already feeling half dead from
exhaustion. Dusty was to see his doctors that day at 4, and they
had asked her not to give the boy the drug he usually takes to
control his hyperactivity and attention problems, a condition
known as attention deficit hyperactivity disorder (ADHD). It was
going to be a very long day without help from Ritalin.
Karenne Bloomgarden remembers such days all too well. The peppy,
43-year-old entrepreneur and gym teacher was a disaster as a child
growing up in New Jersey. ''I did very poorly in school,'' she
recalls. Her teachers and parents were constantly on her case
for rowdy behavior. ''They just felt I was being bad -- too loud,
too physical, too everything.'' A rebellious tomboy with few friends,
she saw a psychologist at age 10, ''but nobody came up with a
diagnosis.'' As a teenager she began prescribing her own medication:
marijuana, Valium and, later, cocaine.
The athletic Bloomgarden managed to get into college, but she
admits that she cheated her way to a diploma. ''I would study
and study, and I wouldn't remember a thing. I really felt it was
my fault.'' After graduating, she did fine in physically active
jobs but was flustered with administrative work. Then, four years
ago, a doctor put a label on her troubles: ADHD. ''It's been such
a weight off my shoulders,'' says Bloomgarden, who takes both
the stimulant Ritalin and the antidepressant Zoloft to improve
her concentration. ''I had 38 years of thinking I was a bad person.
Now I'm rewriting the tapes of who I thought I was to who I really
Fifteen years ago, no one had ever heard of attention deficit
hyperactivity disorder. Today it is the most common behavioral
disorder in American children, the subject of thousands of studies
and symposiums and no small degree of controversy. Experts on
adhd say it afflicts as many as 3 1/2 million American youngsters,
or up to 5% of those under 18. It is two to three times as likely
to be diagnosed in boys as in girls. The disorder has replaced
what used to be popularly called ''hyperactivity,'' and it includes
a broader collection of symptoms. ADHD has three main hallmarks:
extreme distractibility, an almost reckless impulsiveness and,
in some but not all cases, a knee-jiggling, toe-tapping hyperactivity
that makes sitting still all but impossible. (Without hyperactivity,
the disorder is called attention deficit disorder, or ADD.)
For children with ADHD, a ticking clock or sounds and sights caught
through a window can drown out a teacher's voice, although an
intriguing project can absorb them for hours. Such children act
before thinking; they blurt out answers in class. They enrage
peers with an inability to wait their turn or play by the rules.
These are the kids no one wants at a birthday party.
Ten years ago, doctors believed that the symptoms of ADHD faded
with maturity. Now it is one of the fastest-growing diagnostic
categories for adults. One-third to two-thirds of ADHD kids continue
to have symptoms as adults, says psychiatrist Paul Wender, director
of the adult adhd clinic at the University of Utah School of Medicine.
Many adults respond to the diagnosis with relief -- a sense that
''at last my problem has a name and it's not my fault.'' As more
people are diagnosed, the use of Ritalin (or its generic equivalent,
methylphenidate), the drug of choice for ADHD, has surged: prescriptions
are up more than 390% in just four years.
As the numbers have grown, adhd awareness has become an industry,
a passion, an almost messianic movement. An advocacy and support
group called CHADD (Children and Adults with Attention Deficit
Disorders) has exploded from its founding in 1987 to 28,000 members
in 48 states. Information bulletin boards and support groups for
adults have sprung up on CompuServe, Prodigy and America Online.
Numerous popular books have been published on the subject. There
are summer camps designed to help ADHD kids, videos and children's
books with titles like Jumpin' Johnny Get Back to Work! and, of
course, therapists, tutors and workshops offering their services
to the increasingly self-aware ADHD community.
It is a community that views itself with some pride. Popular books
and lectures about ADHD often point out positive aspects of the
condition. Adults see themselves as creative; their impulsiveness
can be viewed as spontaneity; hyperactivity gives them enormous
energy and drive; even their distractibility has the virtue of
making them alert to changes in the environment. ''Kids with ADHD
are wild, funny, effervescent. They have a love of life. The rest
of us sometimes envy them,'' says psychologist Russell Barkley
of the University of Massachusetts Medical Center. ''adhd adults,''
he notes, ''can be incredibly successful. Sometimes being impulsive
means being decisive.'' Many ADHD adults gravitate into creative
fields or work that provides an outlet for emotions, says Barkley.
''In our clinic we saw an adult poet who couldn't write poetry
when she was on Ritalin. ADHD people make good salespeople. They're
lousy at desk jobs.''
In an attempt to promote the positive side of ADHD, some CHADD
chapters circulate lists of illustrious figures who, they contend,
probably suffered from the disorder: the messy and disorganized
Ben Franklin, the wildly impulsive and distractible Winston Churchill.
For reasons that are less clear, these lists also include folks
like Socrates, Isaac Newton, Leonardo da Vinci -- almost any genius
of note. (At least two doctors interviewed for this story suggested
that the sometimes scattered Bill Clinton belongs on the list.)
However creative they may be, people with ADHD don't function
particularly well in standard schools and typical office jobs.
Increasingly, parents and lobby groups are demanding that accommodations
be made. About half the kids diagnosed with ADHD receive help
from special-education teachers in their schools, in some cases
because they also have other learning disabilities. Where schools
have failed to provide services, parents have sometimes sued.
In one notable case that went to the U.S. Supreme Court last year,
parents argued -- successfully -- that since the public school
denied their child special education, the district must pay for
her to attend private school. Another accommodation requested
with increasing frequency: permission to take college-entrance
exams without a time limit. Part of what motivates parents to
fight for special services is frightening research showing that
without proper care, kids with ADHD have an extremely high risk
not only of failing at school but also of becoming drug abusers,
alcoholics and lawbreakers.
Adults with ADHD are beginning to seek special treatment. Under
the 1990 Americans with Disabilities Act, they can insist upon
help in the workplace. Usually the interventions are quite modest:
an office door or white-noise machine to reduce distractions,
or longer deadlines on assignments. Another legal trend that concerns
even adhd advocates: the disorder is being raised as a defense
in criminal cases. Psychologist Barkley says he knows of 55 such
instances in the U.S., all in the past 10 years. ADHD was cited
as a mitigating factor by the attorney for Michael Fay, the 19-year-old
American who was charged with vandalism and caned in Singapore.
Many of those who treat ADHD see the recognition of the problem
as a humane breakthrough: finally we will stop blaming kids for
behavior they cannot control. But some are worried that the disorder
is being embraced with too much gusto. ''A lot of people are jumping
on the bandwagon,'' complains psychologist Mark Stein, director
of a special ADHD clinic at the University of Chicago. ''Parents
are putting pressure on health professionals to make the diagnosis.''
The allure of ADHD is that it is ''a label of forgiveness,'' says
Robert Reid, an assistant professor in the department of special
education at the University of Nebraska in Lincoln. ''The kid's
problems are not his parents' fault, not the teacher's fault,
not the kid's fault. It's better to say this kid has ADHD than
to say this kid drives everybody up the wall.'' For adults, the
diagnosis may provide an excuse for personal or professional failures,
observes Richard Bromfield, a psychologist at Harvard Medical
School. ''Some people like to say, 'The biological devil made
me do it.' ''
A DISORDER WITH A PAST
Other than the name itself, there is nothing new about this suddenly
ubiquitous disorder. The world has always had its share of obstreperous
kids, and it has generally treated them as behavior problems rather
than patients. Most of the world still does so: European nations
like France and England report one-tenth the U.S. rate of ADHD.
In Japan the disorder has barely been studied.
The medical record on ADHD is said to have begun in 1902, when
British pediatrician George Still published an account of 20 children
in his practice who were ''passionate,'' defiant, spiteful and
lacking ''inhibitory volition.'' Still made the then radical suggestion
that bad parenting was not to blame; instead he suspected a subtle
brain injury. This theory gained greater credence in the years
following the 1917-18 epidemic of viral encephalitis, when doctors
observed that the infection left some children with impaired attention,
memory and control over their impulses. In the 1940s and '50s,
the same constellation of symptoms was called minimal brain damage
and, later, minimal brain dysfunction. In 1937 a Rhode Island
pediatrician reported that giving stimulants called amphetamines
to children with these symptoms had the unexpected effect of calming
them down. By the mid-1970s, Ritalin had become the most prescribed
drug for what was eventually termed, in 1987, attention deficit
Nobody fully understands how Ritalin and other stimulants work,
nor do doctors have a very precise picture of the physiology of
adhd. Researchers generally suspect a defect in the frontal lobes
of the brain, which regulate behavior. This region is rich in
the neurotransmitters dopamine and norepinephrine, which are influenced
by drugs like Ritalin. But the lack of a more specific explanation
has led some psychologists to question whether adhd is truly a
disorder at all or merely a set of characteristics that tend to
cluster together. Just because something responds to a drug doesn't
mean it is a sickness.
ADHD researchers counter the skeptics by pointing to a growing
body of biological clues. For instance, several studies have found
that people with ADHD have decreased blood flow and lower levels
of electrical activity in the frontal lobes than normal adults
and children. In 1990 Dr. Alan Zametkin at the National Institute
of Mental Health found that in PET scans, adults with ADD showed
slightly lower rates of metabolism in areas of the brain's cortex
known to be involved in the control of attention, impulses and
Zametkin's study was hailed as the long-awaited proof of the biological
basis of ADD, though Zametkin himself is quite cautious. A newer
study used another tool -- magnetic resonance imaging -- to compare
the brains of 18 ADHD boys with those of other children and found
several ''very subtle'' but ''striking'' anatomical differences,
says co-author Judith Rapoport, chief of the child psychiatry
branch at NIMH. Says Zametkin: ''I'm absolutely convinced that
this disorder has a biological basis, but just what it is we cannot
What researchers do say with great certainty is that the condition
is inherited. External factors such as birth injuries and maternal
alcohol or tobacco consumption may play a role in less than 10%
of cases. Suspicions that a diet high in sugar might cause hyperactivity
have been discounted. But the influence of genes is unmistakable.
Barkley estimates that 40% of ADD kids have a parent who has the
trait and 35% have a sibling with the problem; if the sibling
is an identical twin, the chances rise to between 80% and 92%.
Interest in the genetics of ADHD is enormous. In Australia a vast
trial involving 3,400 pairs of twins between the ages of 4 and
12 is examining the incidence of adhd and other behavioral difficulties.
At NIMH, Zametkin's group is recruiting 200 families who have
at least two members with ADHD. The hope: to identify genes for
the disorder. It is worth noting, though, that even if such genes
are found, this may not settle the debate about ADHD. After all,
it is just as likely that researchers will someday discover a
gene for a hot temper, which also runs in families. But that doesn't
mean that having a short fuse is a disease requiring medical intervention.
In the absence of any biological test, diagnosing ADHD is a rather
inexact proposition. In most cases, it is a teacher who initiates
the process by informing parents that their child is daydreaming
in class, failing to complete assignments or driving everyone
crazy with thoughtless behavior. ''The problem is that the parent
then goes to the family doctor, who writes a prescription for
Ritalin and doesn't stop to think of the other possibilities,''
says child psychiatrist Larry Silver of Georgetown University
Medical Center. To make a careful diagnosis, Silver argues, one
must eliminate other explanations for the symptoms.
The most common cause, he points out, is anxiety. A child who
is worried about a problem at home or some other matter ''can
look hyperactive and distractible.'' Depression can also cause
adhd-like behavior. ''A third cause is another form of neurological
dysfunction, like a learning disorder,'' says Silver. ''The child
starts doodling because he didn't understand the teacher's instructions.''
All this is made more complicated by the fact that some kids --
and adults -- with ADHD also suffer from depression and other
problems. To distinguish these symptoms from ADHD, doctors usually
rely on interviews with parents and teachers, behavior-ratings
scales and psychological tests, which can cost from $500 to $3,000,
depending on the thoroughness of the testing. Insurance coverage
Among the most important clues doctors look for is whether the
child's problems can be linked to some specific experience or
time or whether they have been present almost from birth. ''You
don't suddenly get ADD,'' says Wade Horn, a child psychologist
and former executive director of CHADD. Taking a careful history
is therefore vital.
For kids who are hyperactive, the pattern is unmistakable, says
Dr. Bruce Roseman, a pediatric neurologist with several offices
in the New York City area, who has ADHD himself. ''You say to
the mother, 'What kind of personality did the child have as a
baby? Was he active, alert? Was he colicky?' She'll say, 'He wouldn't
stop -- waaah, waaah, waaah!' You ask, 'When did he start to walk?'
One mother said to me, 'Walk? My son didn't walk. He got his pilot's
license at one year of age. His feet haven't touched the ground
since.' You ask, 'Mrs. Smith, how about the terrible twos?' She'll
start to cry, 'You mean the terrible twos, threes, fours, the
awful fives, the horrendous sixes, the God-awful eights, the divorced
nines, the I-want-to-die tens!' ''
Diagnosing those with ADD without hyperactivity can be trickier.
Such kids are often described as daydreamers, space cases. They
are not disruptive or antsy. But, says Roseman, ''they sit in
front of a book and for 45 minutes, nothing happens.'' Many girls
with ADD fit this model; they are often misunderstood or overlooked.
Christy Rade, who will be entering the ninth grade in West Des
Moines, Iowa, is fairly typical. Before she was diagnosed with
ADD in the third grade, Christy's teacher described her to her
parents as a ''dizzy blond and a space cadet.'' ''Teachers used
to get fed up with me,'' recalls Christy, who now takes Ritalin
and gets some extra support from her teachers. ''Everyone thought
I was purposely not paying attention.'' According to her mother
Julie Doy, people at Christy's school were familiar with hyperactivity
but not ADD. ''She didn't have behavior problems. She was the
kind of kid who could fall through the cracks, and did.''
Most experts say ADHD is a lifelong condition but by late adolescence
many people can compensate for their impulsiveness and disorganization.
They may channel hyperactivity into sports. In other cases, the
symptoms still wreak havoc, says UCLA psychiatrist Walid Shekim.
''Patients cannot settle on a career. They cannot keep a job.
They procrastinate a lot. They are the kind of people who would
tell their boss to take this job and shove it before they've found
Doctors diagnose adults with methods similar to those used with
children. Patients are sometimes asked to dig up old report cards
for clues to their childhood behavior -- an essential indicator.
Many adults seek help only after one of their children is diagnosed.
Such was the case with Chuck Pearson of Birmingham, Michigan,
who was diagnosed three years ago, at 54. Pearson had struggled
for decades in what might be the worst possible career for someone
with ADD: accounting. In the first 12 years of his marriage, he
was fired from 15 jobs. ''I was frightened,'' says Zoe, his wife
of 35 years. ''We had two small children, a mortgage. Bill collectors
were calling perpetually. We almost lost the house.'' Chuck admits
he had trouble focusing on details, completing tasks and judging
how long an assignment would take. He was so distracted behind
the wheel that he lost his license for a year after getting 14
traffic tickets. Unwittingly, Pearson began medicating himself:
''In my mid-30s, I would drink 30 to 40 cups of coffee a day.
The caffeine helped.'' After he was diagnosed, the Pearsons founded
the Adult Attention Deficit Foundation, a clearinghouse for information
about add; he hopes to spare others some of his own regret: ''I
had a deep and abiding sadness over the life I could have given
my family if I had been treated effectively.''
PERSONALITY OR PATHOLOGY?
While Chuck Pearson's problems were extreme, many if not all adults
have trouble at times sticking with boring tasks, setting priorities
and keeping their minds on what they are doing. The furious pace
of society, the strain on families, the lack of community support
can make anyone feel beset by ADD. ''I personally think we are
living in a society that is so out of control that we say, 'Give
me a stimulant so I can cope.' '' says Charlotte Tomaino, a clinical
neuropsychologist in White Plains, New York. As word of ADHD spreads,
swarms of adults are seeking the diagnosis as an explanation for
their troubles. ''So many really have symptoms that began in adulthood
and reflected depression or other problems,'' says psychiatrist
Silver. In their best-selling new book, Driven to Distraction,
Edward Hallowell and John Ratey suggest that American life is
''ADD-ogenic'': ''American society tends to create ADD-like symptoms
in us all. The fast pace. The sound bite. The quick cuts. The
TV remote-control clicker. It is important to keep this in mind,
or you may start thinking that everybody you know has ADD.''
And that is the conundrum. How do you draw the line between a
spontaneous, high-energy person who is feeling overwhelmed by
the details of life and someone afflicted with a neurological
disorder? Where is the boundary between personality and pathology?
Even an expert in the field like the University of Chicago's Mark
Stein admits, ''We need to find more precise ways of diagnosing
it than just saying you have these symptoms.'' Barkley also concedes
the vagueness. The traits that constitute adhd ''are personality
characteristics,'' he agrees. But it becomes pathology, he says,
when the traits are so extreme that they interfere with people's
There is no question that ADHD can disrupt lives. Kids with the
disorder frequently have few friends. Their parents may be ostracized
by neighbors and relatives, who blame them for failing to control
the child. ''I've got criticism of my parenting skills from strangers,''
says the mother of a hyperactive boy in New Jersey. ''When you're
out in public, you're always on guard. Whenever I'd hear a child
cry, I'd turn to see if it was because of Jeremy.''
School can be a shattering experience for such kids. Frequently
reprimanded and tuned out, they lose any sense of self-worth and
fall ever further behind in their work. More than a quarter are
held back a grade; about a third fail to graduate from high school.
adhd kids are also prone to accidents, says neurologist Roseman.
''These are the kids I'm going to see in the emergency room this
summer. They rode their bicycle right into the street and didn't
look. They jumped off the deck and forgot it was high.''
But the psychological injuries are often greater. By ages five
to seven, says Barkley, half to two-thirds are hostile and defiant.
By ages 10 to 12, they run the risk of developing what psychologists
call ''conduct disorder'' -- lying, stealing, running away from
home and ultimately getting into trouble with the law. As adults,
says Barkley, 25% to 30% will experience substance-abuse problems,
mostly with depressants like marijuana and alcohol. One study
of hyperactive boys found that 40% had been arrested at least
once by age 18 -- and these were kids who had been treated with
stimulant medication; among those who had been treated with the
drug plus other measures, the rate was 20% -- still very high.
It is an article of faith among ADHD researchers that the right
interventions can prevent such dreadful outcomes. ''If you can
have an impact with these kids, you can change whether they go
to jail or to Harvard Law School,'' says psychologist James Swanson
at the University of California at Irvine, who co-authored the
study of arrest histories. And yet, despite decades of research,
no one is certain exactly what the optimal intervention should
The best-known therapy for adhd remains stimulant drugs. Though
Ritalin is the most popular choice, some patients do better with
Dexedrine or Cylert or even certain antidepressants. About 70%
of kids respond to stimulants. In the correct dosage, these uppers
surprisingly ''make people slow down,'' says Swanson. ''They make
you focus your attention and apply more effort to whatever you're
supposed to do.'' Ritalin kicks in within 30 minutes to an hour
after being taken, but its effects last only about three hours.
Most kids take a dose at breakfast and another at lunchtime to
get them through a school day.
When drug therapy works, says Utah's Wender, ''it is one of the
most dramatic effects in psychiatry.'' Roseman tells how one first-grader
came into his office after trying Ritalin and announced, ''I know
how it works.'' ''You do?'' asked the doctor. ''Yes,'' the child
replied. ''It cleaned out my ears. Now I can hear the teacher.''
A third-grader told Roseman that Ritalin had enabled him to play
basketball. ''Now when I get the ball, I turn around, I go down
to the end of the room, and if I look up, there's a net there.
I never used to see the net, because there was too much screaming.''
For adults, the results can be just as striking. ''Helen,'' a
43-year-old mother of three in northern Virginia, began taking
the drug after being diagnosed with ADD in 1983. ''The very first
day, I noticed a difference,'' she marvels. For the first time
ever, ''I was able to sit down and listen to what my husband had
done at work. Shortly after, I was able to sit in bed and read
while my husband watched TV.''
Given such outcomes, doctors can be tempted to throw a little
Ritalin at any problem. Some even use it as a diagnostic tool,
believing -- wrongly -- that if the child's concentration improvesn
with Ritalin, then he or she must have add. In fact, you don't
have to have an attention problem to get a boost from Ritalin.
By the late 1980s, over-prescription became a big issue, raised
in large measure by the Church of Scientology, which opposes psychiatry
in general and launched a vigorous campaign against Ritalin. After
a brief decline fostered by the scare, the drug is now hot once
again. Swanson has heard of some classrooms where 20% to 30% of
the boys are on Ritalin. ''That's just ridiculous!''' he says.
the attitude of the doctors and local schools. Idaho is the No.
1 consumer of the drug. A study of Ritalin consumption in Michigan,
which ranks just behind Idaho, found that use ranged from less
than 1% of boys in one county to as high as 10% in another, with
no correlation to affluence.
Patients who are taking Ritalin must be closely monitored, since
the drug can cause loss of appetite, insomnia and occasionally
tics. Doctors often recommend ''drug holidays'' during school
vacations. Medication is frequently combined with other treatments,
including psychotherapy, special education and cognitive training,
although the benefits of such expensive measures are unclear.
''We really haven't known which treatment to use for which child
and how to combine treatments,'' says Dr. Peter Jensen, chief
of nimh's Child and Adolescent Disorders Research Branch. His
group has embarked on a study involving 600 children in six cities.
By 1998 they hope to have learned how medication alone compares
to medication with psychological intervention and other approaches.
A rough consensus has emerged among ADHD specialists that whether
or not drugs are used, it is best to teach kids -- often through
behavior modification -- how to gain more control over their impulses
and restless energy. Also recommended is training in the fine
art of being organized: establishing a predictable schedule of
activities, learning to use a date book, assigning a location
for possessions at school and at home. This takes considerable
effort on the part of teachers and parents as well as the kids
themselves. Praise, most agree, is vitally important.
Within the classroom ''some simple, practical things work well,''
says Reid. Let hyperactive kids move around. Give them stand-up
desks, for instance. ''I've seen kids who from the chest up were
very diligently working on a math problem, but from the chest
down, they're dancing like Fred Astaire.'' To minimize distractions,
adhd kids should sit very close to the teacher and be permitted
to take important tests in a quiet area. ''Unfortunately,'' Reid
observes, ''not many teachers are trained in behavior management.
It is a historic shortfall in American education.''
In Irvine, California, James Swanson has tried to create the ideal
setting for teaching kids with ADHD. The Child Development Center,
an elementary school that serves 45 kids with the disorder, is
a kind of experiment in progress. The emphasis is on behavior
modification: throughout the day students earn points -- and are
relentlessly cheered on -- for good behavior. High scorers are
rewarded with special privileges at the end of the day, but each
morning kids start afresh with another shot at the rewards. Special
classes also drill in social skills: sharing, being a good sport,
ignoring annoyances rather than striking out in anger. Only 35%
of the kids at the center are on stimulant drugs, less than half
the national rate for ADHD kids.
Elsewhere around the country, enterprising parents have struggled
to find their own answers to attention deficit. Bonnie and Neil
Fell of Skokie, Illinois, have three sons, all of whom have been
diagnosed with ADD. They have ''required more structure and consistency
than other kids,'' says Bonnie. ''We had to break down activities
into clear time slots.'' To help their sons, who take Ritalin,
the Fells have employed tutors, psychotherapists and a speech
and language specialist. None of this comes cheap: they estimate
their current annual ADD-related expenses at $15,000. ''Our goal
is to get them through school with their self-esteem intact,''
The efforts seem to be paying off. Dan, the eldest at 15, has
become an outgoing A student, a wrestling star and a writer for
the school paper. ''ADD gives you energy and creativity,'' he
says. ''I've learned to cope. I've become strong.'' On the other
hand, he is acutely aware of his disability. ''What people don't
realize is that I have to work harder than everyone else. I start
studying for finals a month before other people do.''
Adults can also train themselves to compensate for ADHD. Therapists
working with them typically emphasize organizational skills, time
management, stress reduction and ways to monitor their own distractibility
and stay focused.
In her office in white plains, Tomaino has a miniature Zen garden,
a meditative sculpture and all sorts of other items to help tense
patients relax. Since many people with ADHD also have learning
disabilities, she tests each patient and then often uses computer
programs to strengthen weak areas. But most important is helping
people define their goals and take orderly steps to reach them.
Whether working with a stockbroker or a homemaker, she says, ''I
teach adults basic rewards and goals. For instance, you can't
go out to lunch until you've cleaned the kitchen.''
Tomaino tells of one very hyperactive and articulate young man
who got all the way through college without incident, thanks in
good measure to a large and tolerant extended family. Then he
flunked out of law school three times. Diagnosed with ADHD, the
patient took stock of his goals and decided to enter the family
restaurant business, where, Tomaino says, he is a raging success.
''ADHD was a deficit if he wanted to be a lawyer, but it's an
advantage in the restaurant business. He gets to go around to
meet and greet.''
For neurologist Roseman, the same thing is true. With 11 offices
in four states, he is perpetually on the go. ''I'm at rest in
motion,'' says the doctor. ''I surround myself with partners who
provide the structure. My practice allows me to be creative.''
Roseman has accountants to do the bookkeeping. He starts his day
at 6:30 with a hike and doesn't slow down until midnight. ''Thank
God for my add,'' he says. But, he admits, ''had I listened to
all the negative things that people said when I was growing up,
I'd probably be digging ditches in Idaho.''
Whether ADHD is a brain disorder or simply a personality type,
the degree to which it is a handicap depends not only on the severity
of the traits but also on one's environment. The right school,
job or home situation can make all the difference. The lessons
of ADHD are truisms. All kids do not learn in the same way. Nor
are all adults suitable for the same line of work.
Unfortunately, American society seems to have evolved into a one-size-fits-all
system. Schools can resemble factories: put the kids on the assembly
line, plug in the right components and send 'em out the door.
Everyone is supposed to go to college; there is virtually no other
route to success. In other times and in other places, there have
been alternatives: apprenticeships, settling a new land, starting
a business out of the garage, going to sea. In a conformist society,
it becomes necessary to medicate some people to make them fit
This is not to deny that some people genuinely need Ritalin, just
as others need tranquilizers or insulin. But surely an epidemic
of attention deficit disorder is a warning to us all. Children
need individual supervision. Many of them need more structure
than the average helter-skelter household provides. They need
a more consistent approach to discipline and schools that tailor
teaching to their individual learning styles. Adults too could
use a society that's more flexible in its expectations, more accommodating
to differences. Most of all, we all need to slow down. And pay
HAIL TO THE HYPERACTIVE HUNTER
Why is attention deficit hyperactivity disorder so common? Is
there an evolutionary reason why these traits are found in as
many as 1 in 20 American youngsters? Such questions have prompted
intriguing speculation. Harvard psychiatrist John Ratey finds
no mystery in the prevalance of ADHD in the U.S. It is a nation
of immigrants who, he notes, ''risked it all and left their homelands.''
Characteristics like impulsiveness, high energy and risk taking
are therefore highly represented in the U.S. gene pool. ''We have
more Nobel laureates and more criminals than anywhere else in
the world. We have more people who absolutely push the envelope.''
But why would ADHD have evolved in the first place? Perhaps, like
the sickle-cell trait, which can help thwart malaria, attenting
deficit conferes and advantage in certain circumstances. In Attention
Deficit Disorder: A Different Perception, author Thom Hartmann
has laid out a controversial but appealing theory that the characteristics
known today as ADHD were vitally important in early hunting societies.
They became a mixed blessing only when human societies turned
agrarian, Hartmann suggests. ''If you are walking in the night
and see a little flash, distractibility would be a tremendous
asset. Snap decision making, which we call impulsiveness, is a
survival skill if you are a hunter.'' For a farmer, however, such
traits can be disastrous. ''If this is the perfect day to plant
the corps, you can't suddenly decide to wander off into the woods.''
Modern society, Hartmann contends, generally favors the farmer
mentalisty, rewarding those who develop plans, meet deadlines
and plod through schedules. But there's still a place for hunters,
says the author, who counts himself as one.: they can be found
in large numbers among entrepreneurs, police detectives, emergency-room
personnel, race-car drivers and, of course, those who stalk the
high-stakes jungle known as Wall Street.
DO YOU HAVE ATTENTION DEFICIT?
If eight or more of the following statements accurately describe
your child or yourself as a child, particuarly before age 7, there
may be reason to suspect ADHD. A definitive diagnosis requires
- Often fidgets or squirms in seat.
- Has difficulty remaining seated.
- Is easily distracted.
- Has difficulty awaiting turn in groups.
- Often blurts out answers to questions.
- Has difficulty following instructions.
- Has difficulty sustaining attention to tasks.
- Often shifts from one uncomplete activity to another.
- Has difficulty playing quietly.
- Often talks excessively.
- Often interrupts or intrudes on others.
- Often does not seem to listen.
- Often loses things necessary for tasks.
- Often engages in physically dangerous activities without considering
Copyright 1994 Time Inc. All rights reserved.
Modified June 26, 2006